ECTRIMS 2024 Updates: How Menopause Impacts Women with MS

Announcer: 
Welcome to NeuroFrontiers on ReachMD. On this episode, we’ll discuss the impacts of menopause in women with multiple sclerosis with Dr. Riley Bove. Not only is Dr. Bove a practicing neurologist and clinician scientist in the UCSF Weill  Institute for Neurosciences, but she also presented a session on this exact topic at the 2024 Congress of the European Committee for Treatment and Research in Multiple Sclerosis. Here’s Dr. Bove now.

Dr. Bove:
So there are many ways in which menopause and MS are intertwined. So if we think about  the perimenopause period when the menstrual cycles become more spread out and eventually stop, that’s the period where women are most likely to have the vasomotor symptoms, so the hot flashes and other symptoms associated with vasomotor regulation, and the hot flashes can sort of inherently be bothersome to people with MS because of the Uhthoff’s phenomenon, right? People feel less well. Their symptoms feel worse when they’re hot. The second way in which menopause and MS are intertwined is that during the menopausal transition, that’s also when you start to see changes in sleep regulation, mood regulation, and cognition, and those are symptoms that people with MS also have, so there’s sort of this overlap of symptoms where people will commonly say, “Is it my MS or my menopause or both?” So that overlap of symptoms can be really bothersome.

One way in which the experience of menopause is different in women with MS is because of those overlap symptoms, patients are often rightfully uncertain whether what they’re experiencing is a result of just sort of general patterns of hormonal changes and general menopausal transition. They often actually come to me thinking that they’re experiencing disease progression, that their MS has worsened, or that they’re having a pseudo exacerbation, and these things kind of sneak up on them and they attribute them to their MS because for many years MS has been the main issue they have been grappling with. So I think kind of not knowing where to attribute the blame in a way is one thing that is more common in women with MS.

I think when we consider how typical MS symptoms change over the menopausal transition, it’s really a “yes and” situation, right? So yes, there are changes associated with menopause, and yes,  there are symptomatic changes from the MS, and so the approach in evaluating them is really about being comprehensive and really trying to tease apart all the bits that we can. So for instance, if someone is experiencing worsening fatigue, we want to think about the non-MS things, like what is their thyroid regulation? What is their metabolism? We want to think about the overlap things like their sleep; so is their sleep dysregulated because of the hot flashes? Is the sleep dysregulated because changes in the neurogenic bladder and patients have to get up more often to go to the bathroom? Is the sleep dysregulated because of anxiety and patients staying up sort of late worrying or waking up early with depression? So really for any symptom, whether it’s fatigue, cognition, mood, bladder, joint pain, energy levels, etc., for each of these symptoms, it’s really important to think about the full picture. And as neurologists, we can certainly recommend the evaluation that’s appropriate for their neurogenic component, and we can also advocate that the patient see their primary care doctor, their internist, or their GP, to make sure that the other issues are addressed and talked about as well.

Announcer:
That was Dr. Riley Bove discussing her presentation at the 2024 Congress of the European Committee for Treatment and Research in Multiple Sclerosis, which focused on menopause in women with multiple sclerosis. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!