Highlights
- •The relapse rate of multiple sclerosis after menopause is similar to the relapse rate before menopause.
- •The effects of sex hormones on the natural history of multiple sclerosis have not been clarified.
- •Multiple sclerosis is characterized by a high prevalence of sexual dysfunction.
- •Estrogen treatment may decrease the relapse rate of multiple sclerosis.
Abstract
Aim
Sex hormones have been suggested to have neuroprotective effects in the natural history
of multiple sclerosis (MS), particularly in animal studies. The aim of the present
review was to retrieve and systematically synthesize the evidence on the effect of
menopause and hormonal replacement treatment (HRT) on the course of MS.
Methods
A systematic literature search was conducted in the databases MEDLINE (accessed through
PubMed), Scopus, clinicaltrials.gov and Cochrane Controlled Register of Trials (CENTRAL).
Eligible studies were all those that included women with MS and reported on at least
one of the following: a) disability and MS relapse rate before and after menopause,
b) serum sex hormone concentrations, c) sexual function, d) age at menopause onset.
Effects of HRT on MS clinical outcomes were also assessed.
Results
Of the 4,102 retrieved studies, 28 were included in the systematic review. Of these,
one reported the age at menopause for both controls and women with MS and found no
difference between the two groups. There was no difference in the rates of relapse
before and after menopause (risk ratio 1.21, 95 % confidence interval 0.91–1.61, p = 0.218).
Two intervention studies reported beneficial effects of estrogen therapy on women
with MS; however, the majority of women were premenopausal. Three studies addressed
the issue of sexual dysfunction in women with MS, but information on hormonal parameters
was limited.
Conclusions
The age at menopause is not associated with the presence of MS. The evidence on a
potential causal effect of estrogen depletion on disability is inconclusive; still,
relapse rate seems not be associated with menopause. The effect of HRT on the natural
course of the disease remains to be defined.
Keywords
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Article info
Publication history
Published online: March 07, 2020
Accepted:
March 6,
2020
Received in revised form:
March 2,
2020
Received:
December 22,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V.
