Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system that, like many other autoimmune diseases, affects women more frequently. The typical age of diagnosis ranges from 20 to 40 years. Consequently, many women with MS must navigate the period of menopause in parallel with managing the disease.
Since menopause severely changes the hormonal balance in the body, researchers have long been interested in whether these changes cause a rapid progression of MS. A large-scale study conducted in Australia proved that menopause is not an independent risk factor for the worsening of the condition in women with MS.
Study Details:
This multicenter cohort study included 987 women with relapsing-remitting MS (RRMS) who were observed across eight neuroimmunology centers in Australia.
At the initial stage, 583 participants were premenopausal, and 404 were postmenopausal. The average age of menopause was 48.5 years.
Data was collected through the MSBase registry and supplemented by a survey that specified menopause status based on the time of onset. Neurological function and disability progression were measured using the EDSS (Expanded Disability Status Scale), a universally accepted tool in MS research.
Researchers focused on two main indicators of disability: CDP (Confirmed Disability Progression over six months) and transformation to SPMS (Secondary Progressive MS, progression without relapses). Menopause status was considered a time-varying factor to individually assess the impact before and after the onset of menopause. Complex statistical models were used to neutralize factors such as the time of MS onset and the use of high-efficacy disease-modifying therapies (HEDMTs).
Although the focus of the study was on disability progression and not on the side effects of therapy, researchers acknowledged the importance of managing menopause-related symptoms, as they may mimic MS symptoms. Hormone replacement therapy (HRT) and other approaches are important for symptom control, but their effect was not directly assessed in this study.
The study limitations included:
The accuracy of menopause status depended on information provided by the participants (self-reporting), although reliability was partially confirmed by AMH (Anti-Müllerian Hormone) levels.
The study did not allow for distinguishing the etiology of menopause (whether it was natural, surgical, or drug-induced).
The researchers did not account for important variables such as BMI and the use of HRT, which could potentially influence clinical outcomes in MS.
This research confirms that menopause itself does not worsen the prognosis of MS. The severity of the disease is primarily influenced by factors such as age, disease duration, and treatment regimen.
Source: Jama Neurology
