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MS research update – Can the menopause affect MS? – 13 October 2015

Summary

MS is more common in women than men and is typically diagnosed during the reproductive years. Many women with MS find that their MS changes around pregnancy when the levels of hormones change. Hormone levels change again with the menopause, so this study surveyed and followed women over time to look at the impact of the menopause on MS.

724 women were included in the study and about half were post-menopausal. The study found that after menopause EDSS score, which is a measure of level of disability, increased at a faster rate. The equivalent of a one point EDSS change over 10 years. The results could not be explained by other measures including vitamin D levels, changes in treatment, smoking or age.

This study shows that menopause appears to have a small effect on MS and levels of disability. The authors suggest this change might be due to hormone levels, in particular levels of oestradiol (which is a type of oestrogen), which some studies have shown to be neuroprotective. The use of HRT, which replaces and increases the levels of hormones lost during menopause, by participants in the study was low. The researchers suggest that a larger study with more women using HRT would be needed to show if the effects observed were related to hormone levels and if HRT could be neuroprotective for women with MS.

Background

MS is more common in women than men and is typically diagnosed during the reproductive years. Many women with MS find that their MS changes around pregnancy when the levels of hormones change. Hormone levels change again with the menopause. This study looked at the impact of the menopause on the course of individual women’s MS over time.

How this study was carried out

The Comprehensive Longitudinal Investigation of MS at the Brigham and Women’s Hospital (CLIMB) study is a long term study of MS in the USA. 1,210 women with MS who are enrolled in this study were sent an additional questionnaire that asked them reproduction related questions, including:

  • when their last period was
  • if they have had their ovaries or uterus surgically removed
  • when they had first experienced menopausal symptoms
  • if they had taken hormone replacement therapy (HRT) for menopausal symptoms.

Additionally EDSS scores were assessed every six months and participants completed other tests and questionnaires including the timed 25-foot walk test (T25FW), Short-Form-36 (SF-36) and Modified Fatigue Impact Scale (MFIS).

The researchers compared and analysed the participants responses on the reproduction questionnaire to the other information collected about their MS.

What was found

724 women returned completed questionnaires and were included in the study. About half (50.8%) were post-menopausal. Of these around two thirds has experienced a natural menopause at an average age of 49.2 years old. Women who had experienced menopause after surgery were younger, with an average age of 42.9 years at menopause and were also more likely to use HRT.

124 women were followed in the study through their menopause for an average of 10 years. The study found that after menopause EDSS score, which is a measure of level of disability, increased at a faster rate. Changing from 0.051 points change a year before menopause to 0.13 points change a year after menopause. This is the equivalent of a one point EDSS change over 10 years.

The effects were the same in women who had experienced a natural as well as those that had experienced a surgically induced menopause. The results could not be explained by other measures such as vitamin D levels, changes in treatment, smoking or age. Treatment with HRT did not seem to have an effect.

What does it mean?

This study shows that menopause appears to have a small effect on MS and levels of disability. However it is important to note that the increasing levels of disability only equate to a one point change in EDSS score over a period of 10 years. The authors suggest this change might be due to hormone levels, in particular levels of oestradiol (which is a type of oestrogen), which some studies have shown to be neuroprotective. The use of HRT, which replaces and increases the levels of hormones lost during menopause, by participants in the study was low. The researchers suggest that a larger study with more women using HRT would be needed to show if the effects observed were related to hormone levels and if HRT could be neuroprotective for women with MS.

Bove R, Healy BC, Musallam A, et al.
Exploration of changes in disability after menopause in a longitudinal multiple sclerosis cohort.
Mult Scler. 2015 Oct 7. pii: 1352458515606211. [Epub ahead of print]
Abstract

More about hormones and MS

More women are diagnosed with MS than men but the reasons why it is generally more common in women than men are not really known. To try and work out why, there is an active area of research around hormones, as the ratio of men and women being diagnosed with MS is equal before puberty and after the menopause, when hormonal differences are not as extreme. Additionally many women with MS find that their MS changes around their period, during pregnancy and at the menopause when their hormone levels change. Some researchers have started to look at the role of sex hormones as potential treatments for MS with some studies suggesting they could have both an anti-inflammatory and neuroprotective effect.

As this study shows, we do not yet have a definitive answer to the questions of whether hormone replacement can help or if hormones are the reason for the gender difference in MS diagnosis.

Research by topic areas...

Disease modifying drugs

Cohen J, Belova A, Selmaj K, et al.
Equivalence of generic glatiramer acetate in multiple sclerosis: a randomized clinical trial.
JAMA Neurol. 2015 Oct 12:1-9. [Epub ahead of print]
abstract

Ziemssen T, Gilgun-Sherki Y.
Sub-analysis of geographical variations in the 2-year observational COPTIMIZE trial of patients with relapsing-remitting multiple sclerosis converting to glatiramer acetate.
BMC Neurol. 2015 Oct 8;15(1):189.
abstract
Read the full text of this paper

Raffel J, Gafson AR, Malik O, et al.
Anti-JC virus antibody titres increase over time with natalizumab treatment.
Mult Scler. 2015 Oct 8. [Epub ahead of print]
abstract

Meca-Lallana JE, Hernández-Clares R, Carreón-Guarnizo E.
Spasticity in multiple sclerosis and role of glatiramer acetate treatment.
Brain Behav. 2015 Sep;5(9):e00367.
abstract
Read the full text of this paper

Kappos L, Wiendl H, Selmaj K, et al.
Daclizumab HYP versus interferon beta-1a in relapsing multiple sclerosis.
N Engl J Med. 2015 Oct 8;373(15):1418-28.
abstract

Ehling R, Di Pauli F, Lackner P, et al.
Impact of glatiramer acetate on paraclinical markers of neuroprotection in multiple sclerosis: A prospective observational clinical trial.
J Neuroimmunol. 2015 Oct 15;287:98-105.
abstract

Economics

Hawton AJ, Green C.
Multiple sclerosis: relapses, resource use, and costs.
Eur J Health Econ. 2015 Oct 5. [Epub ahead of print]
abstract

Other

Pilutti LA, Motl RW.
Body mass index underestimates adiposity in persons with multiple sclerosis.
Arch Phys Med Rehabil. 2015 Oct 3. [Epub ahead of print]
abstract

Other treatments

Salamonsen A.
Use of complementary and alternative medicine in patients with cancer or multiple sclerosis: possible public health implications.
Eur J Public Health. 2015 Oct 8. [Epub ahead of print]
abstract

Macdonell R, Nagels G, Laplaud DA, et al.
Improved patient-reported health impact of multiple sclerosis: The ENABLE study of PR-fampridine.
Mult Scler. 2015 Oct 7. [Epub ahead of print]
abstract

Paediatric MS

Akhtar S, Alroughani R, Ahmed SF, et al.
Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait.
Mult Scler. 2015 Oct 9. [Epub ahead of print]
abstract

Pathophysiology

Hebert JR, Kindred JH, Bucci M, et al.
Cognitive-motor related brain activity during walking: differences between men and women with multiple sclerosis.
Arch Phys Med Rehabil. 2015 Oct 5. [Epub ahead of print]
abstract

Holtbernd F, Deppe M, Bachmann R, et al.
Deficits in tongue motor control are linked to microstructural brain damage in multiple sclerosis: a pilot study.
BMC Neurol. 2015 Oct 8;15(1):190.
abstract
Read the full text of this paper

Graziano E, Hagemeier J, Weinstock-Guttman B, et al.
Increased contrast enhancing lesion activity in relapsing-remitting multiple sclerosis migraine patients.
Neuroimage Clin. 2015;9:110-6.
abstract
Read the full text of this paper

Hucke S, Wiendl H, Klotz L.
Implications of dietary salt intake for multiple sclerosis pathogenesis.
Mult Scler. 2015 Oct 7. [Epub ahead of print]
abstract

Physical activity

Moradi M, Sahraian MA, Aghsaie A, et al.
Effects of eight-week resistance training program in men with multiple sclerosis.
Asian J Sports Med. 2015 Jun;6(2):e22838.
abstract
Read the full text of this paper

Christensen ME, Brincks J, Schnieber A, et al.
The intention to exercise and the execution of exercise among persons with multiple sclerosis - a qualitative metasynthesis.
Disabil Rehabil. 2015 Oct 7:1-11. [Epub ahead of print]
abstract

Prognosis

Munger KL, Fitzgerald KC, Freedman MS, et al.
No association of multiple sclerosis activity and progression with EBV or tobacco use in BENEFIT.
Neurology. 2015 Oct 9. [Epub ahead of print]
abstract

Provision of care

Turner AP, Roubinov DS, Atkins DC, et al.
Predicting medication adherence in multiple sclerosis using telephone-based home monitoring.
Disabil Health J. 2015 Sep 5. [Epub ahead of print]
abstract

Strupp J, Voltz R, Golla H.
Opening locked doors: Integrating a palliative care approach into the management of patients with severe multiple sclerosis.
Mult Scler. 2015 Oct 7. [Epub ahead of print]
abstract

Psychological aspects

Riccelli R, Passamonti L, Cerasa A, et al.
Individual differences in depression are associated with abnormal function of the limbic system in multiple sclerosis patients.
Mult Scler. 2015 Oct 9. [Epub ahead of print]
abstract

Feinstein A, Banwell E, Pavisian B.
What to make of cannabis and cognition in MS: in search of clarity amidst the haze.
Mult Scler. 2015 Oct 9. [Epub ahead of print]
abstract

Fischer A, Fischer M, Nicholls RA, et al.
Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires.
Brain Behav. 2015 Sep;5(9):e00365.
abstract
Read the full text of this paper

Chillemi G, Scalera C, Terranova C, et al.
Cognitive processess and cognitive reserve in multiple sclerosis.
Arch Ital Biol. 2015 Apr;153(1):19-24.
abstract

Baysal Kıraç L, Ekmekçi Ö, Yüceyar N, et al.
Assessment of early cognitive impairment in patients with clinically isolated syndromes and multiple sclerosis.
Behav Neurol. 2014;2014:637694.
abstract
Read the full text of this paper

Vitamin D

Fitzgerald KC, Munger KL, Köchert K, et al.
Association of vitamin d levels with multiple sclerosis activity and progression in patients receiving interferon beta-1b.
JAMA Neurol. 2015 Oct 12:1-8. [Epub ahead of print]
abstract

Laursen JH, Søndergaard HB, Sørensen PS, et al.
Association between age at onset of multiple sclerosis and vitamin D level-related factors.
Neurology. 2015 Oct 7. [Epub ahead of print]
abstract

Work

Strober LB, Arnett PA.
Unemployment among women with multiple sclerosis: the role of coping and perceived stress and support in the workplace.
Psychol Health Med. 2015 Oct 12:1-9. [Epub ahead of print]
abstract

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