Multiple sclerosis is an autoimmune neurological condition that affects the central nervous system and which is potentially disabling.
The immune system attacks the myelin coating that protects nerve fibers. This disturbs communication between the brain and the rest of the body, and this eventually damages the nerves.
MS and women
MS is most frequently diagnosed in women between the ages of 20 and 40. While women can experience many of the same symptoms that men do, the condition can also have specific effects on menstruation, contraception, pregnancy, and menopause.
Although MS does not affect fertility, a healthcare professional should always be consulted when choosing contraception methods.
A woman's body temperature rises before and during a period, and this can affect the symptoms of MS. Women with MS tend to feel worse during this time, and symptoms such as fatigue, depression, balance, and weakness can be more problematic.
Some MS medications, such as antidepressants and beta interferons, can also affect the menstrual cycle. They may cause "spotting" or irregular periods, although these side effects often improve with time.
Some women opt for reducing or stopping their periods through the use of hormone-based contraceptives.
Fertility is not affected by MS. Women with MS can generally choose to use any of the various available methods of contraception.
When choosing a contraceptive, it is important to take into account the type of MS medication being used and its interaction, if any, with the contraceptive of choice.
Many women with MS experience difficulties relating to arousal, response, and orgasm during sex. There is no available treatment for this, but there are things that can help.
- Lubrication: Vaginal dryness can be caused by MS, or it can be a side effect of some medications. Using a vaginal lubricant can help relieve this.
- Reaching orgasm: MS can make it difficult for a woman to reach orgasm. Extra stimulation such as using a vibrator can help.
Pregnancy and multiple sclerosis
Most women who have MS are diagnosed at a time when they may be thinking about starting a family. It was previously believed that pregnancy could have a negative effect on MS, but now there is evidence that the relapse rate is reduced during pregnancy. The reasons for this are thought to be hormone-related.
It is possible that relapses may increase after birth, when hormones go back to their previous levels. However, research suggests that pregnancy has no effect on the long-term progression of MS.
A woman with MS is equally as likely to have a healthy pregnancy as a woman without MS.
With careful planning, it is perfectly possible for a woman with MS to have a baby.
Because some MS medications are unsafe during pregnancy, it is usually advised to stop treatment and wait 3 months before trying to get pregnant. This needs to be done in strict consultation with a specialist as it can be harmful to suddenly stop taking some medications.
Doctors will look at the risks posed to the mother and the baby when advising on whether or not to continue taking medication.
Pregnancy and MS symptoms
These MS symptoms can be aggravated during pregnancy:
- Back pain
- Bladder and bowel problems
Fatigue may be slightly worse for women with MS during menopause.
Menopause and MS
During menopause, some MS symptoms, including fatigue and bladder problems, can be made worse. As with pregnancy, hormone levels also change during menopause.
A recent study looking at the impact of menopause on MS, found that, after menopause, when the body stops producing estrogen, the level of disability increases at a faster rate. HRT may help delay this in women with MS as a result, by increasing estrogen levels in the body.
Hormone replacement therapies can be used by women with MS in tablet form, patches, gels, or implants.
General signs and symptoms
The signs and symptoms of MS are varied, depending on the level of damage and the nerves that are affected.
They can include:
- Problems with vision, such as prolonged double vision, partial, or complete loss of vision
- Weakness or numbness in one or more limbs
- Tingling or pain
- Poor coordination or loss of balance
- Slurred speech
- Bladder and bowel dysfunction
Causes and risk factors
It is not known why MS develops in some people and not in others. It appears to be due to a mixture of genetics and environmental factors.
Some of the risk factors that can increase the chances of someone developing MS are:
- Gender: Women are about twice as likely as men are to develop MS
- Age: MS usually affects people between the ages of 15 and 60 and more specifically in women, between the ages of 20 and 30
- Family history: A parent or a sibling with MS increases the risk of that person developing MS too
- Viruses such as the Epstein-Barr, the virus that causes infectious mononucleosis, also known as "the kissing disease"
- Certain autoimmune conditions such inflammatory bowel disease, thyroid disease, or type 1 diabetes
- Low vitamin D levels
- Smoking: Someone who smokes and experiences initial symptoms of MS is more likely to experience this a second time, thus confirming MS
- Race and climate: White people, mainly those of Northern European descent, are more likely to develop MS
The condition is most common in countries such as Canada, the Northern United States, New Zealand, South-Eastern Australia, and Europe.
Alongside other tests, blood tests may be used to diagnose MS by ruling out other conditions.
Although there are no MS-specific tests, a diagnosis is often made by ruling out other conditions with similar signs and symptoms.
A thorough neurological exam and medical history are required to diagnose MS. The following tests are also used to help do this:
- Blood tests, to help rule out other diseases with similar symptoms
- MRI scan, to identify any possible lesions on the brain and spinal cord
- Lumbar puncture, to test the fluid in the spinal canal for antibodies or other infections
- Tests that record the electrical signals produced by the nervous system in response to stimuli
Treatments for MS
While there is no cure for MS, there are treatments that can help with symptom management and help those affected to recover faster from attacks. Some people with very mild symptoms do not require any form of treatment.
- Treatments to modify the progression of relapsing-remitting MS (this is not possible to do with primary-progressive MS)
- Corticosteroids to reduce nerve inflammation
- Medications to reduce fatigue
- Stretching and strengthening exercises
- Muscle relaxants to relieve muscle stiffness or spasms, especially in the legs
- Medications for problems associated with MS, such as depression, sexual dysfunction, and bowel or bladder control
When using disease-modifying therapies, it is important for people to choose the right one. Doing so will depend on many factors, such as how long the disease has been present, whether other MS treatments have been effective, and whether having children is a consideration.
There is some evidence to suggest that a number of these therapies may help to relieve some of the symptoms of MS:
- T'ai chi
- Magnetic field therapy
- Neural therapy
- Oral cannabis extract for muscle spasticity and pain