Menopause & Multiple Sclerosis

Whether stated menopause, climacteric or changing years, every woman goes through these years of hormonal change. But what exactly happens during the menopause? The menstrual cycle is a complex interplay of hormones that are released and regulated by the ovaries and the uterus. A cycle usually lasts 28 days and is repeated over 30-45 years. This period is based on the fact that women are born with a fixed number of primary eggs, so the number of ovarian cycles is limited. At the end of the menstrual cycle, the menopause begins and the woman becomes infertile. As this process is accompanied by a series of hormonal fluctuations, various symptoms can occur. Many patients report hot flushes, sweating and sleep disorders. Depressive moods and increased irritability are also not uncommon. The menopause can manifest itself in many different ways, which is why many symptoms are not mentioned here.

The menopause is a challenge even for healthy women. It is therefore probably not surprising that it can lead to more problems in MS patients, who suffer more frequently from concomitant illnesses and physical limitations. One example of this is hot flushes.

The so-called Uhthoff phenomenon can occur in the course of MS.The Uhthoff phenomenon includes a drop in performance and/or a worsening of MS symptoms due to increased body temperature or heat. This connection makes it clear that those affected can react more sensitively to certain symptoms of the menopause.Another problem is described by the term “overlap symptoms”. Both MS and the menopause can cause a variety of symptoms. Some of these symptoms occur in both processes. It is therefore difficult to differentiate whether they are caused by MS or the menopause. Examples include fatigue and incontinence.

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Menopause & MS relapses

It is repeatedly discussed whether the menopause leads to increased relapses. There is currently no scientific link between a worsening of MS or MS symptoms and the menopause.

Nevertheless, it cannot be refuted that a secondary progressive course of MS is more common at the age of menopause; relapses become less frequent during this time, but there is a slow increase in physical limitations.

However, this development is also seen in men, which indicates that there is no connection to the menopause.

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Coping with Menopause with and despite MS

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Hormone replacement therapy (HRT)

Whether treatment with hormone replacement therapy should be considered cannot be answered in general terms and should be discussed with the doctor treating you.

Nevertheless, we would like to address certain points and provide clarity. In the past, hormone replacement therapy was often recommended, but today it is controversial - why?

Various studies show that HRT increases the risk of specific breast cancer and cardiovascular disease. However, it should be noted that another study was able to show that mortality is not increased under HRT. This means that despite the increased risk of breast cancer and cardiovascular disease, life expectancy is the same.

As a result, each woman and her health should be considered individually in order to take all relevant risk factors into account:

• Is there pre-existing cardiovascular disease?
• Are there other risk factors that promote cardiovascular disease, such as type 2 diabetes mellitus, obesity, lipometabolic disorders?
• Is there a family history of cardiovascular disease?
• Is there a history of nicotine consumption?
• Are there any known cases of breast cancer in the family?

The existing risks of breast cancer and cardiovascular disease can be further reduced if close screening and regular check-ups are carried out. This is of course also extremely relevant for non-MS patients.

Despite these risks of HRT, it naturally also has some advantages. HRT reduces the classic symptoms of the menopause. For example, it has a positive effect on weight gain, hot flushes, depression, dry mucous membranes (especially vaginal) and loss of libido.

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Hormon replacement therapy and Osteoporosis

‍HRT not only affects the symptoms mentioned above, but also has a kind of “anti-ageing effect”. This relates, for example, to the skin (elasticity), but also to bone health. The latter is of great importance. This is because the hormone oestrogen supports bone formation. As oestrogen production is reduced during the menopause, bone density decreases.

This can lead to problems in the context of MS because many patients already have reduced bone density due to repeated cortisone shock therapies during the course of the disease. This increases the risk of fractures in the event of a fall. Due to the risks mentioned above, hormone replacement therapy is not the treatment of choice for every patient. In addition to HRT, there are therefore other ways to combat a decrease in bone density.

Sufficient exercise is recommended, combined with a healthy, balanced diet rich in calcium (plenty of fish, quark, yoghurt, vegetables). Specific medication can also be considered in consultation with the doctor treating you. You can read more about this in our blog article on Osteoporosis in MS.

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Measures and tips for everyday use

There are many ways to alleviate the symptoms of the menopause. Studies show a significant improvement in symptoms with cognitive behavioral therapy.Acupuncture is also said to significantly reduce the occurrence of hot flushes.Perhaps these tips for everyday life will already help you:

• A healthy lifestyle
• Plenty of exercise and fresh air
• Exercise
• No smoking and alcohol only in moderation
• A balanced diet (fiber, whole grain products, reduce carbohydrates and sugar, lots of vegetables, fruit, fish)
• Yoga
• Mindfulness exercises (e.g. regular meditation, breathing exercises, progressive muscle training)

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