Menopause in women with multiple sclerosis.
|Title||Menopause in women with multiple sclerosis.|
|Publication Type||Journal Article|
|Authors||Wundes A, Amtmann D, Brown T, Christian S|
|Journal||International Journal of MS Care|
|Edidemiology of MS, Quality of Life in MS|
Background: Given the predominance of multiple sclerosis (MS) in females and reported associations between the course of MS and menarche, pregnancy, or the postpartum period, a modulating role of sex hormones is assumed. As women with MS age, or because of medical interventions interfering with ovarian function, they will enter menopause. This life stage is marked by changes that affect quality of life, such as fatigue, difficulties concentrating, heat intolerance, and so on. In women with MS, these may be difficult to discriminate from MS-related symptoms. Little is known about menopause and effects of hormone replacement therapy (HRT) in women with MS. The objective of these studies was, therefore, to evaluate such issues. At least two types of impact could be hypothesized: Menopause could affect the clinical course of MS directly. Alternatively, symptoms of menopause could be erroneously attributed to MS. Either scenario could be amenable to pharmacologic intervention. A better understanding of menopause in MS is needed to evaluate therapeutic possibilities. Objectives: To evaluate menopause and HRT in women with MS. Methods: Self-reported crosssectional survey in women with MS regarding age of onset/ cause of menopause and HRT usage and perceived association with MS symptoms and course of disease. Results: The mail survey (n = 591) included 316 (53%) postmenopausal women with MS. They had entered menopause between ages 19 and 62 years (median: 46, which is 5 years earlier than in the US population per National Institutes of Health information); in almost half the respondents, menopause had been induced iatrogenically. The majority did not report an association between menopause and MS symptoms, but those who did were more likely to report worsening. Slightly more than half the respondents were ever on HRT, on average for 5 years; at least three-quarters felt that HRT had not affected MS symptoms or overall course. Conclusion: This study represents the largest cohort exploring the relationship between menopause, HRT, and MS to date. Data from two previous studies (n = 19 and 72), suggesting benefits of HRT and worsening of MS with menopause, were not confirmed in this sample. However, none of the questionnaires used, including our own, study the full complexity of menopausal changes, effects of HRT, and natural changes of MS with aging. Further studies are warranted.