𝐌𝐞𝐧𝐨𝐩𝐚𝐮𝐬𝐞 𝐚𝐧𝐝 𝐌𝐒

Hormonal changes in females, such as onset of menses and at menopause, have a well-documented role in headache frequency.  But what, if any effect, does menopause, with a drop in estrogen do to Multiple Sclerosis (MS) disease activity? The answer is a significant effect because estrogen has anti-inflammatory and neuroprotective effects. During  menopause there is a sharp drop in estrogen.  The result is that the effects of  estrogen loss is more noticeable in Relapsing Remitting MS (RRMS) which is more in inflammatory than in Progressive MS which is primarily degenerative

Many women experience fewer relapses after menopause.  This is thought to be more related to aging of the immune system rather than due to menopause alone. Most research show that though the relapse rate does not increase significantly, disability progression is faster. That translates into an increased number of symptoms experienced. The prevailing hypothesis is that though there aren’t new flares, the lower estrogen levels may reduce protection of already damaged nerve cells, allowing for increased neurodegeneration. Menopause may worsen existing MS symptoms or make them harder to control.  These symptoms include, among others, fatigue, cognitive and memory issues, heat sensitivity, mood disturbances such as anxiety depression, bladder problems, and disturbances in sleep. It should be noted these MS symptoms are often reported in women experiencing menopause who do not suffer from MS.  It may be difficult to tease this apart. Some studies show that MRI changes also accelerate in post-menopausal women with MS. Such changes include increased brain volume loss and more rapid spinal cord degeneration.

In women undergoing menopause in the general population, Hormone Replacement Therapy (HRT) may improve fatigue, cognition, and overall quality of life.  HRT is not yet a standard-of-care recommendation for MS patients.  The decision to initiate HRT in any menopausal woman must be made with consideration of age, cardiovascular risk factors, (such as obesity, diabetes, hypertension), and risk of or history of breast cancer.

The best way to manage the increased symptomatology of MS in menopausal women include optimizing disease-modifying therapy, aggressive symptomatic control of fatigue, sleep, mood and bladder symptoms, employing ways to avoid becoming overheated, and strength training and balance work to counter muscle loss.

BeCare MS can help by tracking your symptoms and monitoring for disease progression as you navigate your way through menopause.  The trends identified can help you and your doctor optimize your disease management.  Be empowered.  Become a driver in your MS journey.