Menopause and MS


Impact of natural menopause on multiple sclerosis: a multicentre study. Baroncini D, Annovazzi PO, De Rossi N, Mallucci G, Torri Clerici V, Tonietti S, Mantero V, Ferrò MT, Messina MJ, Barcella V, La Mantia L, Ronzoni M, Barrilà C, Clerici R, Susani EL, Fusco ML, Chiveri L, Abate L, Ferraro O, Capra R, Colombo E, Confalonieri P, Zaffaroni M. J Neurol Neurosurg Psychiatry. 2019. pii: jnnp-2019-320587

OBJECTIVE:To study the effect of natural menopause on multiple sclerosis clinical course.

METHODS: This was an observational, retrospective, multicentre, cohort study. Menopause onset was defined by the final menstrual period (FMP) beyond which no menses occurred for 12 months. We included multiple sclerosis (MS) patients with FMP occurred after 2005 and a recorded follow-up of at least 2 years pre-FMP and post-FMP. We excluded patients with primary progressive course, iatrogenic menopause and with other confounders that could mask menopause onset. We compared relapse-rate and expanded disability status scale (EDSS) scores pre-FMP and post-FMP, searching for possible interactions with age, disease duration, cigarette smoking and nulliparity status.

RESULTS: 148 patients were included (mean observation: 3.5 years pre-FMP and post-FMP). Most patients (92%) received disease-modifying therapies, mainly first-lines. After menopause the annualised relapse rate (ARR) significantly decreased (from 0.21±0.31 to 0.13± 0.24; p=0.005), while disability worsened (increase of mean 0.4 vs 0.2 points after menopause; p<0.001). Older age and long-lasting disease were associated with ARR reduction (p=0.013), but not with disability worsening. Cigarette smokers showed a trend to a higher disability accumulation after menopause (p=0.059).

CONCLUSION:Natural menopause seems to be a turning point to a more progressive phase of MS. Relapse rate is also reduced after menopause, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease. Cigarette smoking could speed up disability progression after menopause.

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    •’s a bad when relapses reduce because it means simple immune inflammation is
      going away to be replaced by innate inflammation of microglia which causes progressive
      disease and neurodegeneration for which there are no treatments. This is why people try to get chemo hsct before this shift happens.

  • Thank you very much for posting this.
    I think this is a hugely important issue – as most of us who have MS are women compared to men (from what I understand the gender ratio is three to one – women: men and growing.). Even though I have MS and am going through the menopause – my MS nursing team (all women) and my (male) neuros have never mentioned this as something to flag.
    Wonder if any neuros/MS nurses out there think it is time for this to come up in discussion with their MS peri-menopausal women patients – and perhaps offer them estrogen supplements? I understand they have been seen as anti-inflammatory.

  • Having had Ms for 25 years I have always known that hormones play a massive part in ms with fluctuations to my MS dependent on where I was in the menstrual cycle but have never found anyone who took this seriously although most neurologist admit there appears to be a link.

    Now going through the menopause I am lucky that I see a gynecologist who buys into this hormone influence and has offered me a higher level of oestrogen patch as part of my HRT rather than the usual lowest possible strength.

    Do you not think that even though more women than men suffer with ms that the menopause is overlooked in msers just as it is in society in general where women are left to suffer these awful effects caused by menopause with little help and are expected to just get on with it?

  • Very interesting. I was diagnosed with RRMS in February this year, a week before my 48th birthday 🙂. I am also peri-menopausal. I went and saw a female GP yesterday about HRT, but she was reluctant to prescribe HRT on the grounds that I had a auntie (my dad’s sister) die of breast cancer, and I am going to start Ocrevus soon. Seems to be little information, as the above lady says!

    • Sarah you may find it helpful to read a Sept 2017 post on this site ‘Clinicspeak: post-menopausal hormone replacement therapy in women with MS’

      If you also google MS and HRT you’ll find reference to studies such as that provided in The Lancet about a group who were given estrogen as well as a DMT and had fewer relapses. I think there may still be studies ongoing looking at the potential benefits of estrogen.
      There’s also info on other sites such as the MS Society website.

      I’m fortunate that my GP Practice is a training surgery and so my doctor is bang up-to-date and very aware that HRT isn’t nearly as dangerous as previously thought and that it is likely to be beneficial for women with MS. Though my paternal grandmother died of beast cancer I’ve confidentally been using estrogen gel for 8 years since the age of 48.

      I know that HRT isn’t for everyone, but having asked your GP for it, I agree with the above 2017 post on HRT, that gives the recommendation that you go back and argue your case.

      • Thanks Fi for your reply, I will read up further on HRT, I know I need to be more assertive in arguing my case 🙂. Part of my GP’s reasoning was that I am not suffering greatly from hot flushes or night sweats, but I thought that HRT has more benefits than just easing those symptoms. Plus I was identified with osteoporosis years ago!

    • “and I am going to start Ocrevus soon. ”

      Show them these articles by the Dr. who helped develop it.
      Read the conclusions…And ask them/yourself how effective it will be.

      Many people now do chemo. hsct before even starting MS drugs.
      Of course your dr. will call you crazy…but what is crazy is stating
      a drug/therapy that everyone admits will fail.

      “Our findings support the concept that peripheral B cell activation and CNS-compartmentalized immune mechanisms can in part be therapy resistant.”

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