Menopause and Multiple Sclerosis: MS May Not Be Affected, Study Shows

Patient Expert

Hey, ladies.   Good news.   Menopause does not appear to affect the clinical course of multiple sclerosis, according to Riley Bove, MD, a research fellow at the Multiple Sclerosis Center at Brigham & Women's Hospital and Harvard Medical School.

Members of the MS community have frequently discussed the impact of hormonal changes on MS and MS symptoms.   We've talked about how symptoms become more prominent for some women around their monthly menstrual cycle.   You have shared how fatigue, physical symptoms, and cognitive and emotional symptoms temporarily get worse on a monthly basis.   In a 1992 study, 82 percent of [pre]menopausal women reported an increase in the severity of MS symptoms premenstrually (Smith, 1992).

A recent study revealed that pregnancy has a protective effect against developing MS by 50 percent and as much as 94 percent for women who had five or more children (Ponsonby, 2012).   For women who are diagnosed with MS, the rate of relapse is increased in the first three months postpartum followed by a return to pre-pregnancy rate (Confavreux, 1998).   Long-term disease progression doesn't seem to be effected by pregnancy.

Exacerbations are more likely to begin before a woman's menstrual cycle in a subgroup of females living with MS.   In a study of 56 premenopausal women with relapsing MS and a regular menstrual cycle, 42 percent had exacerbations starting premenstrually.   Within that group, the proportion of premenstrual exacerbations was significantly higher than in the remaining period of the menstrual cycle (Zorgdrager, 2002).

To be honest, I have no idea if/how my previous relapses may have occurred in relationship to my monthly cycle.   What is your experience?

Are you peri-menopausal or post-menopausal?   Has menopause seemed to effect your MS?   The question as to what extent menopause effects MS is one which has not been thoroughly studied.   Women may talk about MS symptoms getting worse during menopause (Smith, 1992), but does menopause effect the clinical course of the disease?

According to recent research, presented as an abstract at the American Academy of Neurology annual meeting (2012) in New Orleans, menopause does not appear to change the clinical course of multiple sclerosis as measured by brain MRI scans and Expanded Disability Status Scale (EDSS) (Bove, 2012).   Data is derived from a study involving 128 pre-menopausal women living with MS (ages 38 to 46) and 78 menopausal women (ages 54 to 62) as reported in MedPageToday.

The two year change in EDSS among pre-menopausal woman was 0.139 points while the change was 0.122 points in menopausal women.   Not a significant difference.   Changes in MRI scans were similar for both groups of women.   Comparison to men living with MS from the same age groups was used in the study to eliminate the influence age might have on disease course in the analysis.

The question of "Is it Menopause or is it MS?" comes up in discussion occasionally as women notice changes in their daily functioning.   In self-assessments, menopausal women scored lower than pre-menopausal women in judging their level of physical functioning (Bove, 2012).   Participants (men and women) completed the Short Form 36, which is a 36-item Health Survey Questionnaire encompassing eight dimensions: physical functioning, social functioning, role-functioning physical, role-functioning emotional, mental health, vitality, bodily pain and general health perceptions.

On the other hand, men in the 54-62 age group did not report the same deteriorating symptoms, indicating that menopause may indeed be a contributing factor in MS patients perception of physical function and quality of life.   "That's kind of what people are seeing in clinic is that women report things that may have more to do with menopause than with multiple sclerosis," Riley Bove told MedPageToday.

Thus, menopause may not affect the clinical course of MS (as measured by disability and MRI scans).   Symptoms of menopause and peri-menstrual symptoms are difficult to measure.   But it does seem that menopause does affect how MS symptoms are experienced by women aged 54 to 62.

Bove R et al.   Menopause may not modulate disease course in multiple sclerosis.   AAN 2012; P06.183.

Confavreux C et al.   Rate of Pregnancy-Related Relapse in Multiple Sclerosis.
N Engl J Med 1998; 339:285-291.

Daumer M et al.   Pregnancy: A "modifiable" risk factor in MS?   Neurology 2012 Mar 20; 78:846.

Goodman, B.   Study: Multiple Sclerosis Risk May Drop by 50% After First Pregnancy. WebMD Health News.   Accessed May 6, 2012.

Nuyens G et al.   Predictive Value of SF-36 for MS-Specific Scales of the MS Quality of Life Inventory.   Int J MS Care 2003;5(1).

Ponsonby A-L et al.   Offspring number, pregnancy, and risk of a first clinical demyelinating event: The AusImmune Study.   Neurology 2012 Mar 20; 78:867.

Smith R, Studd JW.   A pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle.   J R Soc Med 1992 Oct;85(10):612-3.

Susman, Ed.   Menopause Impact Negligible in MS.   MedPage Today.   Accessed May 6, 2012.

Zorgdrager A, De Keyser J.   The premenstrual period and exacerbations in multiple sclerosis.   Eur Neurol 2002;48(4):204-6.