MS and menopause

Menopause is the natural end to a woman’s periods (menstruation). It usually occurs between the ages of 45 and 55 years.

Why discuss MS and menopause?

The majority of people with MS are women. About 3 in every 10 women with MS is going through menopause currently or has finished menopause.

Menopause can bring a range of symptoms and body changes. Some of these overlap with the effects of MS, and some women find that menopause temporarily worsens some MS symptoms. Many symptoms of menopause are treatable. It’s therefore useful to know what happens to our bodies during menopause and how these changes can be managed.

Menopause is not always spoken about openly. This has left some women unsure what to expect and what help and treatments are available for menopausal symptoms. We hope this guide provides some clarity.

What happens during menopause?

Most women go through menopause in their late 40s or early 50s, although a small proportion have an earlier menopause. MS does not appear to alter the age of menopause.

During menopause, the levels of the reproductive hormones oestrogen and progesterone gradually fall. A woman’s menstrual periods eventually stop. After menopause, levels of natural oestrogen and progesterone remain low.

Women can have symptoms in the years when their hormone levels are falling (the perimenopause) and afterwards (post menopause). Some women find that menopausal symptoms have a big impact on their life, while others do not.

The more common changes that occur during menopause are:

• Less regular periods
• Hot flashes, chills and night sweats
• A dry vagina (which can be uncomfortable and affect your sex life)
• Sleep problems
• Mood changes
• Memory problems
• Weight gain
• Thinner hair, drier skin
• Loss of breast fullness

How does menopause affect women long term?

After menopause, women commonly find that symptoms such as hot flashes, mood changes and memory problems end. However, some effects remain, such as changes to body shape, hair and skin.

Post-menopausal symptoms

• Changes to sex drive
• Thinner hair, drier skin, and loss of breast fullness
• Weight gain
• Sleep problems
• Depression

Due to lower levels of oestrogen and progesterone, post-menopausal women are at higher risk of some health conditions as they get older.

Increased post-menopausal health risks

• Cardiovascular disease
• Weaker, more brittle bones (Osteoporosis)
• Reduced bladder control
• Bladder infections

Are your symptoms due to menopause or MS?

Some of the effects of menopause overlap with the symptoms of MS. For example, either can cause:

• difficulty sleeping
• mood changes, such as feeling low, anxious or irritable
• bladder problems
• memory problems, such as being forgetful or struggling to find the right word
• changes to sex life.

If you have troublesome symptoms, speak to your family doctor, neurologist or gynaecologist (a specialist in the female reproductive system). Together you can work out the likely cause of your symptoms (whether it is menopause, MS or something else). This can make a difference to which treatments are most suitable for you.

What can help menopausal symptoms?

Although menopause is a natural process, you don’t need to suffer its effects without help. Many of symptoms and risks can be reduced with treatments and self-help.

Treatments include:

• hormone replacement therapy (HRT)
• vaginal oestrogen creams, tablets (pessaries) and rings
• medicines to reduce hot flashes
• medicines to improve bone health
• medicines for short-term use to improve sleep.

These treatments have been tested in large groups of women but not specifically in women with MS.

HRT increases the levels of reproductive hormones in your body. It’s usually very effective at reducing menopausal symptoms but has some risks. For women with troublesome symptoms who are younger than 60 years old, the benefits usually outweigh the risks.

Vaginal oestrogen creams, tablets (pessaries) and rings can help with vaginal and bladder symptoms.

Self-help techniques for menopause include:

• regular pelvic exercises to strengthen bladder control
• bedtime routines and techniques to improve sleep
• relaxation techniques to reduce stress and anxiety
• avoiding caffeine and alcohol to lessen hot flashes.

Your doctor or gynaecologist can talk you through the options that could be useful for your symptoms.

Can menopause worsen MS symptoms?

Although there have been a few studies on this, the results don’t give a clear answer.

For most women, menopause doesn’t seem to affect MS greatly. For some women, hot flashes might temporarily worsen some MS symptoms.

In surveys, some women say their MS symptoms and level of disability got worse after menopause. However, MS tends to worsen as we get older. With age, both men and women with relapsing remitting MS have fewer periods of time where their symptoms come and go. As people get older their level of disability due to MS is also likely to increase.

It’s not clear whether any increase in MS symptoms women experience after menopause is due to getting older or hormone changes too.

For more information on living well with MS as you get older, see the MS Resource Hub. 

How do menopause and MS affect bone health?

Women who have been through menopause are at risk of osteoporosis. This makes bones less dense, more fragile and more likely to fracture if you fall or have an accident.

MS can also increase the chance of osteoporosis. It’s estimated that almost 2 in every 10 women with MS have osteoporosis. About 4 in every 10 show a smaller amount of bone weakness (called osteopenia).

Osteoporosis is a condition where bones are less dense, more fragile, and more likely to fracture if you fall or have an accident

Osteopenia is condition in which the bones are less dense than healthy bones, but it is not as bad as osteoporosis. Women with osteopenia might need treatment to reduce their risk of osteoporosis.

Our bones are made of living tissue. At a microscopic level, they’re being replenished and restructured all the time. Menopause increases the risk of osteoporosis because lower levels of oestrogen affect the balance between the amount of new bone being made and the amount of old bone being broken down.

MS can increase the risk of osteoporosis due to:

• The effects of some medicines, such as certain steroids and antidepressants
• Reduced mobility and weight bearing (meaning the bones are ‘trained’ less)

In some countries, women can have screening tests to check their bone health. These are called bone density tests. In the US for example, women can have this screening test when 65 years old or older.

You can help to keep your bones stronger through particular types of exercise, a healthy diet and bone-strengthening medications. Ask your doctor for advice.

Tips on managing menopausal symptoms

• If you have menopausal symptoms, talk to your doctor or gynaecologist. Treatments are available to ease many symptoms. Your doctor or nurse can also recommend self-help techniques and guides.
• Talk to others. Chatting to other women your age about menopause can be valuable. You can help each other by listening, understanding and sharing tips on what has helped you. Support groups can be useful for getting advice on intimate issues that you may find it harder to discuss with others.
• Keep a diary of your symptoms. This will help your doctor, neurologist or gynaecologist to understand how menopause is affecting you and to distinguish the signs from those of MS, getting older or other health conditions.
• Take up invitations for screening tests for osteoporosis. If your screening test shows you have weak bones, this can be treated to reduce your risk of fractures.
• Be regularly physically active, including weight-bearing exercises. This can strengthen your bones, balance your mood, help with MS symptoms, and improve your general health and wellbeing.
• See your doctor if mood changes develop into signs of depression, anxiety or other mental health problems. These can be treated through talking therapies, medications or a mixture of both.