MS in women: Are there specific MS symptoms for women?

Last updated Aug. 9, 2024, by Marisa Wexler, MS
Fact-checked by Patrícia Silva, PhD

While multiple sclerosis (MS) can affect anyone, the disease is estimated to be three times more common in women than in men.

MS is an autoimmune disease that attacks the central nervous system, disrupting the flow of information within the brain and between the brain and body.

Signs of MS in women can be a range of symptoms, including depression, pain, fatigue, muscle spasms, muscle weakness, imbalance, and trouble walking.

How MS affects women

MS affects each person differently. A number of risk factors, including genetics, environmental exposures, and lifestyle habits, play a role in its development and progression.

One of these risk factors is biological sex, with 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. In this article, the term “woman” refers to individuals who are assigned female at birth, with two X chromosomes and estrogen-dominated hormone profiles, unless otherwise noted.

MS in women is more likely initially to be the relapsing-remitting form of MS (RRMS), in which episodes of new or worsening symptoms (relapses) are often followed by periods of remission with less severe symptoms. Women generally experience a slower disability progression compared with men.

Generally, the early signs of MS in women are the same as for men, including problems with vision (optic neuritis), fatigue, numbness, and tingling. Diagnosing MS in women and men can take time and involve a number of tests to reach a definitive answer.

Female hormones are a risk factor

Overall, roughly three times more women than men have the disease. However, the female vs. male ratio varies by MS type.

Women are more likely initially to develop RRMS, the most common type of MS, while primary progressive MS (PPMS) — in which symptoms gradually worsen from the onset of disease — affects women and men at approximately the same rates.

The sex-based difference in risk for relapsing MS is believed to be driven mainly by hormonal differences, particularly the increase in estrogen levels that occurs in women throughout their childbearing years. Before puberty, MS affects both sexes at roughly equal rates. MS rates are also similar for women and men later in life, including after menopause when estrogen levels decrease.

MS can develop at any age, but it most commonly develops in women during their 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.

Symptoms in women vs. men

While no MS symptom is unique to women, some general differences exist in how the disease tends to present in women compared with men.

Specifically, women with MS:

• are more likely to experience vision problems
• tend to have more inflammatory lesions in their brains.

In contrast, MS-related motor problems and cognitive issues more commonly affect men, who also 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 may be felt in the chest/breast area. One type of dysesthesia is called the MS hug, which involves a sensation of pain or pressure similar to a tight hug.

Compared with men, women tend to recover more easily from relapses and become disabled at a slower rate. Rates of transition from relapsing-remitting to secondary progressive MS are lower in women than in men.

Primary progressive MS occur at similar rates across both sexes, as do rates of disability progression.

Menstruation and menopause

The older a girl is when she gets her first period, the lower her risk of developing MS.

Women may be more likely to experience irregular periods after developing MS. Certain MS treatments may also affect the menstrual cycle. For example, beta-interferon therapies can cause irregular periods or light bleeding (spotting) between periods.

While some women with MS report their symptoms worsen right before and/or during their period, how the menstrual cycle affects MS symptoms in women has not been well-studied. Also, some symptoms, such as fatigue or mood changes, are common to both MS and menstruation.

MS does not affect the age of menopause onset. Some women with MS report their symptoms worsen during menopause, though the overlap between MS and menopausal symptoms can make it hard to tell them apart. Some research has suggested MS-related disability happens faster after menopause, but it’s not conclusive, especially because MS-related disability tends to worsen with age.

Birth control

MS symptoms can sometimes interfere with using certain forms of birth control. For example, tremor and coordination problems can make it difficult to insert a diaphragm without assistance.

MS does not affect the safety and effectiveness of hormonal forms of contraception (pill, injection, or implant). These types of birth control can increase the risk of blood clots, but MS itself does not affect this risk.

Some medications for MS can damage a developing fetus, so it’s important to talk to your healthcare provider about contraception risks and birth control options.

Pregnancy and breastfeeding

MS does not seem to affect fertility, or the ability to become pregnant.

Rates of premature birth, miscarriage, stillbirth, and birth defects are no different for women who have MS and those who do not have the disease. MS also does not seem to increase the likelihood of having a cesarean section.

Still, MS symptoms may cause issues during pregnancy, depending on how the disease affects the patient. For example, fatigue and muscle weakness can make a pregnancy physically challenging. Pregnancy may also worsen certain MS symptoms, such as bladder issues.

MS can cause weakness in the muscles that help to push a baby out during labor. 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 women with MS and has been linked with a reduced risk of postpartum relapses.

No disease-modifying therapies for MS have been rigorously studied during pregnancy, though studies suggest some therapies can be safely used in pregnancy.

Talk to your doctor about treatment based on the potential benefits and risks for you and your unborn child.

Sexual intimacy

In MS, inflammatory damage in the nervous system can cause problems with the neuronal circuitry controlling sexual arousal, and this can affect sexual intimacy.

A 2023 review study found about 61% of women with MS report some form of sexual dysfunction. Other MS symptoms, such as depression or movement problems, can also complicate a person’s sex life.

• Vaginal dryness is a common complaint for women with MS. Trying a water-based personal lubricant can help make sexual contact more pleasurable if dryness is an issue.
• Women also may experience reduced libido, genital numbness, and difficulty achieving orgasm. Using vibrators or other toys, incorporating more foreplay, and experimenting with different positions may help with these issues.
• Women with MS may feel pain during sexual activity. Desensitizing lubricants may help with sex-related pain. Other suggested strategies include over-the-counter pain-relieving medications and relaxation techniques.

Life expectancy and prognosis for women with MS

While MS is not a fatal condition, it can increase the risk of having life-threatening health complications such as pneumonia.

Generally speaking, women have a longer average lifespan than men. This is also true in MS, as men with the disease have a poorer prognosis.

Life expectancy for people with MS, on average, is estimated to be about five to 10 years shorter than the general population, though this gap is decreasing as treatments improve. According to a 2022 report from the Multiple Sclerosis Foundation of America, this gap is currently seven years or less, and it continues to decline.

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.