A new study from UC San Francisco has highlighted the significant impact menopause has on the progression of multiple sclerosis (MS), with findings indicating a notable worsening of symptoms following this natural stage in a woman’s life. The study raises intriguing questions about the potential role of hormone therapy in mitigating the effects of menopause on MS, especially among the 30% to 40% of MS patients who are perimenopausal or postmenopausal.
Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system, and women account for around 75% of the MS population. Previous research has shown that hormones significantly influence the course of the disease. The recent study found that after menopause, patients exhibited a noticeable decline in physical abilities, such as slower walking, and there were subtle declines in fine motor skills and cognitive function.
“We know that hormonal changes during puberty can trigger autoimmune diseases like MS,” explained Riley Bove, MD, associate professor of neurology at UCSF and the corresponding author of the study. “We see a lower rate of relapse during the third trimester of pregnancy, followed by a rebound postpartum,” Bove added, emphasizing the significant role of hormonal fluctuations in the course of MS.
The study followed 184 women, examining their MS progression before and after menopause. Data from two UCSF studies, EPIC and ORIGINS, were utilized, tracking the women for an average of 13 years. Researchers measured various aspects of MS progression, including walking speed, dexterity, and cognitive abilities, and found that these areas worsened following menopause. Notably, participants experienced increased difficulty with a 25-foot walking test, even when accounting for age, weight, and tobacco use. Additionally, declines in hand dexterity and cognitive function were observed.
The researchers also identified a biomarker in the blood, neurofilament light chain (NfL), which increased after menopause. Elevated NfL levels indicate nerve cell degeneration, a hallmark of advancing MS, and helped validate the MS-related declines observed through functional testing.
While previous studies have explored the relationship between menopause and MS progression, the results have been inconsistent. Many of these studies relied on the Expanded Disability Status Scale (EDSS), a tool primarily focused on walking ability. However, the EDSS has limitations, as it does not fully capture other changes, such as aging effects or the use of medications that could impact mobility.
Hannah Silverman, a UCSF medical student and the first author of the study, explained that “the EDSS has a number of limitations and may also measure changes that are not related to MS, such as older age and multiple medication use, both of which can affect mobility.”
Hormone therapy was explored in the study, but only 17% of the participants (31 out of 184) used estrogen therapy, which was insufficient to draw definitive conclusions about its effectiveness. While animal studies suggest that sex hormones, including estrogen, may have neuroprotective effects, there is still limited research on this in humans. One small study has examined the protective role of testosterone in men, but larger trials are needed to understand the potential benefits of hormone therapy for MS patients.
“The study shows that menopause represents a unique factor in MS progression, even when we take into consideration the effects of aging,” said Bove. “But we would need large, randomized trials that compare hormone treatment to a placebo before we can know the true effects of hormone therapy in a condition as complex as MS.”
The findings from this study underscore the importance of understanding how hormonal changes during menopause affect MS progression. Although the study points to menopause as a critical factor in the worsening of MS symptoms, the research calls for more comprehensive studies, particularly large-scale randomized trials, to explore the potential benefits of hormone therapy for MS patients in menopause.
Given the growing evidence of hormonal influence on autoimmune diseases like MS, the next step in MS treatment may involve incorporating hormonal management alongside traditional therapies to provide better outcomes for women, particularly as they transition through menopause.
The study’s findings suggest that healthcare providers may need to take a more individualized approach to managing MS in women, considering not only the disease itself but also the hormonal changes that come with menopause. This approach could lead to better management strategies and improved quality of life for women with MS.
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