Multiple sclerosis and the menstrual cycle

Czech version

Authors: S. Flašarová ¹; I. Šrotová ^1,2; M. Hladíková ^1,2; M. Petrášová ^1,2
Authors‘ workplace: Neurologická klinika FN Brno ¹; LF MU, Brno ²
Published in: Cesk Slov Neurol N 2024; 87(5): 317-321
Category: Review Article
doi: https://doi.org/10.48095/cccsnn2024317

Overview

Multiple sclerosis is an autoimmune, inflammatory, and neurodegenerative disease of the central nervous system. MS typically affects young adults between the ages of 20 and 40 years and the disease is more prevalent among women. The course of MS, whether relapsing-remitting or primary progressive, is now well and extensively mapped. With the use of highly effective therapies, we try to influence the disease as therapeutically as possible. Even in cases when patients are clinically and radiologically stable, may still experience some minor fluctuations in their health status, especially transient worsening of subjectively perceived symptoms, such as fatigue or dizziness. One of the factors that may affect the condition of MS patients to a small extent is the menstrual cycle. In this review paper, we will discuss how the menstrual cycle can affect MS, and on the other hand, how MS affects the menstrual cycle.

Keywords:

Multiple sclerosis – menstrual cycle

Sources

1. Rubio-Arias JÁ, Ramos-Campo DJ, Romero-Parra N et al. Response to physical activity of females with multiple sclerosis throughout the menstrual cycle: a protocol for a randomised crossover trial (EMMA Project). BMJ Open Sport Exerc Med 2023; 9 (4): e001797. doi: 10.1136/bmjsem-2023-001797.

2. Hradílek P, Meluzínová E, Kovářová I. Těhotenství a roztroušená skleróza z pohledu neurologa. Cesk Slov Neurol N 2018; 81/114 (6): 647–652. doi: 10.14735/ amcsnn2018647.

3. Zapletalová O. Vliv stárnutí na průběh roztroušené sklerózy u žen v klimakteriu a menopauze. Neurol Praxi 2022; 23 (4): 319–322.

4. Hanulíková P, Mardešić T. Roztroušená skleróza a těhotenství z pohledu gynekologa – možnosti asistované reprodukce. Cesk Slov Neurol N 2019; 82/115 (2): 155–159. doi: 10.14735/amcsnn2019155.

5. Vukusic S, Michel L, Leguy S et al. Pregnancy with multiple sclerosis. Rev Neurol 2021; 177 (3): 180–194. doi: 10.1016/j.neurol.2020.05.005.

6. Mirmosayyeb O, Badihian S, Manouchehri N et al. The interplay of multiple sclerosis and menstrual cycle: which one affects the other one? Mult Scler Relat Disord 2018; 21: 46–50. doi: 10.1016/j.msard.2018.01.020.

7. McCombe PA, Greer JM. Female reproductive issues in multiple sclerosis. Mult Scler 2013; 19 (4): 392–402. doi: 10.1177/1352458512452331.

8. Oertelt-Prigione S. Immunology and the menstrual cycle. Autoimmun Rev 2012; 11 (6–7): A486–A492. doi: 10.1016/j.autrev.2011.11.023.

9. Roeder HJ, Leira EC. Effects of the menstrual cycle on neurological disorders. Curr Neurol Neurosci Rep 2021; 21 (7): 34. doi: 10.1007/s11910-021-01115-0.

10. Midaglia L, Otero S, Baró F et al. Menopause and multiple sclerosis: influence on prognosis and role of disease-modifying drugs and hormonal replacement therapy. Mult Scler J 2022; 28 (2): 173–182. doi: 10.1177/1352458520952022.

11. Vetvik KG, Benth JŠ, MacGregor EA et al. Menstrual versus non-menstrual attacks of migraine without aura in women with and without menstrual migraine. Cephalalgia 2015; 35 (14): 1261–1268. doi: 10.1177/0333102415575723.

12. Kumar D, Iltaf S Sr, Umer A et al. The frequency of catamenial epilepsy in female epileptic patients of reproductive age group presented to the tertiary care hospital. Cureus 2020; 12 (11): e11635. doi: 10.7759/cureus. 11635.

13. Song YJ, Li SR, Li XW et al. The effect of estrogen replacement therapy on Alzheimer‘s disease and Parkinson‘s disease in postmenopausal women: a meta-analysis. Front Neurosci 2020; 14: 157. doi: 10.3389/fnins.2020.00157.

14. Nierenburg HC, Ailani J, Malloy M et al. Systematic review of preventive and acute treatment of menstrual migraine. Headache 2015; 55 (8): 1052–1071. doi: 10.1111/head.12640.

15. Valencia-Sanchez C, Crepeau AZ, Hoerth MT et al. Is adjunctive progesterone effective in reducing seizure frequency in patients with intractable catamenial epilepsy? A critically appraised topic. Neurologist 2018; 23 (3): 108–112. doi: 10.1097/NRL.0000000000000167.

16. Zorgdrager A, De Keyser J. Menstrually related worsening of symptoms in multiple sclerosis. J Neurol Sci 1997; 149 (1): 95–97. doi: 10.1016/s0022-510x (97) 05396-3.

17. Holmqvist P, Hammar M, Landtblom AM et al. Symptoms of multiple sclerosis in women in relation to cyclical hormone changes. Eur J Contracept Reprod Health Care 2009; 14 (5): 365–370. doi: 10.3109/13625180903137329.

18. Steward K, Raja A. Physiology, ovulation and basal body temperature. StatPearls: Treasure Island 2023.

19. Wingerchuk DM, Rodriguez M. Premenstrual multiple sclerosis pseudoexacerbations: role of body temperature and prevention with aspirin. Arch Neurol 2006; 63 (7): 1005–1008. doi: 10.1001/archneur.63.7.1005.

20. Ateş Y, Ünlüer NÖ. The relationship of pain, anxiety, and fatigue with knee position sense, balance, and dual task performance during menstrual cycle in females with multiple sclerosis. Somatosens Mot Res 2020; 37 (4): 307–312. doi: 10.1080/08990220.2020.1828057.

21. Ateş Y, Ünlüer NÖ. An investigation of knee position sense, balance, and dual task performance in different phases of menstrual cycle in females with multiple sclerosis: a pilot study. Mult Scler Relat Disord 2020; 44: 102235. doi: 10.1016/j.msard.2020.102235.

22. Taylor H, Alhasan S, Saleem M et al. Influence of menstrual cycle and hormonal contraceptive use on MS symptom fluctuations: a pilot study. Mult Scler Relat Disord 2023; 77: 104864. doi: 10.1016/j.msard.2023.104864.

23. Ekmekyapar T, Ozcan C, Ciftci O. Relationships of total leukocyte, neutrophil and lymphocyte levels with the menstrual cycle in patients receiving fingolimod treatment. Eur Rev Med Pharmacol Sci 2021; 25 (1): 447–454. doi: 10.26355/eurrev_202101_24413.

24. Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler 2014; 20 (5): 520–526. doi: 10.1177/1352458513519181.

25. Nielsen NM, Harpsøe M, Simonsen J et al. Age at menarche and risk of multiple sclerosis: a prospective cohort study based on the Danish national birth cohort. Am J Epidemiol 2017; 185 (8): 712–719. doi: 10.1093/aje/kww160.

26. Ramagopalan SV, Valdar W, Criscuoli M et al. Age of puberty and the risk of multiple sclerosis: a population based study. Eur J Neurol 2009; 16 (3): 342–347. doi: 10.1111/j.1468-1331.2008.02431.

27. Berr C, Puel J, Clanet M et al. Risk factors in multiple sclerosis: a population-based case-control study in Hautes-Pyrénées, France. Acta Neurol Scand 1989; 80 (1): 46–50. doi: 10.1111/j.1600-0404.1989.tb03841.x.

28. Operskalski EA, Visscher BR, Malmgren RM et al. A case-control study of multiple sclerosis. Neurology 1989; 39 (6): 825–829. doi: 10.1212/wnl.39.6.825.

29. Jiang X, Olsson T, Alfredsson L. Age at menarche and risk of multiple sclerosis: current progress from epidemiological investigations. Front Immunol 2018; 9: 2600. doi: 10.3389/fimmu.2018.02600.

30. Antonovsky A, Leibowitz U, Medalie JM et al. Epidemiological study of multiple sclerosis in Israel. J Neurol Neurosurg Psychiatry 1967; 30 (1): 1–6.

31. Mirmosayyeb O, Badihian S, Manouchehri N et al. The interplay of multiple sclerosis and menstrual cycle: which one affects the other one? Mult Scler Relat Disord 2018; 21: 46–50. doi: 10.1016/j.msard.2018.01.020.

32. Nillni YI, Rasmusson AM, Paul EL et al. The impact of the menstrual cycle and underlying hormones in anxiety and PTSD: what do we know and where do we go from here? Curr Psychiatry Rep 2021; 23 (2): 8. doi: 10.1007/s11920-020-01221-9.

33. Takeda T. Premenstrual disorders: premenstrual syndrome and premenstrual dysphoric disorder. J Obstet Gynaecol Res 2023; 49 (2): 510–518. doi: 10.1111/jog.15484.

34. Sundström-Poromaa I, Bixo M, Björn I et al. Compliance to antidepressant drug therapy for treatment of premenstrual syndrome. J Psychosom Obstet Gynaecol 2000; 21 (4): 205–211. doi: 10.3109/01674820009085589.

35. Bove R, Rankin K, Chua AS et al. Oral contraceptives and MS disease activity in a contemporary real-world cohort. Mult Scler 2018; 24 (2): 227–230. doi: 10.1177/1352458517692420.

36. Coffee AL, Kuehl TJ, Willis S et al. Oral contraceptives and premenstrual symptoms: comparison of a 21/7 and extended regimen. Am J Obstet Gynecol 2006; 195 (5): 1311–1319. doi: 10.1016/j.ajog.2006.05.012.

37. Kubala Havrdová E. Klinický doporučený postupu pro diagnostiku a léčbu roztroušené sklerózy a neuromyelitis optica a onemocnění jejího širšího spektra. [online]. Dostupné z: https: //www.czech-neuro.cz/content/uploads/2023/12/standard_rs_a_nmosd_2023__ v13.pdf.

38. Bove R, Okai A, Houtchens M et al. Effects of menopause in women with multiple sclerosis: an evidence-based review. Front Neurol 2021; 12: 554375. doi: 10.3389/fneur.2021.554375.