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In a recent podcast, Dr. Francesca Bridge, a neurologist and researcher at Alfred Health and Monash University, discussed the link between menopause and Multiple Sclerosis (MS), shedding light on an area of research that hasn't been explored much.
MS affects more women than men, with a three-to-one ratio. Researchers are particularly interested in how sex hormones impact MS. When estrogen and progesterone levels are high during pregnancy, MS activity tends to decrease. Conversely, after giving birth, when estrogen levels drop, MS activity often increases. However, we don't know much about how menopause, another significant hormonal shift, affects MS. Dr. Bridge emphasised the need to fill this knowledge gap because it might be connected to disease activity.
To understand the extent of this gap, Dr. Bridge and her team conducted a thorough review of existing research, which confirmed a lack of evidence on how menopause affects MS.
What is menopause and how does it impact MS?
Menopause is a clinical diagnosis characterised by various symptoms, including hot flashes, mood changes, cognitive alterations, and changes in urinary and sexual function. It's confirmed after 12 consecutive months without menstruation. Symptoms can start before this period, during the perimenopausal stage, which can last for around four to six years.
Researchers are interested in hormones like anti-Mullerian hormone (AMH), estrogen, and progesterone. AMH, produced by the ovaries, indicates ovarian reserve and starts to decrease in the late 20s, becoming very low by around age 50. Estrogen and progesterone have been suggested to be neuroprotective in other conditions like Alzheimer's, but their role in MS needs more research.
Some small studies suggest that menopausal women with MS may have fewer inflammatory brain lesions but may experience brain atrophy, indicating a transition to a more neurodegenerative phase. There are also subtle shifts in MS disease activity during menopause, with some women experiencing a decline in clinical disability measures.
The relationship between menopause, aging, and MS is complex. While aging likely affects MS progression, hormonal changes may worsen these effects, but more research is needed to understand this interaction.
Dr. Bridge also found a lack of understanding and evidence regarding the relationship between menopausal symptoms and MS symptoms. Measuring these symptoms objectively is challenging due to individual variations. Some women report worsened MS symptoms during menopause, while others see minimal changes or even improvements.
Hormone Replacement Therapy (HRT) has been explored in small studies for women with MS, but it's just one option for managing menopausal symptoms and should be discussed with healthcare professionals.
Research into the link between menopause and MS is ongoing. Dr. Bridge's current work aims to differentiate the effects of menopause from those of aging. She hopes to raise awareness and empower women to discuss menopause with their neurologists or women's health specialists, covering various aspects, including lifestyle changes, non-pharmacological measures, and medications including and beyond HRT. By addressing the unique challenges of menopause, women with MS can navigate this phase more effectively.
Published August 2023
Related resources
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