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MS research update - Women with MS: the pros and cons of being female - 30 January 2013

MS is thought to be an autoimmune condition as the immune system attacks the myelin covering of nerves in the central nervous system. In common with many other autoimmune conditions, MS occurs more often in women than in men and the proportion of women is going up.

How this study was carried out

This research paper is a review of the evidence for how female gender can affect MS.

What was found

The review came to the following conclusions:

  • Women whose periods begin earlier in life are more likely to develop MS
  • Women are more likely to develop relapsing remitting MS than men
  • Women of child bearing age are less likely to have primary progressive MS
  • Being a woman of child bearing age helps protect against cognitive problems in MS
  • Fertility treatment is associated with an increased risk of having a relapse especially if it did not result in a pregnancy and if gonadotrophin-releasing hormone agonists were used.
  • Being pregnant is associated with a lower risk of experiencing a relapse especially in months seven to nine
  • There is a higher risk of relapse immediately after giving birth but there is no evidence that childbirth affects the longer term course of a woman's MS
  • In most studies, the number of pregnancies carried to at least 24 weeks (known as parity) did not affect the risk of developing MS. However, a recent study suggested that higher parity (more pregnancies carried to at least 24 weeks) was associated with a reduced risk of a first demyelinating event (which might go on to be diagnosed as MS).

What does it mean?

The authors conclude that these differences between women and men, and between women who have different hormone levels or reproductive histories (due to age, pregnancy or fertility treatment), show that there is substantial evidence that sex hormones play a role in MS.

They comment that, as the level of any one hormone does not predict the risks in MS, it is only possible to speculate what might be happening. However, they suggest that it must be a complex interaction between hormones and the immune, reproductive and nervous systems.

D'hooghe MB, D'Hooghe T, De Keyser J.
Female gender and reproductive factors affecting risk, relapses and progression in multiple sclerosis.
Gynecol Obstet Invest. 2013 Jan 18. [Epub ahead of print]
abstract

More about gender and MS

Who gets MS is a complex subject but, at the moment, it occurs in about three times more women than men.

Women are more likely to be diagnosed with relapsing remitting MS than men but there is about an equal chance of developing primary progressive MS.

MS is often diagnosed when someone is in their twenties or thirties, a time when they may be considering whether to have children. Our A-Z entry on pregnancy and parenthood contains helpful information including on conception, pregnancy and delivery plus life with a new baby. The blog "MS, baby and me" describes one woman's experiences.

Recent research that investigated the effect of fertility treatment on MS was reported in a recent edition of Research Update.

Other sources of information

Sex and MS: a guide for men looks at how MS can affect the sex lives of men and how these issues can be managed.

Sexuality and MS: a guide for women explains how MS can impact on both sexuality and intimacy and offers positive and practical solutions.

Kid's guide to MS is aimed at 6-10 year olds who have a mum or dad with MS. Fully illustrated in bright colours with engaging characters, the Kids' Guide is a book that children can read on their own or with a parent.

Young person's guide to MS is written with the help of 10-16 year olds who know what it is like to have a parent with MS and who share their experiences, worries and emotions about living with MS in their family.

Talking with your kids about MS looks at the concerns parents may have about discussing MS, some of the things children may want to know and what other parents' experiences have been.

Research by topic areas...

Diagnosis

Selchen D, Bhan V, Blevins G, et al.
MS, MRI, and the 2010 McDonald criteria: a Canadian expert commentary.
Neurology. 2012 Dec 4;79(23 Suppl 2):S1-15.
abstract

Symptoms and symptom management

Fletcher SG, Dillon BE, Gilchrist AS, et al.
Renal deterioration in multiple sclerosis patients with neurovesical dysfunction.
Mult Scler. 2013 Jan 21. [Epub ahead of print]
abstract

MS relapses

Shaygannejad V, Ashtari F, Alinaghian M, et al.
Short-term safety of pulse steroid therapy in multiple sclerosis relapses.
Clin Neuropharmacol. 2013 Jan;36(1):1-3.
abstract

Disease modifying treatments

Jeffery DR.
Recent advances in treating multiple sclerosis: efficacy, risks and place in therapy.
Ther Adv Chronic Dis. 2013 Jan;4(1):45-51.
abstract

Bayas A.
Improving adherence to injectable disease-modifying drugs in multiple sclerosis.
Expert Opin Drug Deliv. 2013 Jan 23. [Epub ahead of print]
abstract

Sempere AP, Martín-Medina P, Berenguer-Ruiz L, et al.
Switching from natalizumab to fingolimod: an observational study.
Acta Neurol Scand. 2013 Jan 22. doi: 10.1111/ane.12082. [Epub ahead of print]
abstract

Other treatments

Skovgaard L, Launsø L, Pedersen IK, et al.
Combination treatment of people with multiple sclerosis based on collaboration between conventional healthcare providers and alternative practitioners--patient perspectives on outcomes.
J Complement Integr Med. 2011 Sep 27;8.
abstract

Rehabilitation

Eyssen IC, Steultjens MP, de Groot V, et al.
A cluster randomised controlled trial on the efficacy of client-centred occupational therapy in multiple sclerosis: good process, poor outcome.
Disabil Rehabil. 2013 Jan 24. [Epub ahead of print]
abstract

Assessment tools

Young CA, Mills RJ, Woolmore J, et al.
The unidimensional self-efficacy scale for MS (USE-MS): developing a patient based and patient reported outcome.
Mult Scler. 2012 Sep;18(9):1326-33.
abstract

Benedict RH, Smerbeck A, Parikh R, et al.
Reliability and equivalence of alternate forms for the Symbol Digit Modalities Test: implications for multiple sclerosis clinical trials.
Mult Scler. 2012 Sep;18(9):1320-5.
abstract

Quality of life

Baumstarck K, Pelletier J, Butzkueven H, et al.
Health-related quality of life as an independent predictor of long-term disability for patients with relapsing-remitting multiple sclerosis.
Eur J Neurol. 2013 Jan 24. doi:10.1111/ene.12087. [Epub ahead of print]
abstract

Kikuchi H, Mifune N, Niino M, et al.
Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis.
BMC Neurol. 2013 Jan 22;13(1):10. [Epub ahead of print]
abstract

Causes of MS

Hedström AK, Hillert J, Olsson T, et al.
Exposure to anaesthetic agents does not affect multiple sclerosis risk.
Eur J Neurol. 2013 Jan 24. doi:10.1111/ene.12098. [Epub ahead of print]
abstract

Salzer J, Hallmans G, Nyström M, et al.
Vitamin A and systemic inflammation as protective factors in multiple sclerosis.
Mult Scler. 2013 Jan 18. [Epub ahead of print]
abstract

Psychological aspects

Chiaravalloti ND, Stojanovic-Radic J, Deluca J.
The role of speed versus working memory in predicting learning new information in multiple sclerosis.
J Clin Exp Neuropsychol. 2013 Jan 28. [Epub ahead of print]
abstract

Physical activity

Asano M, Duquette P, Andersen R, et al.
Exercise barriers and preferences among women and men with multiple sclerosis.
Disabil Rehabil. 2013 Mar;35(5):353-61.
abstract

Neven A, Janssens D, Alders G, et al.
Documenting outdoor activity and travel behaviour in persons with neurological conditions using travel diaries and GPS tracking technology: a pilot study in multiple sclerosis.
Disabil Rehabil. 2013 Jan 24. [Epub ahead of print]
abstract

CCSVI

Ghezzi A, Annovazzi P, Cocco E, et al.
Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases.
Neurol Sci. 2013 Jan 25. [Epub ahead of print]
abstract

Comi G, Battaglia MA, Bertolotto A, et al.
Italian multicentre observational study of the prevalence of CCSVI in multiple sclerosis (CoSMo study): rationale, design, and methodology.
Neurol Sci. 2013 Jan 24. [Epub ahead of print]
abstract

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