Multiple sclerosis (MS) is three times more common in women than in men. Although most of the symptoms overlap, women may experience worsening in their symptoms during menstruation, menopause, and the postpartum period. These times are thought to exacerbate MS symptoms due to changes in hormone levels, particularly estrogen.

Common Symptoms of MS

Although men and women share some symptoms of MS, hormones play a large part in disease progression. Men tend to have more neurodegeneration and worse cognitive symptoms than women, but women tend to have more inflammatory lesions compared to men. These factors may affect the symptoms a person with MS experiences.

Vision Problems

Vision problems and the associated symptoms are caused by MS lesions that form in the part of the brain that is responsible for coordinating and controlling vision. Common symptoms affecting the eye include:

• Pain when moving your eyes
• Partial or complete vision loss, which often occurs in one eye
• Blurred vision
• Double vision for an extended period of time
• Development of a condition known as optic neuritis (swelling and inflammation of the optic nerve)
• Dizziness

Muscle Symptoms

In MS, the body’s immune system attacks cells in the central nervous system (CNS), which causes neurological damage. The main target is myelin, which covers nerve cells in the brain, spinal cord, and optic nerves. The immune attack causes severe nerve damage and leads to neurological symptoms, including:

• Numbness or tingling
• Muscle spasms (spasticity)
• Lhermitte sign, or electric-shock sensations that cause the neck to bend forward
• Lack of coordination and balance problems
• Trouble walking or unsteady gait
• Difficulty moving arms and legs
• Muscle weakness
• Tremors

Cognitive Changes

MS is a neurological disease and has a large impact on brain function. Around 50 percent of people with MS have cognitive changes associated with MS. Symptoms include:

• Memory loss and brain fog
• Problems with multitasking
• Decreased attention span
• Difficulties with problem solving or reasoning

Urinary and Bowel Problems

Urinary and bowel dysfunction are common in people with MS due to the neurological damage of nerves controlling these functions. Symptoms include:

• Constipation
• Urinary incontinence (loss of bladder control)
• Frequent urges to urinate
• Problems with starting to urinate
• Bladder infections
• Stool or urine leakage

Other MS Symptoms in Women

Women may experience certain MS symptoms due to changes in hormone levels. Many women report that their symptoms fluctuate during times of hormonal changes, such as during their menstrual cycle and menopause.

Menstrual Problems

It is common for MS symptoms to worsen for women around the time of their period, potentially due to the drop in estrogen levels in the body. One study of women with MS and healthy controls found that almost 40 percent of women with MS reported changes in their menstrual cycle. Women with MS also reported an increase in irregular menstrual cycles (from 21 percent to 40.3 percent). Additionally, the MS group reported experiencing more MS symptoms before, during, and after their periods.

Other research suggests that women with relapsing-remitting MS (RRMS) who take oral contraception (birth control) may not experience an effect on MS symptoms when they start their period. In other words, oral contraceptives may have a protective effect.

Menopause

Like the menstrual cycle, menopause is another time of changes in hormonal levels in a woman’s life. Every woman begins menopause at a different time, but the age of onset is typically not affected by MS. However, one study found that women who treated their MS with corticosteroid drugs or interferon beta-1b began menopause slightly earlier than those who did not.

Menopause and MS overlap in some of their symptoms. If you are unsure if your MS symptoms are worsening or if you’re starting menopause, your doctor can run blood tests to check your estrogen levels. Symptoms of both conditions include:

• Fatigue
• Troubles with sleeping
• Mood swings
• Vaginal dryness
• Disinterest in sex or trouble with arousal
• Depression
• Bladder problems

The effects of menopause on MS symptoms seem to vary by study. One small study of postmenopausal women with MS found that the women had fewer relapses after menopause. Despite this change, their disease continued to progress. However, another study found that up to 50 percent of postmenopausal women experienced worse symptoms.

Estrogen therapy is a treatment used to help alleviate menopause symptoms. It also appears to have beneficial effects in postmenopausal women with MS. A study of 95 postmenopausal women with MS found that women who used hormone therapy had a better quality of life and better physical functioning compared to women who did not use the therapy.

Pregnancy and Postpartum

MS onset typically begins in women between the ages of 20 to 40 years. These are considered childbearing years, and it is important to understand the effects of pregnancy and the postpartum (after birth) time on MS.

Pregnancy has been found to affect disease course in women with MS. During the third trimester, there can be up to a 70 percent decrease in relapse rates. Researchers think this may be due to changes in the woman’s immune system that occur during pregnancy to protect the fetus. Hormonal changes may also play a role, with estrogen and progesterone levels increasing during pregnancy. There is also evidence that women with multiple pregnancies have less long-term MS-related disability.

On the other hand, MS relapses have been reported to occur more frequently postpartum. This can happen up to one year after giving birth, then rates of relapse typically return to prepregnancy levels. If a woman experiences active relapsing MS before her pregnancy, it is likely she will also have postpartum relapse.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. More than 164,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you a woman living with MS? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.