Living Well With MS and Menopause

Multiple sclerosis is a neurological disease in which a person's immune system attacks the protective covering (myelin) of nerve fibers within the brain and spinal cord. When myelin is damaged, nerve signaling is impaired. This results in a variety of symptoms like numbness, fatigue, cognitive problems, and trouble walking.

Unlike MS, menopause is not a disease, but rather a natural part of the aging process. Specifically, menopause is the point in time when a person who has been menstruating has not experienced a menstrual period for 12 consecutive months (in the absence of another medical condition).

Managing MS and menopause symptoms at the same time can be physically and emotionally draining. Certain symptoms can overlap, and there is the possibility that the estrogen decline in menopause could aggravate MS symptoms and/or affect its course.

This article will review the possible influence of menopause on MS. It will also discuss strategies and habits you can adopt to help optimize your overall health and well-being as you enter menopause and beyond.

When Does Menopause Start?

The average age at which a person who menstruates reaches menopause is 51. The years leading up to menopause—called the menopausal transition or perimenopause—are marked by symptoms of slowly declining estrogen levels like hot flashes, vaginal dryness, irregular menstrual cycles, and mood disturbances.  

Timing With MS Diagnosis

MS is usually diagnosed in adulthood, between the ages of 20 and 50 years. People who menstruate who have MS will then usually reach menopause after their MS diagnosis.

Effects of Menopause on MS Symptoms

Experts are uncertain about the precise effect of menopause on MS symptoms. This is because research on this topic is conflicting and somewhat scant.

For example, one study in Multiple Sclerosis Journal found that MS disability may potentially worsen after menopause. On the other hand, another study in European Neurology observed a similar rate of disability progression in postmenopausal females with MS compared to when they were premenopausal.

If MS disability does worsen after menopause, experts suspect that declining estrogen levels could play a role. Age-related changes to a person's immune system associated with nerve cell loss (neurodegeneration) may also contribute.

The following well-documented observations in pregnancy support the estrogen deficiency theory. Keep in mind that estrogen levels are high in the second half of pregnancy and drop steeply after delivery:

• Late pregnancy is associated with a significant decline in MS relapses (flare-ups of disease activity).
• The postpartum period is associated with a rebound rise in MS relapses.

While more investigation is needed to tease apart the influence of menopause on MS symptoms, several menopausal symptoms overlap with those of MS.

Some of these overlapping symptoms include:

• Cognitive impairment, including changes in memory, attention, and information processing
• Depression and anxiety
• Sleep problems (insomnia) and fatigue
• Bladder problems (e.g., recurrent urinary tract infections)

A careful evaluation by your healthcare providers, including your neurologist and primary care doctor or gynecologist, can help determine which of your symptoms are related to MS vs. menopause (or some combination). Sorting out the reason for your symptoms is important because it may affect your treatment plan.

Menopause Tests

Menopause cannot be diagnosed with a single test. Instead, when evaluating you for menopause, your healthcare provider will take into account your age, menstrual history, and symptoms.

They may also check your follicle-stimulating hormone (FSH) level to help confirm menopause. This is because once menopause occurs, FSH blood levels are consistently increased.

Possibilities of Hormone Therapy

Short-term use of hormone therapy—defined as five years or less—is an effective treatment for reducing menopausal symptoms, especially hot flashes. Sleep disturbances, vaginal dryness, and mood changes also tend to respond well to hormone therapy.

Unfortunately, there is still little known about the effect of hormone therapy on a person's MS course.

In one study, oral hormone therapy administered to postmenopausal MS patients was associated with a higher quality of life. That said, it's unclear whether this finding is explained by the fact that people with a better quality of life in the first place are more likely to have access to menopausal care, including hormone therapy.

Another study found that the MS drug Copaxone (glatiramer acetate) plus estriol—a type of estrogen that's only made in pregnancy—decreased relapse rates in women with MS. Even though this study does not involve the use of hormone therapy, it does support the potentially positive effect of estrogen treatment in females with MS.

Drawbacks

While considered effective and reasonably safe for short-term use, there are risks involved when taking hormone therapy (as with any medication).

For example, there is a small increased chance of developing breast cancer in females taking combined estrogen-progestin.

Some other risks appear to be age-dependent. For instance, females who became menopausal more than 10 years ago or who are over age 60 may be at an increased risk of having a heart attack related to the use of hormone therapy.

Coping With MS and Menopause

You have likely encountered many obstacles living with MS. For many, menopause will be yet another hurdle to jump over. Rest assured, with the guidance of your healthcare provider and a proactive mindset, you can manage this potentially taxing change in life well.

Lifestyle Changes

As you approach menopause and middle age, your risk naturally increases for developing heart disease, osteoporosis (a disease of bone weakening), and certain cancers, like breast cancer.

The following lifestyle habits can not only help you feel well physically and emotionally but also help prevent the above diseases:

• Eat well-balanced, nutritious meals.
• Manage your stress—consider incorporating mind-body therapies, like mindfulness meditation, into your daily routine.
• Avoid smoking and excessive alcohol intake.
• Exercise regularly.
• Undergo routine screenings (e.g., dual-energy x-ray absorptiometry, or DEXA) to screen for osteoporosis and a mammogram to screen for breast cancer)
  

Mental Health

Mood changes, especially depression or anxiety, are common in both MS and menopause. If your mood is off—perhaps you are more irritable or feeling unusually worried or sad—please reach out to your healthcare provider. You may benefit from medication or a referral to a therapist.

Physical Health

Just as you would address any new or worsening MS symptoms with your healthcare provider, you should also address any bothersome menopause-related symptoms.

As an example, the most common symptom of menopause is hot flashes. This symptom is caused by estrogen depletion in the body and can severely affect sleep and quality of life.

Simple behaviors such as using a fan at night and dressing in layers that can be quickly removed are often sufficient for managing mild hot flashes. For moderate to severe hot flashes, however, hormone therapy or non-hormonal medications are often needed to obtain relief.

Hormone therapy is available in a pill, vaginal ring, and a skin patch, gel, cream, or spray and includes estrogen and sometimes, progestin. Estrogen is the hormone that eases the symptoms, whereas progestin is only required if a uterus is still present.

Nonhormonal options for treating hot flashes include:

• Certain antidepressants like Paxil or Brisdelle (paroxetine) or Effexor (venlafaxine)
• The anti-seizure and nerve pain medication Neurontin (gabapentin)
• A drug used normally to treat overactive bladder called Ditropan (oxybutynin)
  

Support, Outreach, and Resources

Living with MS and menopause can feel like a double whammy. While doing your best to care for yourself and address your symptoms with your healthcare provider, don't forget to reach out to loved ones and friends for support.

Contacting an organization like the National MS Society or the North American Menopause Society for additional emotional support and educational resources may also be helpful.

There are also online support groups like Menopause Matters or MS World. Connecting with others who are going through what you are experiencing can be comforting and help you feel less alone.

Summary

Since MS is typically diagnosed in young adulthood, most people who menstruate will reach menopause after their MS diagnosis. Going through menopause while living with MS can be physically and emotionally taxing.

Certain symptoms, like cognitive and mood problems, may overlap. Also, the diminishing estrogen levels that occur as menopause approaches could potentially worsen a person's MS. Hormone therapy can improve certain symptoms of menopause, like hot flashes, and may improve the quality of life in females with MS.

A Word From Verywell

It's normal to feel overwhelmed by the number or intensity of your symptoms if you have MS and are approaching or beyond menopause. Focus your efforts on what you can control. Do your best to care for your body and mind, and continue to empower yourself with knowledge, especially as new research emerges.