Menopause may accelerate the progression of MS: Study
Researchers suggest hormone therapy may help slow disease worsening
For women with multiple sclerosis (MS), disability starts to worsen significantly faster after menopause, according to a new study.
“The study shows that menopause represents a unique factor in MS progression, even when we take into consideration the effects of aging,” Riley Bove, MD, study co-author at the University of California, San Francisco (UCSF), said in a press release.
Hormone therapy after menopause may help slow MS progression, but more research is needed to test this idea, the scientists said.
“These findings suggest that further inquiry into the possible neurobiological effects of this major hormonal transition is warranted,” they wrote, adding “menopause is a clinically meaningful transition and an important topic of study in neurologic diseases.”
The study, “Association of Menopause With Functional Outcomes and Disease Biomarkers in Women With Multiple Sclerosis,” was published in Neurology.
MS predominantly affects women and there’s evidence that changes in sex-related hormones such as estrogen may play a role in the disease’s trajectory. During menopause, estrogen levels drop, so there’s reason to think menopause may affect MS disease progression.
“We know that hormonal changes during puberty can trigger autoimmune diseases like MS,” Bove said. “We see a lower rate of relapse during the third trimester of pregnancy, followed by a rebound postpartum.”
Measuring the effects of menopause on MS progression has been difficult, however, and studies attempting to do this have generally relied on the Expanded Disability Status Scale (EDSS) to measure disease progression. The scale has some noteworthy drawbacks however: it mainly focuses on walking ability, it isn’t very good at capturing subtle changes in people who have some walking difficulties, and scores can be affected by normal aging that isn’t related to MS itself.
“The EDSS has a number of limitations and may also measure changes that are not related to MS, such as older age and multiple medication use, both of which can affect mobility,” said Hannah Silverman, first author of the study and a medical student at UCSF.
MSFC changes after menopause
Here, researchers focused on the Multiple Sclerosis Functional Composite (MSFC), a different measure of disability that includes measures of walking ability along with tests of cognition and upper limb function.
The researchers analyzed how MSFC scores changed over time in 184 women followed for a median of 13 years, including the time before and after the onset of menopause. The women were diagnosed at a median age of 37 and were living with MS for about 24 years at the time of their last visit.
As expected, data showed MSFC scores tended to get worse over time, which reflects the progression of MS. But after the women went through menopause, MSFC scores got worse significantly faster than they had before menopause, suggesting menopause leads to an acceleration in disability worsening. Similar trends were seen in all components of the MSFC scores, including measures of walking ability, cognition, and arm and hand function.
By contrast, EDSS scores tended to get worse more slowly after menopause. This is probably because EDSS isn’t as sensitive to changes in patients with more pronounced disability, so this difference more likely reflects issues with the tool than with changes in disease progression.
Consistent with the idea that menopause can speed up MS disease processes, biomarker analyses showed levels of neurofilament light chain (NfL), a nerve damage marker, tended to increase significantly faster after menopause.
The findings lend credence to the idea that the drop in estrogen during menopause may accelerate the progression of MS. If that’s true, then estrogen-replacing hormone therapies may help stave off disease progression. However, other hormones also change during menopause, so further studies will be needed, the researchers said.
“We would need large, randomized trials that compare hormone treatment to a placebo before we can know the true effects of hormone therapy in a condition as complex as MS,” Bove said.
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