Menopause doesn’t worsen multiple sclerosis disability progression
Large-scale study: Older age at disease onset associated with increased risk
Disability progression does not seem to worsen in women with multiple sclerosis (MS) after they undergo menopause, according to the largest study of its kind.
Instead, other factors such as older age at MS onset, longer disease duration, and worse initial disability scores were associated with an increased risk of disability progression, the research showed.
“Our research found that menopause is not associated with an increased risk of disability accumulation in women with MS,” Vilija Jokubaitis, PhD, associate professor at Monash University in Australia and the study’s lead author, said in a university news story. “The increases in disability we see around the age of 50 are not directly due to menopause, but are likely due to other aging processes that affect all people irrespective of sex or gender.”
The study, “Menopause Impact on Multiple Sclerosis Disability Progression,” was published in JAMA Neurology.
Previous studies yielded conflicting results
MS is about three times more common in women than in men, a pattern partly attributed to increases in estrogen and progesterone levels during a woman’s childbearing years.
Although MS usually develops between the ages of 20 and 40, advancing age — particularly in the 50s and 60s — is associated with an increased risk of disability progression in both men and women.
Some studies have suggested that, in women, this increased risk of progression is associated with menopause, where estrogen and progesterone levels drop significantly. But research into the matter has generated conflicting results.
“MS disability typically gets worse in both men and women as people age, with a noticeable shift at about the age of 50, which is also around the age of menopause for most women,” Jokubaitis said. “Previous studies have also looked at this question but have reported conflicting results. These studies have been quite small, reporting on between 74 [and] 148 post-menopausal women studied over long periods of time.”
To address this, the team examined data from 987 women with MS to understand the real impact of menopause on MS. This is “a key priority for the MS community,” they wrote.
Participants were followed at eight Australian specialist centers and included in MSBase, a global registry collecting long-term data from MS patients to support research. During follow-up, about 40% of the women reached menopause, defined as 12 consecutive months without a period, at a median age of 48.5 years.
Longer disease duration associated with multiple sclerosis disability progression
The study’s primary goal was to determine if menopause reduced the time to confirmed disability progression (CPD), defined as an increase in Expanded Disability Status Scale (EDSS) scores sustained for at least six months. The secondary goal was to assess if it affected the transition to secondary progressive MS (SPMS).
“We asked whether the loss of sex hormones at menopause could be the reason for MS worsening in women at midlife,” Jokubaitis said.
Compared with the premenopausal group, slightly more postmenopausal women reached CDP (56.4% vs. 31.7%) and SPMS (24.3% vs. 7.7%). However, statistical analyses that adjusted for potential confounding factors showed that menopause did not alter the risk of CDP or SPMS.
Instead, longer disease duration and higher initial EDSS scores were associated with a higher risk of CDP and SPMS. Older age at MS onset also increased the risk of CDP, while treatment with high-efficacy disease-modifying therapies was protective against CPD.
This study has important implications for women with MS, along with the clinicians that care for them. It provides reassurance that menopause does not significantly alter the risk of disability progression.
To isolate the impact of menopause from aging, the researchers conducted an analysis to determine if early menopause, occurring before the age of 45, was associated with CDP or SPMS, but there was no increased risk in people with earlier menopause. The time spent in menopause was also not related to worsening disability over time.
“This study has important implications for women with MS, along with the clinicians that care for them. It provides reassurance that menopause does not significantly alter the risk of disability progression,” the researchers wrote.
They noted the transitional phase leading up to menopause is challenging, with many women experiencing symptoms such as hot flashes, mood swings, night sweats, cognitive symptoms, and bladder issues.
By showing that menopause will not make MS disability worsen faster, “this study gives women with MS one less thing to be concerned about,” said Francesca Bridge, a neurologist at Alfred Health in Australia and the study’s first author.
“Women with MS will benefit from the holistic management of menopausal symptoms with lifestyle measures such as exercise and maintaining a healthy diet, as well as pharmacological measures … to improve their symptoms and quality of life,” she added.
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