A new large-scale study has found that menopause does not independently increase the risk of disability progression in women with multiple sclerosis. The findings, published in JAMA Neurology, challenge a long-held hypothesis that the hormonal changes associated with the menopausal transition might be a key driver for the worsening of symptoms commonly observed in women with MS around the age of 50. This research provides significant reassurance to patients and offers clearer guidance for clinicians managing the health of women with this chronic autoimmune condition as they age.
Multiple sclerosis is a neurodegenerative condition that affects the nervous and immune systems, with a prevalence three times higher in women than in men. Clinicians and patients have long observed that disability from MS tends to accelerate around midlife, a timeframe that directly coincides with the average age of menopause. This overlap led researchers to question whether the substantial decline in sex hormones like estrogen and progesterone was a direct cause of this worsening disease trajectory. Previous investigations into this question were conducted on much smaller scales, yielding conflicting and inconclusive results. The new study, led by researchers at Monash University, aimed to provide a definitive answer by leveraging a massive international patient registry to disentangle the effects of menopause from the natural process of aging.
Landmark Study Scope and Methodology
This investigation stands as the most extensive research of its kind to address the link between menopause and MS disability. The research team utilized data from the MSBase Registry, the largest global clinical outcomes register for the disease, which tracks over 120,000 individuals with MS worldwide and is headquartered at Monash University. By tapping into this comprehensive resource, the scientists could analyze long-term data with a high degree of statistical power, overcoming the limitations of earlier, smaller studies that reported on fewer than 150 post-menopausal women.
The core analysis focused on a cohort of 987 Australian women with relapse-onset MS who were recruited from eight specialized neuroimmunology centers across the country. Within this group, 404 women, representing 40% of the cohort, had already undergone menopause. Each participant’s health progression was followed for an average of just over 14 years, providing a robust, long-term view of their disease course. The study’s primary objective was to determine if the onset of menopause acted as an independent trigger for the accumulation of physical disability, separate from other age-related factors.
Disentangling Aging from Menopause
The central conclusion of the study is that menopause is not directly responsible for the increased disability seen in women with MS during their late 40s and early 50s. While the research confirmed that disability progression does indeed accelerate during this period, it found that this trend is attributable to the broader effects of somatic aging—the general biological aging process that affects all people, irrespective of their sex or hormonal status. In essence, the worsening of MS symptoms around this age is a component of aging itself, not a specific consequence of the loss of female sex hormones.
Associate Professor Vilija Jokubaitis, the study’s senior author and Deputy Head of Monash University’s Department of Neuroscience, explained the context for the research. “MS disability typically gets worse in both men and women as people age, with a noticeable shift at about the age of 50,” she stated. The team specifically asked whether the loss of sex hormones at menopause could be the reason for this worsening in women. Their findings decisively indicated that it is not. “The increases in disability we see around the age of 50 are not directly due to menopause, but are likely due to other aging processes,” Jokubaitis affirmed. The study’s authors noted that while reproductive aging may contribute additively to overall aging, it does not appear to be the leading factor for disability progression.
New Guidance for Clinical Practice
These findings have profound implications for the clinical management of women with MS. Dr. Francesca Bridge, the study’s first author and a neurologist at Alfred Health, emphasized that the results should provide peace of mind. “The menopausal transition can be challenging for many women,” she said. “This study gives women with MS one less thing to be concerned about.” For physicians, particularly neurologists, the research provides a solid evidence base to reassure their patients that menopause itself will not cause their MS to worsen more rapidly. This clarity can help shift clinical conversations away from fears about an inevitable, hormone-driven decline and toward proactive management of symptoms.
The study is expected to guide the health management of women with MS as they navigate menopause. Rather than focusing on menopause as a driver of the underlying disease, clinicians can now more confidently address it as a separate, albeit concurrent, health event. This distinction is crucial for developing appropriate treatment plans that target menopausal symptoms to improve a patient’s overall quality of life without incorrectly linking them to MS progression.
Managing the Challenge of Overlapping Symptoms
A significant challenge for both patients and doctors is the overlap between the symptoms of menopause and those of multiple sclerosis. Many common menopausal experiences can mimic or exacerbate existing MS symptoms, leading to diagnostic confusion and patient distress. The study highlights the importance of recognizing and managing this symptomatic convergence to enhance patient well-being.
Commonly Confused Symptoms
Women going through the menopausal transition often experience a range of symptoms that can be difficult to distinguish from an MS relapse or progression. These include:
- Hot flashes and temperature sensitivity: Sudden feelings of intense heat can worsen MS symptoms, a phenomenon known as Uhthoff’s phenomenon.
- Cognitive and memory issues: Often referred to as “brain fog,” difficulties with memory and concentration are hallmarks of both menopause and MS.
- Mood disturbances: Both conditions can be associated with an increased risk of depression, anxiety, and mood swings.
- Urinary dysfunction: Bladder urgency and incontinence are common issues in both MS and during the menopausal transition.
- Fatigue: Profound physical and mental exhaustion is a primary symptom of MS and is also frequently reported during menopause.
A Holistic Management Approach
Given that menopause does not drive MS progression, the clinical focus should be on holistic management aimed at improving quality of life. Dr. Bridge stressed the value of this approach, recommending that women with MS benefit from proactive management of menopausal symptoms. This includes lifestyle modifications such as regular exercise and maintaining a healthy diet. Furthermore, pharmacological options should be considered where appropriate. Menopausal hormone therapy (MHT) can be an effective treatment for symptoms like hot flashes and can be considered for women with MS. For those who cannot or do not wish to use hormonal treatments, other non-hormonal therapies are also available to help manage symptoms and improve daily life.