Symptoms of multiple sclerosis in women in relation to cyclical hormone changes

Abstract

Objectives To prospectively investigate if women with multiple sclerosis (MS) experience changes in MS-symptoms in relation to cyclical hormonal changes.

Methods Sixty-three women with MS, either with regular, spontaneous menstrual cycles or taking combined oral contraceptives (COCs), were asked to score their MS symptoms every day during three cycles. Symptom scores were analysed in relation to different phases of the spontaneous menstrual- or pill-driven cycle.

Results Twenty-three women completed the score record. Among the 16 women who were not using a COC there were no significant differences in symptom scores between the phases of the menstrual cycle. The seven women taking a COC reported significantly higher symptom score points for weakness, numbness and tiredness during the pill-free interval compared with the phase during which they took the COC daily.

Conclusions This prospective study appears to contradict earlier retrospective studies regarding variations in MS symptoms in relation to the menstrual cycle in women who are not using a COC. The lower symptom scores during the three weeks of pill taking suggest a positive effect of the steroids on the manifestations of MS. Further studies concerning both short- and long-term effects of OC-use on MS symptoms are needed.

KEYWORDS:

• Multiple sclerosis
• Oestrogen
• Menstrual cycle
• Oral contraceptive

Acknowledgements

The authors are indebted to Gunn Johansson, Department of Neurology, University Hospital of Linköping, and Malena Söderström, Department of Medical Rehabilitation, County Hospital of Sundsvall, for technical assistance; to Erling Englund, Centre of Research and Development, County Hospital of Sundsvall, for statistical advice, and to the County Councils of Östergötland and Västernorrland, for financial support.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.