Multiple sclerosis (MS) is an autoimmune condition that interferes with the flow of information in the central nervous system. It causes a variety of symptoms and can affect females differently than males.

Researchers do not know what triggers MS. Once it develops, the condition causes the immune system to destroy a type of tissue called myelin, which insulates nerve fibers.

Without enough myelin, it is difficult for the nerves to transmit and receive signals properly.

MS randomly affects nerves in the brain, spinal cord, and eyes. It can cause a wide range of unpredictable physical, mental, and emotional symptoms that vary from person to person.

This article will discuss some of the most common symptoms of MS and explain why females might experience symptoms somewhat differently from males. It will also cover diagnosis and treatment.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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The symptoms of MS in females are similar to those in males, but they can include additional issues due to hormonal changes. MS can also affect sexual health and bladder function differently in females.

MS symptoms in females include the following:

1. Vision problems

For many people, a vision problem is the first noticeable symptom of MS.

Three vision problems that commonly occur are:

For around 1 in 5 people with MS, optic neuritis is the first symptom they experience.

Other symptoms that can affect the eyes of a person with MS include:

  • blurred vision
  • poor color vision or contrast vision
  • painful eye movements
  • blindness in one eye
  • a dark spot in the field of vision

People with MS develop vision problems either because their optic nerves become inflamed or because of nerve damage in the pathways that control visual coordination and eye movement.

Although vision problems due to MS can be scary, most resolve without treatment or are highly treatable.

2. Numbness

Numbness in the face, body, arms, or legs is another common symptom of MS. It is often one of the earliest symptoms of the condition.

The numbness can range from mild and barely noticeable to severe enough to interfere with everyday activities, such as holding objects and walking.

Most periods of numbness due to MS resolve without medication and do not become permanently disabling.

Around 80% of people with MS experience numbness or tingling in some part of their body.

3. Fatigue

About 80% of people with MS experience fatigue or unexplained exhaustion.

Sometimes, the cause of fatigue relates to another symptom of MS. For example, people with bladder dysfunction may get insufficient sleep because they have to wake to go to the bathroom throughout the night.

People with MS who have nocturnal muscle spasms may not sleep well either, leaving them feeling tired during the day. MS can also increase the risk of depression, which can cause fatigue.

Another type of fatigue that seems to be unique to MS is called lassitude. A person may be experiencing lassitude if their fatigue:

  • occurs daily
  • worsens as the day goes on
  • happens in the morning, even after a good night’s sleep
  • worsens with heat or humidity
  • interferes with daily activity
  • is unrelated to physical impairments or depression

4. Bladder problems

Bladder problems affect at least 80% of people with MS. These issues occur when scars on the nerves impair nerve signaling that is necessary for the function of the urinary sphincters and bladder.

MS can make it difficult for the bladder to hold urine and may reduce the amount that it can store, causing symptoms such as:

5. Bowel problems

Many people with MS experience bowel problems, such as:

Bowel problems can make other MS symptoms worse — especially bladder problems, muscle stiffness, and involuntary muscle spasms.

Some researchers believe that people with MS have problems controlling their bowels because of the neurological damage that the condition causes. People with MS may also have trouble controlling their bowels when they have constipation.

Around half of people with MS may have bowel problems at some time.

6. Pain

Some research suggests that 55% of people with MS experience clinically significant pain, while 48% live with chronic pain.

Females with MS may be more likely than males to experience pain as a symptom of this condition, according to a 2020 study. The study authors suggest a link between this and a higher risk of depression among females with MS compared with males.

Acute MS pain seems to be due to problems with the nerves that help transmit sensations in the central nervous system.

Some of the acute pain symptoms associated with MS include:

  • trigeminal neuralgia, which is a stabbing pain in the face that people may confuse with dental pain
  • Lhermitte’s sign, a short sensation resembling an electric shock that moves from the back of the head down the neck and spine, usually after bending forward
  • the “MS hug,” which describes a stabbing, squeezing, painful, or burning sensation around the torso or in the legs, feet, or arms

Some of the symptoms that people with chronic MS pain may report include:

  • burning
  • aching
  • pins and needles
  • prickling

Many people with MS also experience chronic pain as a secondary effect of the condition. For example, this could be due to:

7. Cognitive changes

More than 50% of people with MS experience changes in cognition, which means that they may sometimes have difficulty:

  • processing new information
  • learning and remembering new information
  • organizing information and problem solving
  • focusing and maintaining attention
  • perceiving the environment around them
  • understanding and using language
  • doing calculations

The cognitive symptoms of MS are typically mild to moderate and only affect a few aspects of cognition.

In rare cases, people with MS may experience disabling cognitive problems.

8. Depression

Clinical depression is one of the most common symptoms of MS. Depression is more common in people with MS than in people with other chronic health conditions. Up to half of all people with MS may have depression at some time.

Although almost everyone experiences periods of sadness or grief, clinical depression refers to depressive symptoms that last for a minimum of 2 weeks.

Symptoms of clinical depression include:

Clinical depression can also worsen other MS symptoms, including:

  • fatigue
  • pain
  • cognitive changes

9. Muscle weakness

Many people with MS also experience muscle weakness. This symptom is due to damage to the nerve fibers that help control muscles.

People with MS may also experience muscle weakness because a lack of use has caused their muscles to become deconditioned over time.

MS-related muscle weakness can affect any part of the body. It can be especially challenging for people with MS to walk and stay mobile when muscle weakness affects their legs, ankles, and feet.

According to an older study, around 80% of people with MS experience muscle weakness.

10. Muscle stiffness and spasms

MS can cause spasticity, which refers to muscle stiffness and involuntary muscle spasms in the extremities, especially the legs. It affects 40–80% of people with MS at some point.

Some of the symptoms of spasticity include:

  • tightness in or around the joints
  • painful, uncontrollable spasms in the arms and legs
  • lower back pain
  • hips and knees that bend and become difficult to straighten
  • hips and knees that stiffen while close together or crossed

11. Dizziness and vertigo

Some people with MS experience dizziness and the sensation of being lightheaded, woozy, weak, or faint. Less commonly, they may experience vertigo, which makes it feel as though they or their surroundings are spinning.

MS may cause vertigo by damaging the pathways that coordinate the spatial, visual, and sensory input that the brain needs to maintain balance in the body.

The symptoms of vertigo include:

Research suggests that around 49—59% of people with MS experience vertigo, dizziness, or balance problems.

12. Sexual problems

People with MS often experience sexual problems and may find it difficult to become aroused or have an orgasm. For example, MS may reduce natural vaginal lubrication, potentially making sexual intercourse painful for females.

The condition can also cause sexual problems by damaging nerves in the sexual response pathways that connect the brain and the sexual organs.

People with MS may also experience issues with sex as a result of other MS symptoms, such as:

  • muscle spasms and stiffness
  • mood or self-esteem changes
  • fatigue

According to the National Multiple Sclerosis Society (NMSS), sexual problems may affect up to 91% of males and 72% of females with MS. In one study, 61% of men and 63% of women said they experienced problems with sexual intercourse due to the condition.

13. Emotional changes

A wide range of emotional symptoms and changes commonly occur with MS, including:

  • mood shifts
  • periods of uncontrollable laughter or crying
  • irritability
  • grief
  • worry, fear, and anxiety
  • distress, anger, or frustration

The condition is unpredictable, often has fluctuating symptoms, and can become disabling, all of which can be frightening.

MS can also cause emotional changes by damaging the nerve fibers in the brain. Some of the medications people take to manage MS can also cause mood changes.

For example, corticosteroids can have many emotional side effects, including:

  • anxiety
  • irritability
  • agitation
  • tearfulness
  • restlessness
  • fear

Some changes may appear to be emotional but, in fact, stem from neurological changes in the brain.

According to the National MS Society, around 10% of people with MS experience pseudobulbar affect, which involves uncontrollable bouts of laughing or crying. It is a treatable neurological condition that is not related to depression. A small percentage of people experience euphoria, an extreme type of happiness not related to the person’s real-life situation.

Very rarely, a person may show inappropriate behavior, such as sexual disinhibition. This most likely stems from damage to parts of the brain related to inhibition.

14. Difficulty walking

People with MS can develop problems with gait or how they walk because of several factors. Some MS symptoms that may affect how a person walks include:

  • muscle stiffness and spasms
  • numbness or other sensory problems in the hips, legs, ankles, or feet
  • fatigue
  • muscle weakness
  • loss of balance

According to research, around 75% of people with MS experience mobility problems due to changes in their ability to walk.

15. Hormonal effects

There is some evidence to suggest that MS can affect females differently than males due to hormonal changes, including those that occur during the following times of life.

Menstruation

More research is necessary to draw firm conclusions, but the NMSS states that some studies have found that females with MS have worse symptoms within a week of starting their period.

Studies that used an MRI scan have also shown that MS disease activity may change according to the different hormonal levels during menstruation.

MS may also affect how regularly periods occur. A 2018 study looked at menstruation patterns in 181 people with MS and 202 people without the condition. After starting to experience MS, the chance of irregular menstruation rose from 21% to 40.3%. For comparison, reported irregular menstruatIon in those without MS was 24.7%. People with MS also reported more premenstrual symptoms than those without.

Pregnancy

During pregnancy, there may be a lower risk of MS symptom flare-ups, especially during the second and third trimesters.

Researchers believe that pregnancy may have a protective effect against MS by raising the levels of compounds that help reduce inflammation and the effects of the condition.

Higher levels of corticosteroids — another type of immunosuppressant — naturally circulate in the body during pregnancy.

Although pregnancy can temporarily reduce some MS symptoms, flare-ups tend to return in the first 3–6 months postpartum. However, there is no proven link between pregnancy and a higher risk of disability in the long term.

Although being pregnant can temporarily reduce the risk of flare-ups, pregnancy also puts a lot of physical stress on the body, which can make certain symptoms of MS worse.

In addition, some of the medications that people use for MS are not safe to take during pregnancy and can worsen symptoms.

Anyone with MS who is pregnant or planning to become pregnant should discuss their medications with a doctor.

MS symptoms that pregnancy can often exacerbate include:

  • fatigue
  • gait problems
  • bladder and bowel problems

Some research suggests that around 10% of women with MS may have difficulty conceiving. However, assisted reproductive techniques, such as in vitro fertilization, also known as IVF, can have a success rate of up to 39% in women under 35 years old.

Menopause

MS symptoms may worsen after menopause, possibly because declining estrogen levels adversely affect disease progression.

However, it is difficult to tell whether MS symptoms worsen because of menopause or just as a natural result of aging or the progression of the condition. Much more research is necessary to understand the relationship.

There is little evidence to show how menopause affects the course of MS and its symptoms. The United Kingdom’s MS Trust reviewed three studies, but they were small, and one was an older study from 1992. Overall, the three studies did not produce conclusive evidence.

The 1992 study involved 30 women with MS. Of these, 54% said their symptoms worsened around menopause, 8% said they improved, and 38% said they did not change. In 2016, a study involving 124 women concluded that disability rates might accelerate after menopause.

However, a 2018 study of 37 women concluded that disability rates did not increase after menopause. Instead, the women reported a drop in relapse rates in the 5 years after menopause.

The authors of one review, published in 2020, note that MS tends to change from relapsing-remitting MS before menopause to progressive during menopause. In relapsing-remitting MS, a person may experience flares when symptoms worsen and times of remission when they improve. In progressive MS, people spend less time in remission, and symptoms tend to worsen steadily.

Some early symptoms of MS include:

Although the symptoms above are the most common, MS affects everyone differently. Some less common symptoms of MS include:

According to the NMSS, at least twice or three times as many females than males receive a diagnosis of MS.

Overall, MS seems to affect males and females similarly. However, a doctor cannot predict which symptoms a person with MS will experience, the severity of the symptoms, or the condition’s progression.

This is because the condition attacks the myelin randomly, and the nerves that it affects can differ from person to person.

Although males and females with MS often experience similar symptoms, certain factors — such as menstruation, pregnancy, and menopause — may influence MS symptoms in females.

Why are females more at risk?

Females may be more at risk of MS because their bodies suppress the immune system while pregnant.

There may also be a link between Vitamin D deficiency and MS. Some researchers believe that there is a connection between MS and the differences in how male and female bodies process vitamin D. Experts say there is growing evidence that low vitamin D levels affect both the risk of developing MS and the levels of disease activity in people with the condition. However, more studies are necessary to confirm this.

Other researchers theorize that X chromosomes play a direct role in autoimmune function. X chromosome inactivation in females may result in them having more MS susceptibility genes. Again, more research into this is necessary.

MS is an autoimmune condition that randomly affects parts of the central nervous system, resulting in unpredictable physical, cognitive, and emotional symptoms.

Although MS tends to affect more females than males, it usually causes similar symptoms in people of different genders. However, females may experience variations in their symptoms due to hormonal changes, such as those that take place during menstruation, pregnancy, or menopause.

Vision problems and random localized numbness are often the first symptoms of the condition. Depression, bladder problems, cognitive changes, and pain are also among the most common symptoms of MS.

There is currently no cure for MS, but different drugs and complementary therapies can typically help manage the symptoms or even slow the progression of the condition.

Anyone who is experiencing concerning symptoms should contact a doctor for a diagnosis.

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