Multiple sclerosis (MS) is an autoimmune disorder in which the immune system attacks the nervous system. The resulting neurological damage can cause a range of MS symptoms in patients including depression, pain, fatigue, muscle spasms, muscle weakness, imbalance, and trouble walking.
MS affects each person differently and there are a number of risk factors — including genetics, environmental exposures, and lifestyle habits — that can contribute to its development and influence its progression. One such factor is biological sex; there are some general differences in how MS tends to affect women compared with MS in men.
Of note, biological sex and gender identity are separate concepts that both exist on spectrums. For simplicity, in this article, the term “woman” is used to refer to individuals who are assigned female at birth, with two X chromosomes and estrogen-dominated hormone profiles, unless otherwise noted.
MS can develop at any age, but it most commonly develops in women during the childbearing years, between the start of menstruation and the onset of menopause. Most people with MS are diagnosed between the ages of 20 and 50.
Overall, there are roughly three times more women with MS than men with the disease, though this varies by MS type.
Specifically, women are more likely to initially develop relapsing-remitting MS (RRMS), the most common type of MS, which is characterized by bouts of worsening symptoms (relapses) interspersed with periods of less severe symptoms (remission).
In contrast, primary progressive MS (PPMS) — where symptoms gradually worsen from the onset of disease — affects men and women at roughly the same rates.
The sex-based difference in risk for relapsing MS is thought to be driven mainly by hormonal differences, particularly the increase in estrogen levels that occurs in women throughout the childbearing years. Prior to puberty and accompanying hormone changes, MS affects youths of all genders at roughly equal rates. MS rates also are similar for men and women later in life, after menopause when estrogen levels decrease.
Reinforcing the role of hormones in MS, transgender women on hormone therapy — who were assigned male at birth and have a Y chromosome but have a female hormone profile with high estrogen levels — have an increased MS risk comparable to that of women assigned female at birth.
No two people with MS experience the exact same symptoms, and there are no symptoms of MS that are exclusively unique to women. Nonetheless, some general differences exist in how the disease tends to manifest in women compared to men.
Specifically, women with MS:
In contrast, MS-related motor problems and cognitive issues more commonly affect men. Furthermore, men seem to have faster rates of neurodegeneration, nerve cell death.
On occasion, some women have reported breast pain, although it’s unclear if it is directly associated with MS. MS is characterized by muscle spasms and dysesthesia (abnormal sensations) that can manifest in the chest/breast area. One type of dysesthesia in particular, called the MS hug, is characterized by a feeling of pain or pressure around this specific part of the body — a sensation similar to a tight hug.
Women are more likely than men to develop relapsing forms of MS, although relapsing MS is generally more severe in men than in women and the disease tends to have a faster progression. Compared with men, women tend to have an easier recovery after relapses, and disability tends to accumulate more slowly. Rates of transition from relapsing-remitting to secondary progressive MS (SPMS) are lower in women than men.
Primary progressive MS is similarly common across sexes, and rates of disability progression are similar in men and women with PPMS.
MS affects each person differently, but some experiences tend to be more common for women. MS and its treatments may affect menstruation or require special consideration with the use of contraception. The disease also may require special consideration during pregnancy, and it commonly causes complications with sexual intimacy.
Older age at menarche (a first menstrual period) has been shown to correlate with a significantly reduced risk of developing MS.
Women may be more likely to experience irregular periods after developing MS. Certain MS treatments also may affect the menstrual cycle — for instance, beta-interferon therapies can cause irregular periods or light bleeding (spotting) between periods.
Some women with MS report their symptoms worsen in the days right before and/or during their period. But the impact of the menstrual cycle on MS symptoms has not been well studied, and there is not enough evidence to be sure if this is a common phenomenon. This is further complicated by the fact that some symptoms, such as fatigue or mood changes, are commonly associated with both MS and menstruation.
MS does not affect the age of onset of menopause. Some women with MS report their symptoms worsen during menopause — though overlap between MS symptoms and manifestations of menopause means it can be hard to tell one from the other. Some research has suggested MS-related disability accumulates faster after menopause, but the data are not yet conclusive and are complicated by the fact that MS-related disability tends to worsen with age.
Sometimes, MS symptoms can make certain forms of birth control difficult to use — for example, tremor and coordination problems can make it difficult to put on a condom or insert a diaphragm without assistance.
The safety and effectiveness of hormonal forms of contraception (pill, injection, or implant) are similar in people with MS as in those without the disease. These types of birth control can increase the risk of blood clots — MS itself does not affect this risk, but clot risk may be particularly high in people who are not very active, and MS can limit mobility. These risks should be discussed between patients and their healthcare providers.
Some medications used to treat MS can cause damage to a developing fetus, so patients receiving these treatments should use effective methods to prevent pregnancy. Patients should talk to their healthcare team about adequate birth control options.
MS does not seem to affect fertility or a person’s ability to become pregnant. Rates of premature birth, miscarriage, stillbirth, and birth defects are no different between women with MS and those without. Having MS also does not seem to increase the likelihood of undergoing a cesarean section for delivery.
Still, it is possible for MS symptoms to cause issues during pregnancy, depending on how the disease affects a specific person. For example, fatigue and muscle weakness can make a pregnancy physically challenging. Pregnancy also may aggravate certain MS symptoms, such as bladder issues.
It also is possible for MS to cause weakness in the muscles that help to push a baby out during labor. MS patients who have reduced sensation in and around the pelvis may not feel pain when contractions start.
The frequency of MS relapses tends to decrease during pregnancy, particularly during the third trimester. Relapse frequency tends to then increase in the period immediately following birth (postpartum), but pregnancy does not substantially alter the overall course of the disease.
Breastfeeding is generally considered safe for MS patients and has been linked with a reduced risk of experiencing postpartum relapses.
No disease-modifying therapies for MS have been rigorously studied during pregnancy, though some studies suggest interferon-beta therapies and glatiramer acetate can be safely used in pregnancy.
Nonetheless, any decisions on treatments need to be made on a case-by-case basis by healthcare professionals based on the potential benefits and risks for the patient and the fetus.
In MS, inflammatory damage in the nervous system can cause problems with the neuronal circuitry controlling sexual arousal. This can cause challenges during sexual intimacy — up to 80% of women with MS report some form of sexual dysfunction. Other MS symptoms, such as depression or movement problems, also can complicate a person’s sex life.
Communication among sexual partners and with healthcare providers is essential and a critical first step to addressing any dissatisfaction.
MS is diagnosed via a combination of clinical examinations and a careful review of a person’s medical history; there is no single test to detect the disease. No special considerations are needed for diagnosing MS in women compared with men. The official criteria used to diagnose the disease, called the McDonald criteria, do not make any specifications based on a person’s sex or gender.
MS itself is not a fatal condition, though it can increase the risk of some life-threatening health complications such as pneumonia. Life expectancy for MS patients, on average, is about five to 10 years shorter than the general population, though this gap is continually shrinking as treatments improve.
In the general population, the average lifespan is longer in women than men; this is also true in MS. A 2017 study from Norway, which assessed data for 1,388 MS patients across more than 60 years, found that the median lifespan for women with MS was 77.2 years, compared with 84.6 years for women without MS — a difference of 7.4 years. Among men, the median lifespan was 6.7 years shorter in those with MS than in the general population (72.2 vs. 78.9 years).
The time it takes for MS symptoms to progress to the point that they cause meaningful disability varies substantially from person to person and is strongly dependent on the type of MS and treatments. In general, progressive forms of MS lead to a faster accumulation of disability than relapsing-remitting disease.
A 2015 study on data from 15,826 MS patients across 25 countries found that the average time from the onset of MS to the development of moderate disability is about 10 years for women with relapsing MS, and about eight years for men with relapsing MS. Women with relapsing MS, on average, went more than three decades without needing an aid to walk while men needed it sooner.
In the same study, both men and women with PPMS developed moderate disability within about two to three years of the onset of symptoms on average. The average time to requiring an aid to walk was about 15 years for PPMS patients regardless of sex.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Multiple sclerosis (MS) can cause a number of symptoms affecting daily life including fatigue, depression, pain, and muscle spasms. The disease affects each patient differently, and its impact on day-to-day life can vary based on the unique set of symptoms it causes. Compared with men, women usually have a better recovery after MS relapses and a slower rate of disability accumulation over time. Proper therapeutic care, support, and beneficial lifestyle changes can improve daily life for MS patients.
Hair loss is not a symptom of multiple sclerosis (MS), and people with MS are no more likely to experience hair loss than the general population. Some medications used to treat MS may, however, cause hair loss as a side effect. Patients are advised to talk to their healthcare team if they experience unexpected hair loss.
The majority of women with MS experience some form of sexual dysfunction, with decreased libido and difficulty achieving orgasm being especially common. Some women with MS may experience reduced genital sensation, pain during sexual activity, and/or vaginal dryness.
MS can affect a woman’s sex drive. Most commonly, the disease is associated with decreased sexual desire. Hypersexuality — an unusual increase in libido — is not commonly reported in women with MS, though there have been scattered case reports of women with MS who experience hypersexuality associated with the disease.
Multiple sclerosis (MS) affects each person differently. In relapsing forms of MS, the prognosis of the disease is better for women than for men — compared with men, women tend to have an easier recovery after relapses and a slower accumulation of disabling symptoms. In primary progressive MS, however, rates of disability are comparable between men and women. Some studies have suggested that disabling MS symptoms have a larger impact on the quality of life and functional capacity in men, as men tend to view their own physical, psychological, and social well-being more unfavorably than women with MS with similar disability scores.
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