• The main sex hormone in men is called testosterone
• Studies have shown that men with MS are more likely to have low testosterone levels than men without MS
• Among men with MS, those with low testosterone levels more commonly encounter worsening physical and cognitive function than those with higher levels of the hormone
• Research suggests that high levels of testosterone, as seen naturally in younger males, may have a protective effect against MS disease – this helps to explain why men tend to develop MS later in life than women
• Despite these findings, it’s important to remember that this is a developing area of research and not all studies have come to the same conclusion; it’s also unclear whether low testosterone is a cause or a symptom of MS

• Oestrogen is mostly known to reduce immune system activity, thereby exerting a protective effect against MS relapses
• This is supported by women living with MS who experience fewer symptoms during pregnancy when oestrogen levels increase; in the months after birth, relapses become more likely, during which time oestrogen has fallen to pre-pregnancy levels
• During one trial, women who took oestrogen alongside their prescribed DMT experienced a reduced number of relapses over a 2-year period
• Other studies have shown similar benefits, with oestrogen reducing the number of MS lesions
• Although there is little research into testosterone in women, one study demonstrated that women living with MS who had lower levels of testosterone showed more lesions on an MRI scan

Given the association between hormones and MS, it shouldn’t be too surprising to hear that some women have observed a link between MS and their menstrual cycle. You may have even noticed this yourself!

Many women have described worsening of their MS symptoms in the two to three days before their period starts, with symptoms easing after they have come on. However, this is not universal and is thought to depend on the type of MS and whether or not you are taking oral contraceptives.

A large study has also found that women with MS tend to report more menstrual symptoms than women without MS. It should be noted, however, that one limitation of this finding is the overlapping similarity of MS and menstrual symptoms, which can make it hard to distinguish between them.

What is the menopause?

On our MS One to One social channels, some of you have asked for information about the menopause and MS. The menopause is a process that women go through, usually between the ages of 45 and 55, during which the ovaries stop producing much, or any, oestrogen and stop the release of eggs to make a baby.

As a result of the hormonal changes your body goes through during the menopause, you can experience a number of symptoms. The most common menopausal symptoms are:

As symptoms of the menopause are similar to those of MS, it can be difficult to determine whether a symptom is the result of the menopause or your MS. If you’re unsure, talk to your doctor – they can discuss your symptoms with you and decide on the best way to manage them that works best for you.

You might have also heard of the perimenopause. This is the time leading up to the menopause when oestrogen production starts to decrease and before your periods stop. When you enter the perimenopause, you may start to experience menopausal symptoms.

The impact of the menopause on MS is not well understood, with limited research on this topic. However, some women have reported that hot flushes and sleep disturbances cause by the menopause have triggered worsening of their MS symptoms. A study in 2015 has also found that women with MS have experienced faster disability progression post-menopause.

Managing menopausal symptoms with MS

Hormone replacement therapy (HRT) is often used to treat women who are suffering with unpleasant symptoms of the menopause. Although there isn’t much research looking into the effectiveness of HRT in people living with MS, there’s no reason to think that MS would affect how well HRT works.

There is some evidence that HRT has helped to improve MS symptoms which have worsened during the menopause. Another study also found an association between HRT and better physical quality of life in post-menopausal women. However, further results are mixed, and more studies are required to establish more robust conclusions about the potential benefit of HRT for women with MS.

If you’re going through the menopause and think you might benefit from HRT, talk to your doctor. They can help to determine the right option for you.