Background: Hormonal variations are known to influence the course of multiple sclerosis (MS). Objectives: We aimed to evaluate the impact of menopause in MS course, including disease activity and disability progression. Methods: We conducted a retrospective longitudinal cohort study including all women, older than 44, post-menopausal, with a diagnosis of MS at least 1 year before menopause. We evaluated the impact of menopause in MS course comparing clinical and radiologic outcomes within 5 years before and after menopause. We repeated the analysis in subgroups of patients without disease-modifying treatment (DMT) change or co-morbidities diagnosed during the observation period, considering that those factors might also impact MS outcomes. Results: Thirty-seven women, with a mean age at the time of menopause of 49.8 (±4.06) years were included in the analysis. Within 5 years following menopause, we observed a decrease in the annualized relapse rate (0.37 ± 0.35 pre-menopause vs. 0.08 ± 0.18 post-menopause, p < 0.001) compared with the same period before menopause, while the EDSS progression rate remained stable (0.13 ± 0.24 EDSS point/year pre-menopausal vs. 0.13 ± 0.18 post-menopause, p = 0.935). EDSS progression events frequency was similar before and after the menopause (37.8 vs. 48.6%, respectively, p = 0.424). These observations persisted in patients’ subgroups without DMT switch or co-morbidities. Conclusions: Following menopause, we observed a reduction in the relapse rate, but the disability progression continued at a similar rate, compared to the pre-menopausal period. These observations persisted in the subgroup of patients without changes in DMT or co-morbidities diagnosed during the observation period.

Miller DH, Fazekas F, Montalban X, Reingold SC, Trojano M: Pregnancy, sex and hormonal factors in multiple sclerosis. Mult Scler 2014; 20: 527–536.
Bove R, Chitnis T, Houtchens M: Menopause in multiple sclerosis: therapeutic considerations. J Neurol 2014; 261: 1257–1268.
Ramien C, Taenzer A, Lupu A, Heckmann N, Engler JB, Patas K, et al: Sex effects on inflammatory and neurodegenerative processes in multiple sclerosis. Neurosci Biobehav Rev 2016; 67: 137–146.
Bove R, Healy BC, Musallam A, Glanz BI, De Jager PL, Chitnis T: Exploration of changes in disability after menopause in a longitudinal multiple sclerosis cohort. Mult Scler 2016; 22: 935–943.
Bove R, Vaughan T, Chitnis T, Wicks P, De Jager P: Women’s experiences of menopause in an online MS cohort: a case series. Mult Scler Relat Disord 2016; 9: 56–59.
Bove R, White CC, Fitzgerald KC, Chitnis T, Chibnik L, Ascherio A, et al: Hormone therapy use and physical quality of life in postmenopausal women with multiple sclerosis. Neurology 2016; 87: 1457–1463.
Bove RM, Healy B, Augustine A, Musallam A, Gholipour T, Chitnis T: Effect of gender on late-onset multiple sclerosis. Mult Scler 2012; 18: 1472–1479.
Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, et al: Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2015; 100: 3975–4011.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.