Significantly more women than men are affected by multiple sclerosis. For this reason, the topic of menopause in multiple sclerosis is of great relevance. Because this affects everyone affected during the course of the disease. There are some rumors and ambiguities regarding the connection between multiple sclerosis and menopause, which we will clear up in this article.

‍

Menopause & Multiple Sclerosis

Whether menopause, climacteric period or the so-called “menopause”, every woman goes through these years of hormonal change. But what exactly happens during menopause? The menstrual cycle is a complex interplay of hormones that are released and regulated by the ovaries and uterus. A cycle usually lasts 28 days and is repeated over 30-45 years. This period is based on the fact that women are born with a fixed number of primary single cells, meaning that the number of ovarian cycles is limited. With the end of the menstrual cycle, menopause and female infertility begin. Since this process is associated with a number of hormonal fluctuations, there may be various symptoms. Many patients report hot flashes, sweats and sleep disorders. Depressive moods and increased irritability are also not uncommon. Menopause can manifest itself in many ways, which is why many symptoms remain unmentioned here.

Menopause is a challenge even for healthy women. It is therefore probably not surprising that it can lead to problems more frequently in MS patients, who are increasingly suffering from concomitant diseases and physical limitations. Hot flashes are one example here. MS disease can lead to the so-called Uhthoff phenomenon. This phenomenon includes a drop in performance and/or a worsening of MS symptoms due to increased body temperature or heat. This connection makes it clear that those affected can react more sensitively to certain symptoms of menopause.
The term “overlap symptoms” describes another problem. Both MS and menopause can cause a wide range of symptoms. Some of these symptoms occur in both processes. It is therefore difficult to differentiate whether they are caused by MS or menopause. Examples include fatigue and incontinence.

‍

Menopause & MS flare-ups

It is repeatedly discussed whether menopause leads to increased relapses. There is currently no scientific connection between worsening MS or MS symptoms and menopause.
Nevertheless, the fact that there is a secondary progressive course of MS at the age of menopause cannot be refuted; relapses become less frequent during this period, but there is a slow increase in physical limitations. However, this development is also evident in men, which suggests that there is no connection with menopause.

‍

Hormone replacement therapy (HRT)

There is no general answer as to whether treatment using hormone replacement therapy should be considered and should be discussed with the treating physician.

Nevertheless, we want to address certain points and provide clarity. Once upon a time, hormone replacement therapy was frequently recommended, but today it is controversial - why?
Various studies show that HRT increases the risk of specific breast cancer and also of cardiovascular diseases. However, it should be noted that another study was able to show that the mortality rate under HET is not increased. This means that, despite the more frequent risk of breast cancer and cardiovascular disease, the lifespan is the same.
As a result, every woman and her health should be considered individually in order to take into account all relevant risk factors:

• Are there any pre-existing cardiovascular diseases?
• Are there other risk factors that promote cardiovascular diseases, such as type 2 diabetes mellitus, obesity, lipid metabolism disorders?
• Are there frequent cases of cardiovascular diseases in the family?
• Is there nicotine consumption?
• Are breast cancers known in the family?

The existing risks of breast cancer and cardiovascular diseases can be further reduced if close screening and regular monitoring are carried out. This is of course also of great relevance for non-MS patients.

Despite these risks, HET naturally also has some benefits. HRT reduces the classic symptoms of menopause. For example, it has a positive effect on weight gain, hot flashes, depression, dry mucous membranes (especially vaginally) or even loss of libido.

osteoporosis
‍HRT not only influences the symptoms mentioned above, but also has a kind of “anti-aging effect.” This applies, for example, to skin (elasticity), but also to bone health. The latter is of great importance. This is because the hormone estrogen supports bone formation. As estrogen production is reduced during menopause, there is a decrease in bone density.

This can lead to problems in MS because many patients already have reduced bone density as a result of repeated cortisone shock therapy as the disease progresses. The risk of contracting a fracture in the event of a fall is therefore increased. Because of the risks mentioned above, hormone replacement therapy is not the drug of choice for every patient. In addition to HET, there are therefore also other ways to combat the decrease in bone density.

Sufficient exercise combined with a healthy, balanced and calcium-rich diet (lots of fish, quark, yogurt, vegetables) is recommended. In addition, specific medications can be considered in consultation with treating doctors. In our blog article on the topic Osteoporosis in MS Can you read more about it.

‍

Coping with menopause: Further measures and tips for everyday life

There are many ways to alleviate the symptoms of menopause. Studies show a significant improvement in symptoms with cognitive behavioral therapy.
Acupuncture should also significantly reduce the incidence of hot flashes.

Perhaps these tips for everyday life will already help you:

• A healthy lifestyle
• Lots of exercise and fresh air
• sports
• No smoking and alcohol only in moderation
• A balanced diet (reduce fiber, whole grains, carbohydrates and sugar, lots of vegetables, fruit, fish)
• yoga
• mindfulness exercises (e.g. regular meditation, breathing exercises, progressive muscle training)

‍

synopsis

Menopause and multiple sclerosis are a very complex issue without an easy solution. Patients experience menopause to varying degrees and are therefore subject to individual suffering. Based on a personal benefit-risk assessment, each patient can find her way in this challenging situation. If necessary, it is worthwhile to talk extensively with doctors in order to find a solution together.

‍