Multiple sclerosis (MS) is an immune-mediated, inflammatory condition that interferes with the flow of information in the central nervous system (CNS). 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 affects nerves in the brain, spinal cord, and eyes. It can cause unpredictable physical, mental, and emotional symptoms that vary from person to person.
Read on to learn about the most common symptoms of MS, diagnosis, treatment, and why females might experience symptoms somewhat differently from males.
A note about sex and gender
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.
According to a National Multiple Sclerosis Society (NMSS) study, nearly three times as many females as males receive an MS diagnosis.
Overall, MS seems to affect males and females similarly. However, there are no tests that can 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 without a specific pattern, and the nerves it affects can differ from person to person.
Although males and females with MS often experience similar symptoms, certain factors — such as inherent hormonal differences between males and females, and fluctuations during menstruation, pregnancy, and menopause — may influence MS symptoms in females.
Why are females more at risk?
Some researchers theorize that X chromosomes play a direct role in autoimmune function. A higher expression of genes on the X chromosome in females may result in them having more MS susceptibility genes. However, more research into this is necessary.
Researchers have also found that sex hormones can affect the immune system and the development of immune system-related conditions.
Males and females have different levels of sex hormones, such as estrogen, progesterone, prolactin, and testosterone. In females, these hormones also fluctuate throughout their lives and menstrual cycles.
Testosterone
Research has found that lower testosterone levels
According to the study, testosterone may be a natural anti-inflammatory hormone. High levels of testosterone may protect against immune-mediated diseases.
Another way that lack of testosterone may affect MS in females is during puberty. During this time, males experience a surge of testosterone, which may protect against immune-related conditions such as MS.
Females also experience a rise in testosterone during puberty, though not to the same degree.
Estrogen, progesterone, prolactin
Estrogen and progesterone levels rise in pregnancy and can change how the immune system responds. This can have a protective effect on the course of the disease in the short term.
Studies have found a
In addition,
Other factors
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.
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:
Hormonal effects
The difference in hormones means that MS can affect females differently than males.
Menstruation
More research is necessary to draw firm conclusions, but research has found that females with MS can experience worse symptoms during their menstrual period.
MS may also affect how regularly periods occur. One 2018 study examined menstruation patterns in 181 people with MS and 202 without the condition.
After starting to experience MS, the chance of irregular menstruation rose from
Pregnancy
Although pregnancy can temporarily reduce some MS symptoms, flare-ups tend to return in the first 3 months postpartum. However, this is not conclusive.
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Despite the influence of hormones, 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
Menopause
Little evidence shows 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
However, the
The authors of another
With RRMS, 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.
Vision problems
For many people, a vision problem is the first noticeable symptom of MS.
Three vision problems that commonly occur include:
- optic neuritis, which can cause blind spots and eye pain
- double vision, which happens when the eyes do not align correctly
- nystagmus, which causes the eyes to make involuntary movements
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 because of inflammation of their optic nerves, nerve damage in the pathways that control visual coordination and eye movement, or lesions in parts of the brain that control vision or eye movements.
Although vision problems due to MS can be scary, most resolve without treatment or are highly treatable.
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
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 often to go to the bathroom.
People with MS who have nocturnal muscle spasms may not sleep well, leaving them 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 experience 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
Bladder problems
Bladder problems affect at least 80% of people with MS. These issues occur when scars on the nerves impair nerve signaling 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:
- more frequent or urgent urination
- hesitancy starting urination
- frequent overnight urination
- an inability to empty the bladder
- an inability to hold urine or urine leaks
- inability to empty the bladder (urine retention)
Bowel problems
Many people with MS experience bowel problems, such as:
Bowel problems can worsen other MS symptoms, 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 those with MS may have bowel problems at some time.
Pain
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
Acute MS pain seems to be due to problems with the nerves that help transmit sensations in the CNS.
Some of the acute pain symptoms associated with MS include:
- trigeminal neuralgia: 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
- MS hug: a stabbing, squeezing, painful, or burning sensation around the torso or in the legs, feet, or arms
Some of the symptoms 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 the following:
- compensating for gait changes
- muscle stiffness, cramps, and spasms
- incorrect use of mobility aids
- muscle changes from mobility loss
Cognitive changes
More than 50% of people with MS experience changes in cognition, which means 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.
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:
- a loss of interest in everyday activities
- an increase in appetite or appetite loss
- sadness
- irritability
- insomnia or excessive sleep
- feelings of guilt and worthlessness
- difficulty thinking or concentrating
- behavioral changes
- thoughts of death or suicide
Clinical depression can also worsen other MS symptoms, including:
- fatigue
- pain
- cognitive changes
Muscle weakness
Many people with MS experience muscle weakness. This symptom can result from several reasons, including damage to the nerve fibers that help control muscles.
People with MS may also experience muscle weakness because a lack of use has caused the 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.
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
Dizziness and vertigo
Some people with MS experience dizziness and the sensation of being lightheaded, dizzy, weak, or faint. Less commonly, they may experience vertigo, making it feel like they or their surroundings are spinning.
MS may cause vertigo by damaging the pathways that coordinate the spatial, visual, and sensory input the brain needs to maintain balance in the body.
The symptoms of vertigo include:
- balance problems
- motion sickness
- nausea and vomiting
- lightheadedness
- a spinning sensation
Research suggests that
Sexual problems
People with MS often experience sexual problems and may find it difficult to become aroused or 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 sex 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 NMSS, sexual problems may affect up to 91% of males and 72% of females with MS. In one study,
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 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 emotional but stem from neurological changes in the brain.
According to the NMSS, 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.
Difficulty walking
People with MS can develop problems with their 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
Due to the differing nature of MS, a person may experience various symptoms that affect many different areas of their body. The severity, location, and areas affected can vary between people.
The following infographic shows some of the areas that MS can affect.
Early symptoms
Some early symptoms of MS include:
- a temporary loss of vision
- color blindness
- eye pain that worsens with eye movement
- flashes of light with eye movement
- numbness or tingling in different parts of the body
Rarer symptoms
Although the symptoms above are the most common, MS affects everyone differently. Some less common symptoms of MS include:
- speech problems
- seizures
- hearing loss
- swallowing problems
- tremors
- breathing problems
- itching
- headaches
This section answers frequently asked questions about MS.
Does MS show up in blood work?
No single blood test can check for MS. However, a doctor may order one or more blood tests to help rule out other conditions. Several other conditions have symptoms similar to MS and may appear on different blood tests.
What are usually the first signs of MS?
Although they vary between people, some common first signs include loss of vision in one eye, a rising sense of numbness in the legs, and loss of power in the arms or legs.
What triggers MS?
The exact trigger of MS is still unclear. It occurs when the immune system attacks the spinal cord and brain. A combination of genetic and environmental factors likely trigger the initial attack. One study from
At what age does MS usually begin?
Most cases of MS begin when the person is between 20 and 50 years. However, it can begin earlier or later in life.
What are the three most common symptoms of multiple sclerosis?
MS can cause a wide range of symptoms. The condition can affect people in different ways. Examples of some common symptoms include fatigue, muscle problems, and vision changes.
Learn more about MS research and resources at our dedicated hub.
MS is an immune-mediated, inflammatory condition that intermittently affects parts of the CNS in a patchy distribution, 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 inherent hormone differences and hormone changes, such as those that take place during menstruation, pregnancy, or menopause.
Vision problems and patchy localized numbness are often the first symptoms of the condition. Depression, bladder problems, cognitive changes, and pain are among the most common symptoms of MS.
There is currently no cure for MS, but different drugs and complementary therapies can usually help manage the symptoms or even slow the condition’s progression.
Anyone who is experiencing concerning symptoms should contact a doctor for a diagnosis.