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There’s really no other way to ask it.  You’re a woman living with a menstrual cycle, and now you are a woman living with MS and a menstrual cycle.  Sometimes, around or during your period, your MS symptoms seem worse.  You may be more fatigued or foggy, or you may feel more tingling, pain, weakness or spasticity.  Maybe your bladder acts up.  You ask your OB-GYN who tells you to ask your MS provider.  You ask your MS provider and don’t really get a straight answer.   There is not much in the medical literature about menstrual cycle and MS in young women.  You go to the next best “doctor”, Google.  There are volumes written about pregnancy and family planning and MS, a few studies about menopause, and lots about the effect of hormones on the disease.  Not too much on just being a normal girl trying to make it each month.  You begin to feel a little crazy.  Please don’t.  It’s not just PMS, it’s PMS on MS. 

Between approximately 40% and 80% of women experience worsening of MS symptoms in the premenstrual period.1,2 One study compared 44 people living with MS to 14 healthy controls during ovulation and premenstrual phases.3 All women performed worse on cognitive measures during the premenstrual period, but the difference was more pronounced in the MS group.  The MS group also had deteriorated physical measures during the premenstrual period.  Women on disease modifying therapy, however, had better cognitive performance in general.  Finally, a study of 56 women living with relapsing MS reported 42% had exacerbations starting in the premenstrual phase of their cycles.4 This may be due to the immune shift that happens with changing levels of estrogen and progesterone during the premenstrual period.5 It is those changing levels of hormones that cause the increase in your MS symptoms, too.

The rise in progesterone during the luteal phase (latter part) of the menstrual cycle drives PMS symptoms like bloating, sore breasts, and even water retention.  The rapid swings in estrogen and progesterone levels can confuse the hypothalamus, causing rises in body temperature.  Remember, even a small increase in temperature slows down nerve conduction.  The steep drop in estrogen as your period starts may trigger migraines and sleep trouble.  Any of these changes could make your MS symptoms seem worse during the premenstrual or menstrual phase of your cycle. 

What can you do about it?  There is some suggestion that using an oral contraceptive may be protective against worsening of MS symptoms premenstrually.3 One very small study of 3 women suggested that daily treatment with aspirin for at least 2 months may help symptom worsening or pseudo-exacerbation related to the menstrual cycle, but this study was not large enough to justify the risks of taking daily aspirin.6

It’s safe to say, “Be prepared.”  Use an app that tracks your menstrual cycles so that you can anticipate PMS.  Make plans to do less during the weeks that are tough for you, like the week before or during your period.  Use cooling equipment when you feel hot or sweaty.  Talk to your health care providers about supplements or medications that can improve PMS symptoms or adjustment in symptom management medications around your period.  With a little help, you can handle PMS on MS!

 

  1. Zorgdrager, A., & De Keyser, J.  (1997). Menstrually related worsening of symptoms in multiple sclerosis.  Journal of Neurological Sciences, 149(1), 95-97.
  2. Smith, R., & Studd, J.  (1992).  A pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle.  Journal of the Royal Society of Medicine, 85(10), 612-613.
  3. Yorgun, Y., & Ozakbas, S.  (2019).  Effect of hormonal changes on the neurological status in the menstrual cycle of patient with multiple sclerosis.  Clinical Neurology and Neurosurgery, 186, Epub 2019 Sep 10.
  4. Zorgdrager, A., & De Keyser, J.  (2002).  The premenstrual period and exacerbations in multiple sclerosis.  European Neurology, 48(4), 204-206.
  5. Ysrraelit, M., & Correale, J.  (2019).  Impact of sex hormones on immune function and multiple sclerosis development.  Immunology, 156(1), 9-22. 
  6. Wingerchuck, D., & Rodriguez, M.  (2006).  Premenstrual multiple sclerosis pseudoexacerbation: role of body temperature and prevention with aspirin.  JAMA Neurology, 63(7), 1005-1008.