Anecdotally, women report that their MS symptoms fluctuate depending on where they are in their menstrual cycle. Here, we look at why this might be and what could help. This information is evidence-based, using information from research studies and insights from health professionals with expertise in women’s health and MS.
Menstruation
How can periods affect MS symptoms?
Many women describe a worsening of their MS symptoms in the two to three days before, or at the start, of their period. Once bleeding begins, they then tend to improve. Some women find that their periods become more irregular after being diagnosed with MS. It is also possible that for women with relapsing remitting MS (RRMS), relapses are more likely in the few days before your period starts, or around the time of first menstruation.
If you take a beta interferon drug, you might experience spotting, irregular bleeding, early or late periods. This side effect tends to go away after a few months, but you might wish to get a referral to a gynaecologist if this is a concern.
The effect of periods on MS is a difficult topic to research. Women are often asked to remember symptoms and events from many years ago. There is also considerable overlap between MS symptoms and pre-menstrual symptoms. Fatigue, arm and leg weakness, pain and nocturia (the need to go to the toilet during the night) are the symptoms that are usually mentioned. So, it can be difficult to determine whether the symptoms are due to MS or are normal pre-menstrual symptoms.
Some small studies have confirmed a worsening of symptoms linked to periods. But the effect was only seen in women with RRMS who weren’t taking oral contraceptives. The hormones in oral contraceptives may already be affecting your menstrual cycle. This is why you’re unlikely to see an effect on your MS if you take one.
A more recent and much larger study found no evidence for menstrual cycle-related changes in MS symptoms. They actually found that women with MS generally reported more menstrual symptoms than other women. As a woman with MS, you may simply be more aware of your symptoms. Or you may have other issues with your physical or mental health that could make symptoms more noticeable.
Why do symptoms worsen?
Women are affected by periods in all kinds of ways that we can't always explain or understand.
Research in pregnant women with MS has shown that changes in sex hormone levels can affect MS. So, it is reasonable to assume the changes in sex hormone levels during your monthly cycle could also have an impact. Different people are vulnerable to hormone fluctuations in different ways. This is why not all women experience an increase in their symptoms.
Another potential cause for symptoms worsening is the change in body temperature seen around the start of your period. Your body temperature rises just before and during your period. This can trigger Uhthoff’s phenomenon, where symptoms temporarily worsen and then improve once your body temperature returns to normal. It could also be caused by fluid shifts that occur as a normal part of your menstrual cycle.
There are some women whose periods aren't responsible for fluctuating symptoms – every woman is individual.
How can I manage worsening symptoms due to my period?
It's important to find a solution that's right for you. It can be a bit of trial and error to find what works best. Sometimes simply being knowledgeable about your cycle and being able to plan around it can help. For instance, if you know you’re going to feel awful for a couple of days each month, you could keep try to keep plans to a minimum on those days.
Strategies which help pre-menstrual symptoms may also be of benefit if you’re not entirely sure if the symptoms are due to MS, such as:
- eating a healthy, balanced diet
- exercising regularly
- getting plenty of sleep
- trying relaxation or distraction techniques such as mindfulness, meditation or yoga
In other neurological conditions where periods affect symptoms, some women find that things improve when they take hormonal contraception that stop their periods. Depending on your circumstances, that may be something that can help.
Find out more
- Period information hub – from Wellbeing of Women website
- Premenstrual syndrome (PMS) – information from the NHS website
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Effects of the menstrual cycle on neurological disorders.
Current Neurology and Neuroscience Reports 2021;21(7):34.
Summary (link is external)
The interplay of multiple sclerosis and menstrual cycle: which one affects the other one?
Multiple Sclerosis and Related Disorders 2018;21:46-50.
Full article (link is external)
Menstrual irregularities and related plasma hormone levels in multiple sclerosis patients treated with beta interferone.
Acta Medica Iranica 2010; 48(1): 36-41.
Summary (link is external)
Symptoms of multiple sclerosis in women in relation to cyclical hormone changes.
European Journal of Contraception and Reproductive Health Care. 2009;14(5):365-70.
Summary (link is external)
Understanding fluctuations of multiple sclerosis across the menstrual cycle.
International Journal of MS Care 2000;2(4):2
Full article (PDF, 275KB) (link is external)
Menstrually related worsening symptoms in multiple sclerosis.
Journal of Neurological Science 1997;149(1):95-97.
Summary (link is external)
