A new study by researchers at UC San Francisco has revealed that menopause accelerates the progression of multiple sclerosis (MS). The findings show that postmenopausal patients experience slower walking speeds, along with more subtle declines in fine motor skills and cognitive abilities.
This discovery raises questions about whether hormone therapy could benefit the 30% to 40% of MS patients who are perimenopausal or postmenopausal. Women make up 75% of MS patients, and hormonal fluctuations appear to significantly influence the course of the disease.
“Hormonal changes during puberty are known to trigger autoimmune diseases like MS,” said Riley Bove, MD, an associate professor of neurology at UCSF and the study's corresponding author. Published in Neurology on Jan. 28, the study is available online. “We also see a lower relapse rate during the third trimester of pregnancy, followed by a rebound postpartum,” Bove added.
Study Details
The research tracked 184 women before and after menopause using data from two UCSF studies, EPIC and ORIGINS, which aim to uncover the causes and progression of MS. Participants were evaluated annually over an average of 13 years.
The findings contrast with earlier studies, which offered mixed conclusions on menopause's role in MS progression. Many of those studies relied on the Expanded Disability Status Scale (EDSS), a tool that primarily measures walking ability.
“The EDSS has limitations and may also capture changes unrelated to MS, such as those caused by aging or multiple medication use, both of which can affect mobility,” explained Hannah Silverman, a UCSF medical student and the study's first author.
Declines in Walking, Dexterity, and Cognitive Skills
The UCSF study used the MS Functional Composite (MSFC), a more comprehensive tool that evaluates walking speed and other functions. Researchers observed that after menopause, participants took longer to complete a 25-foot walk, even when accounting for factors such as age, weight, and tobacco use. Declines in dexterity and cognitive abilities were also noted.
Additionally, researchers identified an increase in neurofilament light chain (NfL) in participants’ blood after menopause. NfL is a biomarker of nerve cell degeneration, a hallmark of MS progression, further supporting the MSFC findings.
Hormone Therapy: A Potential Avenue for Research
Only 17% of participants (31 out of 184) used estrogen therapy, which was insufficient to draw conclusions about its impact. While prior animal studies suggest sex hormones may have neuroprotective effects, and limited research has explored testosterone’s benefits in men with MS, more evidence is needed.
“This study highlights menopause as a distinct factor in MS progression, even when aging is taken into account,” said Bove, who is also a member of the Weill Institute for Neurosciences. “However, large, randomized trials comparing hormone therapy to a placebo are necessary to determine its true effects in a condition as complex as MS.”
