A to Z of MS Menopause

Menopause appears to have no effect on multiple sclerosis, although there has been little published research in this area.

There is some anecdotal evidence which indicates that symptoms that worsen during menopause may be responsive to hormone replacement therapy (HRT), and a small pilot study in 1992 included data on the effects of menopause on MS. It consisted of a questionnaire asking about changes in the severity of symptoms of MS with the menstrual cycle, menopause and use of HRT which was answered retrospectively by 11 pre-menopausal and 19 post-menopausal women. Of the post-menopausal women 54% reported a worsening of symptoms with the menopause. 75% of those who had tried HRT reported an improvement.

It is thought that female hormones may have a neuroprotective effect and this is why HRT may be useful. The majority of women with MS who have used this therapy report an improvement rather than deterioration in their condition. However, owing to the lack of evidence that oral oestrogen-progestogen combinations have an influence on MS, the condition remains a warning on the drug information sheet for HRT.

Given that loss of bone density may be a problem for people with MS, the beneficial effect of HRT in reducing the risk of osteoporosis for women with MS should be taken into account.

The results of a recent study of the menopause in MS were presented at the 2012 meeting of the American Academy of Neurology. These presentations have not been peer-reviewed so should be considered as preliminary until published in a journal.

The study found that, based on clinical measures of disability and MRI scans, the menopause did not affect the course of MS. Self reported symptoms, especially fatigue, worsened in menopausal women more than in a group of similarly aged men. However, the researchers suggested that this is most likely due to the menopause itself causing a change in symptoms, such as fatigue, rather than to any change in the women's MS.

References

Smith R, Studd JWW.
A pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle.
Journal of the Royal Society of Medicine 1992; 85(10): 612-613.
abstract

Bove R, et al.
Menopause may not modulate disease course in multiple sclerosis.
Abstracts of the 64th annual meeting of the American Academy of Neurology (AAN) 2012
Conference abstract

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