Menopause can cause many uncomfortable symptoms. People with multiple sclerosis (MS) may wonder about the effects of menopause on their health and their MS treatment plans. MyMSTeam members frequently discuss menopause, and many have questions about what to expect.

“Are menopause symptoms just menopause symptoms, or are they kind of different because we have MS? Any comments?” one team member asked.

Another asked, “Does menopause affect MS? And when do you know menopause is over?”

What Is Menopause?

Menopause occurs naturally 12 months after a person has their last menstrual period, at which point it is no longer possible to become pregnant. Menopause also happens after the surgical removal of the ovaries and uterus (a hysterectomy).

The natural transition into menopause — also known as perimenopause — can last between seven and 14 years. During this time, a number of menopausal symptoms may occur, including irregular menstrual cycles, weight gain, painful sex, difficulty sleeping, and hot flashes. Cognitive changes can cause irritability, mood swings, brain fog, and depression.

Menopause frequently starts between the ages of 45 and 55. It’s caused by hormonal changes as the body produces less estrogen and progesterone. After menopause, these changes may continue to affect bone health, heart health, and bladder function.

It’s important to note that symptoms of menopause, like symptoms of MS, can vary considerably. Everyone’s experience is unique. While some may experience more severe menopause symptoms, others may have few or no symptoms.

How Are MS and Menopause Related?

Multiple sclerosis is a neurological disease in which the immune system attacks healthy nerve fibers and damages the central nervous system. Symptoms of MS include problems with mobility, vision issues, feelings of tingling and numbness, and cognitive difficulties. Some symptoms of menopause and MS are similar, which can make it challenging to discover the cause.

More than two-thirds of people who develop MS are women. Most are diagnosed with MS before they start perimenopause, so they will eventually experience both conditions at the same time.

Here are some of the ways menopause may affect someone with MS. If you have concerns or questions, be sure to discuss these points further with your neurologist and your gynecologist.

1. MS and Menopause Symptoms May Overlap

It may be hard to know if your symptoms are from MS or menopause. Both can cause issues with memory, concentration, and feeling mentally “foggy.” Menopausal neurological symptoms may be linked to changes in the brain that occur during the menopause transition. However, most menopause-related neurological symptoms, like brain fog or trouble focusing, resolve on their own after menopause.

Menopause and nerve pain are also connected, and this pain can feel like MS symptoms. Studies show as many as 71 percent of women in perimenopause report musculoskeletal pain that affects muscles, tendons, and nerves. This risk can continue into the postmenopausal years. The prevalence of body pain during the menopause transition has also been associated with sleep problems, depression, and mood swings.

“Achy, super emotional. Menopause and MS are hellish together,” said one MyMSTeam member.

If you’re between your mid-40s and early 50s, talk to your doctor about the overlapping symptoms that can occur with menopause and MS. These include:

• Hot flashes, night sweats, or suddenly feeling very warm
• Sleep disturbances and fatigue
• Cognitive impairment that affects memory or concentration
• Muscle or joint pain
• Discomfort during sex or less interest in sex
• Mood changes
• Bladder problems

2. MS Symptoms May Worsen During the Menopausal Transition

Although research is limited, some evidence shows MS symptoms may worsen during the menopausal transition. This may be temporary, as you navigate hot flashes or find yourself sleeping less. “Menopause is when all the symptoms I’d had for years came on full force. Heat, cold, walking — everything changed with menopause,” a MyMSTeam member wrote.

Another member said, “I have classic perimenopause symptoms and feel that my MS is playing up. No relapses but shaky, rubbery legs!”

Because the transition to menopause can last several years, it may be hard to distinguish between worsening symptoms of MS and symptoms of menopause.

Studies conflict about whether menopause permanently affects disability for people with MS. In one small study with 37 participants, MS relapse rates decreased after menopause, although disability progression stayed the same as before the menopause transition. Other studies have found no change in relapse rate after menopause.

3. Hot Flashes Can Intensify MS Symptoms

Hot flashes are a common menopause symptom. A hot flash is a sudden feeling of being very warm, particularly in the face, neck, and chest. People with MS are often sensitive to heat and may experience a temporary worsening of symptoms whenever they feel too warm. Hot flashes may cause MS symptoms to temporarily intensify, particularly bladder problems and fatigue.

“Menopause, oh yay! Because life isn’t challenging enough. #hotflashessuck,” a MyMSTeam member wrote. Another member responded, “I feel your pain. It’s like someone turned up the heat, and my MS always feels it!”

4. Both Menopause and MS Raise the Risk of Depression

People with MS have higher rates of anxiety and depression than the general population. As many as 50 percent of people with MS develop depression. During and after menopause, a decrease in estrogen may raise the risk of depression even more. If you’re having lasting feelings of anxiety or depression, talk to your doctor about a referral to a mental health specialist.

5. Monitoring Bone Health Is Important

Postmenopausal women have an increased risk of osteoporosis and bone fractures. The risk is also higher for people with MS and may be related to the use of steroids to treat MS inflammation. Talk to your doctors about monitoring your bone density and treatment options to protect bone health.

6. MS Won’t Change the Timing of Menopause

Having multiple sclerosis doesn’t affect the age you’ll start menopause. In addition, some research shows that disease-modifying therapies for MS don’t influence when menopause occurs.

However, one small study with 184 participants found that long-term use of methylprednisolone (sold as Solu-Medrol), a synthetic steroid, may be linked to starting menopause earlier. The researchers also found that treatment with interferons was associated with heavier menstrual bleeding. More studies are needed to determine whether MS treatments influence the menopause transition.

7. The Effects of Hormone Replacement Therapy on MS Are Unclear

Some women benefit from hormone replacement therapy (HRT), which is used to replace decreasing hormone levels during the transition to menopause. In one small 1992 study of 30 women with MS, 75 percent of the participants reported feeling better with the use of HRT.

Results of other studies also suggest that HRT might benefit women with MS by decreasing the relapses and new lesions on brain imaging. Ask your doctor about which hormonal and nonhormonal treatments for menopausal symptoms may be appropriate for you. HRT is not for everyone, and for those with a risk of cancer or cardiovascular disease, the potential harms may outweigh the benefits.

Discuss Menopause and MS With Your Health Care Providers

If you think you may be experiencing perimenopause, your doctor can do a blood or urine test to measure hormone levels and help determine if you are in the transition to menopause.

“I’ve had a menopause test done. Apparently, I’m not going through it yet,” a MyMSTeam member said.

Managing menopausal symptoms with MS can be challenging. Talk to your neurologist about your symptoms to be sure you’re treating your MS as well as possible and to learn about treatment options for menopausal symptoms. No matter the cause, it’s always important to discuss any worsening symptoms with your neurologist.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

What symptoms have you experienced with menopause and MS? Do you have any tips for others going through the same transition? Share your experiences in the comments below, or start a conversation by posting on your Activities page.