Menopause and Its Impact on Multiple Sclerosis Presentation and Comorbidities

Recent research presented at the 41st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2025) has shed light on how menopause significantly influences the initial presentation and associated health conditions in women with multiple sclerosis (MS). These findings underscore the importance of considering hormonal and biological changes when tailoring treatment strategies.

While gender differences in MS progression are well-recognized, the specific role of menopause in shaping early symptom patterns has been less explored. A study led by Dr. Yasemin Şimşek analyzed data from 864 MS patients out of a larger cohort of 4,191, including 298 premenopausal women, 300 postmenopausal women, and 265 men of similar ages. The research revealed that premenopausal women more frequently experienced initial MS symptoms related to the optic nerve—about 21.8%—compared to 15% of postmenopausal women and only 11.7% of men. Conversely, the spinal cord was typically the first site affected in 44% of postmenopausal women and 48.3% of men, whereas only 27.5% of premenopausal women showed initial spinal cord symptoms.

These differences are believed to reflect hormonal impacts on immune response and neurodegeneration. Younger premenopausal women tend to have more activated inflammatory responses, leading to certain symptom patterns, while older women and men often exhibit progression driven more by neurodegenerative processes. Moreover, the study found that comorbidities varied significantly with menopausal status, with only 15.1% of premenopausal women having additional health conditions, compared to 41% of postmenopausal women and 36.6% of men.

Cardiovascular issues, including hypertension and coronary artery disease, were especially common among postmenopausal women, affecting nearly 25%. Endocrine and metabolic disorders like diabetes and hypothyroidism were also more prevalent in this group. In contrast, premenopausal women experienced higher rates of psychiatric conditions such as depression and anxiety, likely influenced by hormonal fluctuations and psychosocial factors.

Mortality data during the study period indicated no deaths among premenopausal women, while 15 men and 9 postmenopausal women died, highlighting distinct survival patterns that may relate to comorbidity burdens.

These insights emphasize the need for personalized treatment approaches in MS. Younger women might benefit from focused management on relapse activity and disease modulation, whereas addressing neurodegeneration and preventing disability may be more relevant for older women and men. Overall, considering menopausal status can improve clinical care and outcomes for women with MS.

This research was presented by the European Committee for Treatment and Research in MS and offers valuable guidance for clinicians seeking to understand gender and hormonal influences on MS progression and comorbidity management.