Is Multiple Sclerosis Different in Women?

Anyone can get multiple sclerosis. But the disease has a gender gap that baffles experts.

Two to three times as many women get MS at ages 20-40 as men the same ages do. Doctors don’t know why that is, though they have some theories.

Hormones may be part of it, says Joseph Berger, MD, chief of the multiple sclerosis division at the University of Pennsylvania’s Perelman School of Medicine. “But we’re not yet sure.”

On the plus side, when young women get MS they are more likely than men to get a milder form of the disease.

Shared Symptoms

Both sexes have the same symptoms, which include problems with:

“If there are differences between male and female symptoms, they are probably trivial,” Berger says.

Yet there are a few differences in how men and women experience the disease.

Urinary Tract Infections (UTIs)

It’s a matter of simple anatomy: Women tend to get more UTIs than men, Berger says.

“Bacterial and viral infections can make symptoms worse and spur relapses, he says. “UTIs tend to worsen clinical symptoms that people already have.”

Menstruation

For some women with MS, ovulation and menstrual cycles can temporarily worsen their MS symptoms, says Thomas Leist, MD, director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University Hospital in Philadelphia.

It doesn’t mean you’re having a relapse. It usually gets better within 24 hours.

If it happens, those women may feel fatigue, depression, problems with balance, and weakness. Before and during a period, a woman’s core body temperature can rise a bit, and heat is known to worsen MS.

You may not have that problem. “I’ve seen thousands of patients,” Berger says. “And have not seen much evidence of this, so it must not be terribly frequent.”

Pregnancy

A woman with MS who wants to become pregnant should talk to her doctor about what her treatment plan will be, since none of the MS medicines are approved for use during pregnancy or while breastfeeding.

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MS should not affect your ability to get pregnant or deliver the baby. And for reasons doctors don’t completely understand, relapses are less likely in the second and third trimesters of pregnancy.

“However, over the 3 to 4 months following delivery, the relapse rates tend to go up,” Leist says. That may be due in part to hormonal changes. “It’s most likely a complex combination of factors,” Leist says.

In the long run, having had a baby likely will not affect a woman’s MS.

Menopause

There isn’t a lot of research on whether menopause affects MS. It’s also not clear whether hormone replacement therapy is particularly helpful for women with multiple sclerosis.

If you notice a change in your symptoms, like problems with sex, shifts in your mood, or trouble with sleep or your bladder and bowels, as you near or go through menopause, tell your doctor. It’s not always easy to know whether MS causes those changes or hormones do. So work with your doctor to find ways to feel your best.

WebMD Feature Reviewed by Neil Lava, MD on December 13, 2015

Sources

SOURCES:

Joseph Berger, MD, chief of the multiple sclerosis division, University of Pennsylvania Perelman School of Medicine.

Thomas Leist, MD, director, Comprehensive Multiple Sclerosis Center, Thomas Jefferson University Hospital, Philadelphia.

Lahey Hospital & Medical Center: “Frequently Asked Questions.”

Multiple Sclerosis Society: “Women and MS.”

National Multiple Sclerosis Society: “Pregnancy and Reproductive Issues.”

Wundes, A. International Journal of MS Care, May 2011.

Bove, R. Journal of Neurology, July 2014.

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