Sunday, 4 January 2015

Menopause and MS worsening

Bove R et al. Patients report worse MS symptoms after menopause: Findings from an online cohort Mult Scler rel Dis DOI: http://dx.doi.org/10.1016/j.msard.2014.11.009

Background Many women with multiple sclerosis (MS) are post-menopausal, yet the impact of menopause on MS symptoms is unknown.
Objective To investigate patient-reported impact of menopause in a large online research platform, PatientsLikeMe (PLM).
Methods A detailed reproductive history survey was deployed to PLM members, and responses were linked to PLM's prospectively collected patient-reported severity score (MS Rating Scale, MSRS). The MSRS has previously shown good correlation with physician-derived EDSS scores.
Results Of the 513 respondents, 55% were post-menopausal; 54% of these reported induced menopause. Median age at natural menopause was 51. Surgical menopause occurred at an earlier age (p<0.001) and was associated with more hormone replacement therapy use (p=0.02) than natural menopause. Post-menopausal status, surgical menopause, and earlier age at menopause were all associated with worse MSRS scores (p≤0.01) in analysis adjusting for age, disease type and duration.
Conclusion Post-menopausal patients in this study reported worse MS disease severity. Further, this study highlights a utility for online research platforms, which allow for rapid generation of hypotheses that then require validation in clinical settings.

Yesterday we had a post that MS was worse after puberty suggesting that female sex hormones may play a part in the development of MS and autoimmunity in general. In this study it appears that there are more problems after the menopause and again suggesting that female sex hormones are playing a part n the disease. However, the younger MSers have a problem with more sex hormones and the older MSers less hormones. This dictomy is also seen in animal studies where male and female sex hormones can have different influences on disease susceptibility. Studies are ongoing in MSers using sex hormones as treatments, it may not be a straight forward issue.

9 comments:

  1. Also
    Menstruation and MS worsening

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    1. I have noticed this too. I seem to be less able to regulate my body temperature and I feel warmer, especially at night during my time of the month.

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    2. It would make sense that pre menstural tension and mensturation can cause MS symptoms to worsen. Anxiety can increase with PMT, a feeling of tension, and feeling warmer. Anxiety can exacerbate MS symptoms. I've noticed if I get anxious my feet spasm at night. There must be a chemical change in the brain that gives a feeling of reflief after a few days into mensturation.

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  2. This cause me a lot of anxiety as I must be approaching peri-menopaus s:-) oon, though no signs yet at almost 49. I read different medical reports on age at which the mother etc enters menopause is or isn't a good determinant of when you will. As my mum didn't enter menopause until 56, (same with maternal grandmother, I think 58) this would be good news for me, if true. Although as I have many residual MS symptoms back before menstruation (not every time), I'm not sure what is worse. What is true is that there is very little research and it is very contradictory, with some neurologists suggesting menopause has no impact on MS, others saying menopause is often earlier than average in MS. So not exactly clear, is it.

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  3. This is very interesting - looking back I can see that my MS (non-relapsing, and at that time un-diagnosed) really seemed to get a lot worse as I came out of menopause, although this also coincided with a long period of very high stress work and family issues. I wonder what would happen if I went off the HRT I am still on, as I am aware that there is some research out there looking at female and male hormones in the context of MS.

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    1. All the available evidence so far is that oestrogen is neuroprotective (post menopausal stroke patients do worse than pre-menopausal patients although obviously the number of pre-menopausal stroke patients is lower) so the loss of oestrogen at menopause may be a contributor to progression although this needs to be studied properly in the context of MS.

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    2. Thank you MD2 - I've realised since posting my question that the gradual onset of my MS symptoms actually coincided with when menopause really started to impact on me. It's probably all just pure coincidence - but just maybe some food for thought about another line of investigation into factors influencing/causing late onset non-relapsing MS in women - I wonder if some retrospective demographic analysis would reveal any patterns...............

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    3. Mousedoctor2 Please could you explain what you mean by post menopausal stroke patients do worse?

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    4. Have more deficit more damage than younger/oestrogen producing females

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