The impact of menopause on multiple sclerosis, 2023, Francesca Bridge et al

Highlights

• Menopause is associated with changes in sex hormones and the immunological profile which may impact MS disease course.
• Conflicting evidence on the impact of menopause on MS remain an important gap in the literature.
• Understanding the impact of menopause is critical for reducing disability and improving quality of life for women with MS.
  

Abstract
Menopause, defined as the permanent cessation of ovarian function, represents a period of significant fluctuation in sex hormone concentrations. Sex hormones including oestrogen, progesterone, testosterone and anti-Mullerian hormone are thought have neuroinflammatory effects and are implicated in both neuroprotection and neurodegeneration.

Sex hormones have a role in modifying clinical trajectory in MS throughout the lifespan. MS predominantly effects women and is typically diagnosed early in a woman's reproductive life. Most women with MS will undergo menopause. Despite this, the effect of menopause on MS disease course remains unclear. This review examines the relationship between sex hormones and MS disease activity and clinical course, particularly around the time of menopause. It will consider the role of interventions such as exogenous hormone replacement therapy in modulating clinical outcomes in this period.

Understanding the impact of menopause on MS is fundamental for delivering optimal care to women with MS as they age and will inform treatment decisions with the aim of minimizing relapses, disease accrual and improving quality of life.

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