Estrogen, aging, and MS: Notes from the front lines of midlife
This year I've had more signs than ever that I'm growing older
It’s official: This is the year I aged — physically, emotionally, visibly. With menopause on the horizon and multiple sclerosis (MS) quietly lurking in the background, I’ve been thinking a lot about how best to care for my brain, body, and beyond.
Aside from the 3 a.m. hot flash that lasts two hours (so much for a “flash”), perimenopause has been relatively quiet. What hasn’t been quiet is the steady, every-other-week breakdown of yet another body part.
- My sacroiliac joint pain used to resolve in a month or two. We’re now on month 13.
- My eyeballs are bone dry, despite the round-the-clock rotation of drops, gels, ointments, and medications.
- I can’t see near or far, even with the three pairs of glasses permanently stationed on my face, head, and shirt collar.
- My skin? No longer smooth. I’m making friends with the Big Dipper constellation of sun spots shining under my right eye.
- And I’ve gained 20% of my former weight.
I’m observing my aging process with both curiosity and awe, and my respect for estrogen only continues to grow. Yes, it gave me glowing skin and glossy hair in my 20s, 30s, and during pregnancies, but its steep postpartum plunge also triggered my first MS attack.
Now, with perimenopause in full swing and estrogen levels in free fall, I’m acutely aware of how this powerful hormone modulates the immune system — and what its decline might mean for my MS symptoms and long-term brain health.
My response to aging
That’s why, last June, I started hormone replacement therapy (HRT), after thoughtful conversations with both my gynecologist and neuroimmunologist to make sure I was a good candidate. My primary motivation? MS, of course, but also a strong family history of osteoporosis, heart disease, and dementia. I’ve been following the research of neurologist Rhonda Voskuhl, and if an extra decade of estrogen might slow these processes down, I’m all in.
A year of HRT hasn’t reversed the clock; I’m still visibly aging. But knowing that a modest estrogen boost, combined with healthy habits, might support my brain, bones, and cardiovascular system over the long haul gives me a sense of agency.
If I’m lucky enough to make it into my 80s or 90s, I won’t care much about laugh lines, gray hair, or the number on the scale. What I’ll care about is having the energy to do meaningful work and the health to enjoy deep relationships with the people I love.
I may not outrun time, but at least I’ll know I gave it my best shot.
Note: 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. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.
About the Author
Kristi Cumming
Wow, Dr. Payrovi, your article sure hit home. I was diagnosed with MS in 1984, at age 27. DMTs were not available until 1996. I said no to them and have never used them. I went on oral contraceptives at age 33 Then I was switched to HRT 20 yrs later. I stopped them at age 63 which was 5 yrs ago. My GYN recommended HRT because he feared menopause would make me miserable and he was concerned that my MS would act up. Sometimes I wish I was still on them. While on the OCP and HRT I was very asymptomatic. Throughout my entire MS journey, I was and still am very active, doing yoga, walking and sticking to a healthy diet. In over 40 yrs I have had probably a total of 7 significant flare-ups. My MRIs are riddled with plaques. My original neurologist is shocked that I am still ambulating. I have used oral Prednisone 3-4 times in the past, and one course of iV steroids, and that was over 13 yrs ago. Enough about me. I wish you the best in your journey. I love reading all your articles. Welcome to this stupid MS club. I have met some of the most amazing people along the way with this dumb-ass disease. May it be history soon.
Be safe, be well.
Kristi Cumming
San Bernardino CA