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.

1.
Miller DH, Fazekas F, Montalban X, Reingold SC, Trojano M: Pregnancy, sex and hormonal factors in multiple sclerosis. Mult Scler 2014; 20: 527–536.
2.
Bove R, Chitnis T, Houtchens M: Menopause in multiple sclerosis: therapeutic considerations. J Neurol 2014; 261: 1257–1268.
3.
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.
4.
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.
5.
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.
6.
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.
7.
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.
8.
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.
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