As if menopause wasn’t hard enough on women, new research out of UC San Francisco suggests it could threaten the mobility of those already struggling with multiple sclerosis (MS).
The UCSF researchers drafted the paper, appearing in Neurology, based on the longitudinal data from 184 postmenopausal women with MS. They unearthed several noteworthy shifts among critical biomarkers and functional outcomes after the onset of menopause. Subjects had a harder time walking, along with additional difficulty with fine motor skills and cognitive functions.
Breaking New Ground in Understanding MS
The journals are replete with research pondering the influence of hormonal changes on MS during puberty and pregnancy. But menopause has lingered as uncharted territory – until now. (It’s somewhat surprising since postmenopausal women account for a third of MS patients.)
“We know that hormonal changes during puberty can trigger autoimmune diseases like MS,” UCSF associate professor and corresponding author Riley Bove, MD, explained. “We see a lower rate of relapse during the third trimester of pregnancy, followed by a rebound postpartum.”
Menopause as an Inflection Point?
Researchers relied on the Multiple Sclerosis Functional Composite (MSFC) to gauge functional outcomes and serum neurofilament light chain (sNfL) levels. The data covered a median follow-up window of 13 years, which offered a clear look into the disease trajectories both before and after menopause.
The team found a link between menopause and accelerated neurodegeneration and functional decline in MS. In one example, the researchers found that, after menopause, it took participants longer to complete a 25-foot-walk (after accounting for age, weight and tobacco use).
The data also showed a notable uptick in sNfL levels, which suggests heightened neuronal injury post-menopause. Those changes often synced up with the final menstrual period (FMP).
Finally, the study’s authors noticed that functional performance, measured by the MSFC, also dropped off quickly after menopause.
The findings highlighted the potential role of menopause in secondary progression, which is typically characterized by neural repair deficits rather than inflammation. Unlike T2 lesion volumes, which remained static, sNfL levels – along with functional outcomes – showed clear inflection points. This, the authors contend, suggests that menopause primarily influences neurodegeneration rather than inflammatory processes.
“The study shows that menopause represents a unique factor in MS progression, even when we take into consideration the effects of aging,” Bove added. “But we would need large, randomized trials that compare hormone treatment to a placebo before we can know the true effects of hormone therapy in a condition as complex as MS.”
Mechanisms and Implications
The root cause of these changes could involve hormonal fluctuations, the researchers contend. This could be traced back to the drop in estrogen after menopause, which removes a critical safeguard against neuronal injury. And while early trials have illustrated the anti-inflammatory benefits of exogenous estrogen, the research isn’t there yet to back up its role in mitigating MS progression.
The study’s authors argue for the development of more targeted management strategies around menopause, including hormone therapy. That being said, hormone therapy use among the study participants was limited. So it’s difficult to draw meaningful conclusions about its impact.
Nevertheless, the results highlight the importance of studying hormonal transitions in neurological diseases. Understanding the nuanced effects of menopause on MS could help steer clinical care, ranging from disease management to rehabilitation strategies.
This paper doesn’t just advance our knowledge about menopause’s impact on MS. It underscores the need for a more comprehensive approach to understanding and treating neurological diseases in women. As future research unravels the relationship between hormones and the central nervous system, menopause appears to be a crucial factor in shaping the trajectory of MS.
Further Reading
Assessment of Neurologic Signs and Symptoms: Establishing a Diagnosis of Multiple Sclerosis
