How does multiple sclerosis affect women?
Women can experience many of the same symptoms as men, but they can also experience some specific issues due to the impact of female sex hormones.
A diagnosis of MS is most likely to occur between the ages of 20–40 years. The condition can have an impact on menstruation, contraception, pregnancy, and menopause, due to the influence of hormonal changes.
This article looks at how MS affects women.
MS can affect women slightly differently to men.
The temperature of the female body rises before and during a period, and this can affect the symptoms of MS.
A survey carried out in one clinic found that 70% of women experienced more severe symptoms at around the same time each month, a week after the start of menses. This suggests that hormonal changes may play a role.
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 to use hormone-based contraceptives to reduce or stop their periods.
Females with MS can usually choose to use any of the various available methods of contraception.
However, it is essential for people to take into account the type of MS medication they are using, and its interaction, if any, with their chosen contraceptive.
A woman should speak to her doctor about the options.
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 result from 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 female to reach orgasm. Extra stimulation, such as using a vibrator, can help.
A woman with MS can have a healthy pregnancy.
A woman who receives a diagnosis of MS may be thinking about starting a family. In the past, experts believed that pregnancy could have a negative effect on MS.
However, it now appears that a woman with MS is equally likely to have a healthy pregnancy as someone without MS.
Research from 2013 suggested that the MS relapse rate is lower during pregnancy, possibly due to hormonal activity. This gave rise to concerns that a relapse could occur soon after delivery.
However, a preliminary 2019 study concluded that the relapse rate is not likely to be higher soon after delivery than before pregnancy. Overall, the chance of relapse appears to reach prepregnancy levels 6 months after delivery.
In the study, those who breastfed their infants had a 40% lower chance of relapse than those who did not. The study authors based their results on data for 375 women who experienced 466 pregnancies between 2008 and 2016.
In addition, pregnancy does not appear to affect the long-term progression of MS.
There is no evidence that MS affects fertility, but having MS may involve extra planning.
Some MS medications are unsafe during pregnancy, and a doctor may advise stopping treatment and waiting until after delivery to start again. The doctor will advise on how to halt a medication, as it may not be safe to stop some drugs suddenly.
Doctors will look at the risks to the mother and the baby when advising on whether or not to continue taking medication.
Pregnancy and MS symptoms
Some symptoms can worsen during pregnancy.
- problems with balance
- back pain
- bladder and bowel problems
Issues, such as balance, can worsen in late pregnancy, as the body's center of gravity shifts. An assistive device, such as a walking cane, might help.
As with pregnancy, hormone levels also change during menopause. During menopause, some MS symptoms, including fatigue and bladder problems, can become more severe.
Hormone therapy may help delay this impact in females with MS by increasing estrogen levels in the body. Hormone therapies are available in tablet form, patches, gels, or implants.
Adjusting a work schedule can help during a relapse.
If a female receives a diagnosis of MS between the ages of 20–40 years, she may face additional challenges around childcare, employment, and caring for dependent parents.
In a 2015 survey of 1,248 working women in the United States, 60% of participants said they tried to hide their symptoms at work.
However, 61% said they were comfortable discussing their condition with colleagues, and 59% said they could talk to their boss about their MS. Also, 40% said they had been able to adjust their schedule to help them cope.
An MS support group can be a good place to seek encouragement, meet people in a similar situation, and get practical advice on issues such as health insurance, help with childcare, and managing working conditions.
Click here to download MS buddy, a free app where you can find information and online community support.
About multiple sclerosis
In MS, the immune system attacks the myelin coating that protects nerve fibers. As this process starts to damage the nerves, symptoms can appear throughout the body.
Learn more here about MS.
The signs and symptoms of MS vary, depending on the level of damage and the nerves involved.
Symptoms can include:
- vision problems, such as double vision and partial or complete vision loss
- weakness or numbness in one or more limbs
- tingling or pain
- poor coordination or loss of balance
- slurred speech
- bladder and bowel problems
Causes and risk factors
It is unclear why MS affects some people and not others. One theory is that some people have genetic factors that increase their risk of MS in certain circumstances.
Some of the risk factors that appear to increase the risk include:
- being female
- being aged 20–40 years old
- having a parent or sibling with MS
- experiencing a virus, such as the Epstein-Barr virus, which causes infectious mononucleosis
- having another autoimmune condition, such as rheumatoid arthritis or lupus
- having low vitamin D levels
- living in northern Europe, away from the equator
There is no cure for MS, but there are treatment options.
- Disease-modifying therapies (DMT) can slow the progression of MS and reduce the number of flares.
- Corticosteroid injections can treat flares and severe symptoms of inflammation.
- Specific medications can relieve some symptoms, such as depression, muscle spasms, and tremor.
- Physical therapy can boost an individual's strength.
Current guidelines recommend starting a DMT as soon as possible after diagnosis, as this may improve the outlook for MS. A doctor will discuss the options with the individual, as each person's experience of MS is different.
If, in time, researchers can confirm that hormonal factors play a role and that the benefits outweigh the risks, hormone therapy (HT) might prove to be an option for women with MS.
Natural and alternative remedies
Options that may help include:
- yoga, tai chi, and mindfulness
- warm or cold compresses for pain
- reflexology to reduce burning or tingling sensations
- acupuncture for pain with a qualified practitioner
- some cannabinoids from the marijuana plant
According to the National Center for Complementary and Integrative Therapy, there is no evidence that bee-sting therapy or dietary supplements help.
However, following a healthful diet and getting as much exercise as possible can boost overall health and may help reduce stress that, in turn, may reduce the risk of a flare.
I am a working, single mother, and I have just had a diagnosis of MS. I am really worried about how I will work and take care of my children. Can you give me any advice?
It can be a challenge to balance work, family, and the demands of MS.
The best advice is to seek ways that work for you, as an individual, to cope with your symptoms. For example, fatigue is a common symptom of MS so plan rest periods. This includes not overscheduling activities.
Build a network or team of family and friends to help out when you need it. There is no shame in asking someone else to do car-pool duty.
And, finally, find ways that help you manage stress such as yoga or meditation.Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.