What is the menopause?
The menopause is a completely normal and natural part of ageing which usually happens in women between the ages of 45 and 55. It describes the period when a woman’s oestrogen levels gradually fall and her ovaries stop releasing eggs. Women who have been through the menopause stop having periods and are no longer able to fall pregnant naturally. The menopause can be different for every woman, but most will experience some menopausal symptoms. Some of the most common ones include hot flushes, sleep disturbances, mood changes and a reduced sex drive.
What do we know about the impact of the menopause on women with MS?
There are lots of questions surrounding MS and the menopause. Do MS symptoms worsen during and after the menopause? Does MS disability progress quicker in postmenopausal women? Do women experience fewer relapses after the menopause? Unfortunately many of these questions remain unanswered as the impact of the menopause on women with MS is still not clearly understood. This is largely due to the limited number of studies that have investigated this topic.
Anecdotally, some women have reported that their MS symptoms worsened either during or after the menopause, but others have seen no effect on their MS at all. To shed a little bit more light on this topic here we summarise some of the studies that have been done over the years and see what, if any, conclusions can be drawn from them.
Effect of the menopause on MS symptoms
In a small pilot study published in 1992, 30 women with MS completed a questionaire on their menstrual cycle, the menopause and their use of hormone replacement therapy (commonly referred to as HRT, which relieves menopausal symptoms by replacing oestrogen).
Of the 19 postmenopausal women in the study, 54% reported that their MS symptoms worsened with the menopause, 38% noticed no change and 8% reported an improvement. In the women who’d been given HRT to help with menopausal symptoms, 75% reported an improvement in their MS symptoms.
This research suggests the menopause may be associated with a worsening of MS symptoms in some women and that HRT may help to prevent this, however bigger studies are needed to prove this.
A larger study conducted a few years ago explored the experiences of the menopause in a group of 127 women with MS. The women involved in this study completed a survey which allowed free-text responses, enabling them to provide more detailed accounts of their experiences.
A number of key themes were picked up on in the survey results. Many women reported that hot flushes caused their MS symptoms to flare up. Women also described an overlap between their menopausal symptoms and MS symptoms (e.g. sleep problems, mood changes, cognitive issues and bladder problems). Other themes included a worsening of MS course after the menopause (particularly increased fatigue and cognitive problems) and many women described the beneficial effect of HRT on their MS symptoms.
It’s also worth noting that although these were the key themes highlighted in the survey results, some women reported no effects of the menopause or HRT on their MS at all.
Effect of the menopause on relapse rates and disability progression
A study published in 2016 looked at changes in the level of disability after the menopause by following 124 women through their menopause for an average of 10 years. This study found that after the menopause EDSS scores increased at a slightly faster rate, equivalent to a one point change in EDSS score over a 10 year period.
This research suggests the menopause may have a small effect on MS and levels of disability.
Finally, a more recent study published in 2018 evaluated the impact of the menopause on relapse rates and disability progression in MS. The study followed 37 women before and after they went through the menopause. Results found that within five years following the menopause, relapse rates were reduced. Disability progression was compared before and after the menopause, and results showed that – unlike the previous study – progression continued at the same rate after women had been through the menopause.
Effect of the menopause on bone health
Research suggests that people with MS may have lower bone density than people without MS, increasing the risk of weak bones (osteoporosis) and bone fractures. Some factors that increase this risk include mobility problems, long-term exposure to steroids, smoking, and a lack of vitamin D and calcium.
In women with MS, the risk of developing osteoporosis can increase further after the menopause because levels of oestrogen – the hormone which helps to protect bone strength – are falling.
HRT can help to maintain bone density and reduce the risk of fractures. You can also take steps to help keep your bones healthy and reduce your risk of osteoporosis after the menopause by staying active, doing weight-bearing and resistance exercises, eating healthily and getting enough sunlight.
It’s difficult to draw clear conclusions from these relatively small studies, however they do suggest that the hormone changes caused by the menopause may increase symptom severity and disability progression in MS. They also suggest that HRT may improve symptoms that worsen during the menopause. But this is clearly an area where much more research is needed to provide clarity on how the menopause affects the course of MS.
The menopause is also a topic which needs to be talked about more openly in the MS community so it’s no longer seen as a ‘taboo’ topic. By talking more openly about the menopause and raising awareness in articles like this one, hopefully more women with MS will feel comfortable sharing their experiences and be encouraged to bring up the topic with the health professionals in their MS team.
Managing common symptoms of the menopause
It’s always best to speak to your GP if menopausal symptoms are affecting your everyday life, however there are some things you can try to minimise the impact of these symptoms. Here are a few suggestions:
- Hot flushes – Wear layers of light clothing so you can remove some layers if necessary; carry a handheld fan or cooling spray with you in your bag; avoid potential triggers such as caffeine, alcohol, smoking and spicy foods; exercise regularly; and have cold drinks.
- Night sweats – Keep your room cool and well ventilated; have a cold drink by your bed; have a cool or lukewarm shower; put a towel on your bed if necessary; wear light clothing to bed; try a cooling mattress topper or pillow.
- Low mood – Make sure you’re getting enough sleep; try to exercise regularly; have a go at some relaxing activities like yoga or meditation; talk to someone about how you’re feeling; do something you enjoy every day.
- Reduced sex drive – Talk to your partner about how you’re feeling; take it slow and make more time for foreplay; try to relax by doing some breathing exercises or practising mindfulness; and explore your body through a body mapping exercise.