Hormone therapy, MS and menopause

Published 18 March 2022

What role in a woman’s hormones, and in particular, the hormone changes during the menopause, play in the progression of multiple sclerosis (MS)?

At the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), Forum 2022, Dr Burcu Zeydan, assistant professor of neurology and radiology at Mayo Clinic, posed this question and gave an overview of research into hormones and ageing that was currently available.

Experts know that biological sex affects MS development, with around three times more females than males being diagnosed with the condition. While males tend to develop MS earlier, males also tend to have a faster progression of disability in the early stages, Dr Zeydan said.

While in the relapsing-remitting stages of MS, women often relapse more frequently than men, and the relapses tend to cause more sensory issues. With men, they are more likely to cause motor issues. Men also tend to have a poorer recovery from relapses, which leads to greater disability.

In the later stages of MS, when the disease tends to become progressive, the pattern tends to reverse. “In a way, women catch up with men,” said Dr Zeydan.

Menopause happens on average at age 50, and this is around the age that most people develop progressive MS. Dr Zeydan said that age at menopause and beginning of progressive MS are ‘tightly correlated’.

“The transition from the relapsing phase to the progressive phase usually happens during the fifth decade,” she said. “The same fifth decade marks the perimenopausal transition. So, the question is, does MS impact menopause, or vice versa?”

There are some small trials taking place to ascertain whether therapies designed to reduce hormone changes caused by the menopause will benefit women with MS. Early results are indicating that this type of therapy can help prevent MS-related brain damage, lead to lower relapse rates and improve cognition. “The findings so far are promising, but of course, we need more trials and data,” said Dr Zeydan.