Dealing with Menopause When You Have Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disorder that affects the spinal cord and the brain. In this disease, the immune system starts attacking the protective sheath known as myelin that covers the nerve fibers in the body. This leads to communication problems between the brain and the rest of the body. Eventually, as the disease progresses, it can cause permanent damage to the nerves. Menopause is the time in a woman’s life when the menstrual periods permanently stop, and you are no longer able to get pregnant. Women start experiencing the first symptoms of menopause during their late 40s and early 50s. However, for women who have multiple sclerosis, it becomes difficult to tell the difference between the signs of menopause and the symptoms of multiple sclerosis. Some women even find their multiple sclerosis getting worse once they reach menopause, and their menstrual cycle comes to an end. We take a closer look at how women can deal with menopause when they have multiple sclerosis.

Overlap Between the Symptoms of Multiple Sclerosis and Menopause

In women who are in their late 40s and early 50s, signs of menopause may start developing. However, if you have multiple sclerosis, then it becomes quite difficult to tell whether you are experiencing the start of menopause or if you are experiencing a flare-up of multiple sclerosis. This is because there is considerable overlap between the symptoms of both these conditions.

Some of the symptoms that are common to both menopause and multiple sclerosis include:

If you have doubts on whether you are entering menopause or if you are about to experience an multiple sclerosis flare-up, then it is best to consult a gynecologist. A quick blood test that checks the levels of estrogen and other hormones can help you confirm whether you are about to start menopause or whether it is your multiple sclerosis that is taking a turn for the worse.

Menopause Age and Multiple Sclerosis

Many research studies have looked at whether multiple sclerosis has an impact on the age at which a woman first begins to experience the symptoms of menopause. For instance, in 2018, a study was carried out by the University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital in Turkey that found that women who had multiple sclerosis started experiencing the signs of menopause at the exact same age as women who did not have multiple sclerosis.(1)

However, the study also found that women who were taking an interferon beta-1b or a corticosteroid medication for the treatment of their MS, went into menopause slightly earlier than women who were not taking these medications for multiple sclerosis. Since this was a small study, there is a need for further research to confirm whether MS and its treatments have any effects on the age of menopause.

What Happens to Multiple Sclerosis Symptoms During Menopause?

The symptoms of MS, including depression and fatigue, tends to worsen during the monthly periods. Due to this, the onset of menopause can bring around some relief to women who have multiple sclerosis. A smalls study done in 2019 by the Universidade Nova de Lisboa in Portugal found that women who had menopause were more likely to have fewer relapses, even though the disease continued to progress.(2)

On the other hand, another study carried out by the Brigham and Women’s Hospital in 2017 found that nearly half of all postmenopausal women who participated in their survey reported that their multiple sclerosis symptoms became worse after menopause.(3)

Furthermore, hot flashes that are commonly associated with menopause are known to aggravate the symptoms of MULTIPLE SCLEROSIS because people who have multiple sclerosis are highly sensitive to heat.

Menopause and the Progression of Multiple Sclerosis

A study in 2017 carried out by the Harvard Medical School found that the symptoms of multiple sclerosis start to progress at a faster rate after a woman reaches menopause.(4) This fact was found to be true even after the researching team took into account factors such as smoking and low levels of vitamin D that could be responsible for speeding up the progression of the disease.

It is believed that the worsening of MS has something to do with the sudden drop in estrogen levels after menopause. Younger women who have MULTIPLE SCLEROSIS and have had surgery to remove their ovaries are also known to experience a worsening in their multiple sclerosis symptoms after the surgical procedure.

Can Estrogen Therapy Benefit in Multiple Sclerosis?

Medical experts have concluded that the hormone estrogen protects women against MS symptoms. Many women report an improvement in their multiple sclerosis symptoms during pregnancy, only to have the symptoms return after delivery.

It is therefore believed that taking estrogen can help slow down the progression of MS during and after menopause. Estrogen is known to have a protective effect on the nervous system, reducing inflammation, and also protecting nerves from the damage caused to the outer covering due to multiple sclerosis.

A study done by the Sandler Neurosciences Center and published in the Neurology journal found that postmenopausal women who have multiple sclerosis and who were taking hormone therapy reported having a better physical function as compared to women who were not on hormone therapy.(5)

A phase II study that followed up this study had 164 women participants, all of whom had multiple sclerosis. The researching team found that the women who were taking estrogen, as well as an multiple sclerosis medication that is known as glatiramer acetate, experienced a decreased relapse rate as compared to women who were taking a placebo.(6)

Nevertheless, larger and more in-depth studies are required to confirm whether taking estrogen hormone therapy during menopause actually helps decrease the symptoms of MS. Since the loss of bone density is a major challenge in women who have multiple sclerosis, hormone therapy could also offer this added benefit of lowering the risk of osteoporosis in these women.

Conclusion

Every woman experiences menopause and the symptoms of multiple sclerosis differently. While some find their symptoms actually improving during and after menopause, others find that the symptoms become worse after menopause. If you feel your multiple sclerosis symptoms have worsened after or during menopause, you should talk to your doctor.

You can consider consulting your gynecologist if menopausal hot flashes are aggravating your multiple sclerosis symptoms. Many women have found that hormone therapy helps with menopause symptoms and also helps improve the symptoms of multiple sclerosis at the same time.

References:  

  1. Türk Börü, Ü., Köseoğlu Toksoy, C., Bölük, C., Bilgiç, A. and Taşdemir, M., 2018. Effects of multiple sclerosis and medications on menopausal age. Journal of International Medical Research, 46(3), pp.1249-1253.
  2. Türk Börü, Ü., Köseoğlu Toksoy, C., Bölük, C., Bilgiç, A. and Taşdemir, M., 2018. Effects of multiple sclerosis and medications on menopausal age. Journal of International Medical Research, 46(3), pp.1249-1253.
  3. Bove, R., Vaughan, T., Chitnis, T., Wicks, P. and De Jager, P.L., 2016. Women’s experiences of menopause in an online MULTIPLE SCLEROSIS cohort: A case series. Multiple sclerosis and related disorders, 9, pp.56-59.
  4. Bove, R., Healy, B.C., Musallam, A., Glanz, B.I., De Jager, P.L. and Chitnis, T., 2016. Exploration of changes in disability after menopause in a longitudinal multiple sclerosis cohort. Multiple Sclerosis Journal, 22(7), pp.935-943.
  5. Bove, R., White, C.C., Fitzgerald, K.C., Chitnis, T., Chibnik, L., Ascherio, A. and Munger, K.L., 2016. Hormone therapy use and physical quality of life in postmenopausal women with multiple sclerosis. Neurology, 87(14), pp.1457-1463.
  6. Voskuhl, R.R., Wang, H., Wu, T.J., Sicotte, N.L., Nakamura, K., Kurth, F., Itoh, N., Bardens, J., Bernard, J.T., Corboy, J.R. and Cross, A.H., 2016. Estriol combined with glatiramer acetate for women with relapsing-remitting multiple sclerosis: a randomised, placebo-controlled, phase 2 trial. The Lancet Neurology, 15(1), pp.35-46.

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