#T4TD menstruation

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Women with MS may notice increased fatigue and intermittent symptoms in the second half of their menstrual cycle and during menstruation. Why?

After ovulation, a woman’s body temperature rises by ~0.4℃ (range = 0.3 to 0.6℃) which in someone with MS is enough to cause temperature-dependent conduction block. In addition, the process of menstruation involves a mild systemic inflammatory reaction that may exacerbate fatigue. I refer to this as catamenial fatigue

Catamenial = relating to or associated with menstruation

Over the years I have had several female patients with MS who have reported using aspirin or non-steroidal anti-inflammatories or paracetamol (acetaminophen) to self-manage these two periods of their cycle. Interesting? 

If you suffer from catamenial fatigue you may want to try one of these agents that almost certainly work by lowering body temperature.

#T4TD = Thought for the Day

CoI: none in relation to this post

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

15 comments

  • I was told not to take NSAIDs as regular use can cause kidney damage. Not sure that is the answer. Women need to get themselves checked, not head for the medicine cabinet.

  • Really interesting. I have mentioned several times to my neurologist that my MS has worsened during menopause, mainly due to hot flushes and night sweats. Heat has ALWAYS worsened my symptoms. Will try the ibubrofen route to reduce temperature.

    • I have always been hugely affected by the raging hormones happening – I’d have thought these also have a big part to play in MS.
      For me personally I blame hormones. When I take EPO it calms and levels out my hormones and lessens my MS symptoms but I can’t take it for long as my gums bleed heavily – I’m told this is because EPO thins blood… Typical! 🙄

      • Epo=Erythropoietin ?

        Makes you win the tour de France 🙂

        Manny times

        Risks of therapy include death, myocardial infarction, stroke, venous thromboembolism, and tumor recurrence. Risk increases when EPO treatment raises hemoglobin levels over 11 g/dL to 12 g/dL: this is to be avoided.

        rhEPO has been used illicitly as a performance-enhancing drug.[8] It can often be detected in blood, due to slight differences from the endogenous protein; for example, in features of posttranslational modification.

        Usage as doping product

        As a performance-enhancing drug, EPO has been banned since the early 1990s, but a first test was not available until the 2000 Summer Olympics.[37] Before this test was available, some athletes were sanctioned after confessing to having used EPO, for example in the Festina affair, when a car with doping products for the Festina cycling team was found.

        The first doping test in cycling was used in the 2001 La Flèche Wallonne. The first rider to test positive in that race was Bo Hamburger, although he was later acquitted because his B-sample was not conclusive.[38]

        The U.S. Postal Service Pro Cycling Team, under the leadership of Lance Armstrong and Johan Bruyneel, ran a sophisticated doping program that lasted for many years during the late 1990s and early 2000s. Erythropoietin was a common substance used by the cyclists.

        A 2007 study showed that EPO has a significant effect on exercise performance,[39][8] but a 2017 study showed that the effects of EPO administered to amateur cyclists was not distinguishable from a placebo.[40]

        In March 2019, American mixed martial artist and former UFC Bantamweight Champion T.J. Dillashaw tested positive for EPO in a drug test administered by USADA, and he subsequently was stripped of the UFC bantamweight title and suspended for 2 years.[

        https://en.wikipedia.org/wiki/Erythropoietin

  • Really interesting
    My ms fatigue got really bad a couple of weeks ago when we had those high temperatures and as usual with high temperatures I became very floppy and weak
    Maybe I should try aspirin three times a day next time and see if it helps?

  • I am a pwms and am post menopausal. I am experiencing hot flushes and night sweats which does not help the MS fatigue. Am getting menopause advice on diet to help with this. Do you know of any MS research relating to this?

    Many thanks

  • I have always been hugely affected by the raging hormones happening – I’d have thought these also have a big part to play in MS.
    For me personally I blame hormones. When I take EPO it calms and levels out my hormones and lessens my MS symptoms but I can’t take it for long as my gums bleed heavily – I’m told this is because EPO thins blood… Typical! 🙄

  • I was diagnosed 6 months ago with RRMS at the age of 46. The onset of perimenopause definitely triggered MS symptoms. I am hot all the time and am very heat sensitive which I was blaming on my hormones all the time. I’ve gone back on HRT.
    Wonder if paracetamol might be safer to take to lower body temperature rather than ibuprofen (it’s also antipyretic). Interesting!

  • Thank you so much for this
    Im suffering from this problem so much ,i literally turn into a zombie just days before my menses which i absolutely hate myself for that
    Unexplainable fatigue and brain fog
    Ms sucks

  • I really ike your coined phrase “Catamenial fatigue”. Can the phrase also be expanded to “Catamenial pseudo- exacerbation” ? From the beginning of my MS journey, I noticed that many of my symptoms appeared to increase in severity at one point during my cycle. I was able to learn through my own research, not my top neuros, that a “ms pms” had been antedoteally well documented and only somewhat scientifically explored. Knowledge that a catamenial increase in my MS symptoms was likely a pseudo exacerbation and not a genuine flare has given me much needed reassurance during those more symptomatic days. I too treat with NAISD and get much relief from it. I note that the anti-inflammatory aspect of the drug appears to be what helps me because Tylenol does not aid me. I do keep my drs informed about my in take of NAISD, and gently suggest that anyone who questions its use for this purpose, hasn’t needed it.

  • So that’s the reason .. thanks. Now to know what to do.

    What do you have in terms of info about the menopause and hormonal changes … (asking for my 50 year old self come 12/20!)?

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