Multiple Sclerosis & Menopause

According to the National Multiple Sclerosis Society (NMSS), approximately 2.5 million people worldwide have been diagnosed with multiple sclerosis (MS). More women than men have MS, as do more Caucasians than other races. The term multiple sclerosis refers to the effects of the disease; namely, multiple plaques or scleroses. These plaques are the result of inflammatory disease from an autoimmune disorder that occurs within the central nervous system. The body's own immune system attacks the protective myelin sheath that surrounds the nerves. Damage to the myelin creates disruptions in the flow of nerve impulses from the brain and spinal cord extending through the body. As a result, the MS patient experiences a host of debilitating symptoms that affect function and the overall quality of life. Women, in particular, face additional challenges as they enter menopause. When menopausal symptoms combine with multiple sclerosis, a postmenopausal woman often requires a thorough medical examination to evaluate her options for care.

Types and Symptoms of Multiple Sclerosis

• Multiple sclerosis is presented in one of four forms. Patients may be diagnosed with relapsing-remitting, primary-progressive, secondary-progressive, or progressive-relapsing. Relapsing-remitting MS may transition after about ten years into secondary-progressive MS; however, the use of disease-modifying drugs might help to attenuate the illnesses' progression. Individuals suffering from multiple sclerosis may experience a wide range of symptoms, ranging from very mild to severe. Often patients not yet diagnosed with MS seek the help of their doctor when they notice a sudden onset of visual disturbances. Optic neuritis is a common symptom of MS, which usually remits after a few weeks or months. Other symptoms include headache, dizziness, numbness and tingling, depression, extreme fatigue, bladder and bowel changes; spasticity and pain.

Symptoms of Menopause

• Menopause occurs when a woman has not had a menstrual period in one year or when surgically induced by a hysterectomy. Because menopause is accompanied by a decrease in estradiol and estrogen hormones, unpleasant symptoms may result. Hot flashes, night sweats, heart palpitations, forgetfulness, and emotional lability are common. Women experience menopause at varying levels of severity. As a result, not all women require hormone-replacement therapy (HRT).

Treatment of Multiple Sclerosis

• Neurologists and primary-care physicians treat multiple sclerosis on two levels; namely, disease modification and symptoms management. Disease-modification drugs include the interferons, such as Betaseron and Avonex, as well as Copaxone, which is a combination of four amino acids. Other disease-modifying drugs are recommended depending on the severity of the illness. Although these drugs do not cure MS, they help to decrease the frequency and severity of exacerbations. Because MS symptoms are unique to each individual, physicians prescribe those drugs that offer the best safety, efficacy and tolerability for the patient. Commonly prescribed drugs for MS symptoms include Amantadine, Meclizine, Elavil, Neurontin, and Dilantin. Severe exacerbations are often treated with IV corticosteroids to reduce inflammation. There are several other medications that can help alleviate MS symptoms. Your doctor is the best judge of what is appropriate for you.

Menopause and HRT

• Because menopause results from a decline in estrogen, progesterone, and estradiol, one might be inclined to replace what is missing. However, hormone-replacement therapy (HRT) has come under scrutiny as a result of the outcome of significant research. According to a 2001 article by Elizabeth Barrett-Connor and Cynthia Stuenkel, physicians have prescribed HRT for over 50 years. The goal was to keep women on HRT long term to protect the heart, bones, and cognitive functioning. The new recommendation is to use HRT for short-term treatment of menopausal symptoms, because the benefits of long-term use do not outweigh the risks.

Warning

• In 2001, Barrett-Connor and Stuenkel reviewed the results of hormone-replacement-therapy studies that revealed new concerns and limitations. HRT is effective and appropriately recommended for short-term use to reduce hot flashes and night sweats. However, long-term use is linked to breast cancer, stroke, heart attacks and blood clots. Your physician will carefully monitor your multiple sclerosis and menopausal symptoms. Changes to your prescription medications will be made as needed.

Recommendations

• Menopausal women who also have multiple sclerosis contend with challenging and sometimes debilitating symptoms. With the appropriate medications and lifestyle modifications, women can forge ahead through the transition of menopause and multiple sclerosis while living full, enjoyable lives.