Contrary to popular belief, experts now say menopause doesn’t worsen long-term disability accumulation in women with multiple sclerosis.
Australian research has found that menopause does not increase the risk of disability progression in women with multiple sclerosis.
Sex hormones have been considered likely modulators of MS disease activity, but previous studies on the impact of menopause were small and had conflicting findings.
Monash University researchers conducted the largest of its kind study to confirm the association between menopause and MS progression.
However, that’s not what they found.
Data from nearly 1000 women with relapse-onset MS who had recorded menopausal status and at least three Expanded Disability Status Scale (EDSS) measurements in the MSBase Registry was analysed.
Of these, about 600 were premenopausal and 400 were postmenopausal. A secondary analysis included another 200 women with EDSS measurements both before and after menopause.
“Our study is the largest study to-date and uses real-world patient information collected over a long period of follow up,” first author and neurologist with Alfred Health, Dr Francesca Bridge, told The Medical Republic.
“MS disproportionately affects women and is commonly diagnosed prior to menopause. Managing the menopausal transition is important for most women with MS,” she said.
Women with MS were recruited from eight Australian neuroimmunology specialist centres between 2018 and 2021.
The median age at menopause was 48 years and the median observation period was seven years.
They completed a dedicated retrospective women’s health survey during routine clinical visits, which were then linked to MSBase Registry clinical data.
After adjusting for age at MS onset, baseline disease duration, baseline EDSS score, baseline relapse and exposure to high-efficacy disease-modifying therapy, menopause was not associated with a higher risk of confirmed disability progression (CDP) or secondary progressive MS (SPMS).
Related
Older age at MS onset, longer disease duration and higher baseline EDSS were linked to increased risk, while treatment with high-efficacy disease-modifying therapies appeared to be protective.
To distinguish the effects of menopause from those of aging, the researchers compared disability progression in women who experienced early menopause compared to those who were 45 or older.
They found no evidence of increased risk among women with early menopause but noted that potential confounders such as medically or surgically induced menopause were difficult to directly compare to natural menopause.
Researchers also modelled potential inflection points at three and five years before menopause and concluded that menopause did not mark a turning point in disability worsening.
Authors concluded that while reproductive aging may add the effects of somatic aging, the results of their research does not support menopause as the leading factor for disability progression in older women with MS.
Dr Bridge explained that the study assessed global disability measures including mobility, balance, vision, and cognition, but some factors such as BMI could not be accounted for.
“This study offers important reassurance for women with MS and the clinicians who care for them, that for most women, menopause will not accelerate disability in the long-term,” she said.
“However, it is recognised that menopause may overlap with symptoms of MS and transiently worsen pre-existing neurological symptoms.”
“Therefore, proactive and holistic management of menopause is recommended for women with MS to reduce the symptoms of menopause and improve quality of life.”
This includes regular exercise, maintaining a healthy diet and considering pharmacological measures, she said.
