Perimenopause With Multiple Sclerosis: Managing Hormonal and Neurological Change Together
Perimenopause adds a new layer of complexity for women living with MS. Discover how hormonal changes interact with MS symptoms, what the research shows, and how to manage both well.
How Hormones and MS Interact
Multiple sclerosis is a condition in which the immune system attacks the myelin sheath protecting nerve fibres. Estrogen has immune-modulating properties, and research has shown that pregnancy, a high-estrogen state, is often associated with a reduction in MS relapses. Perimenopause, with its declining and erratic estrogen levels, has the opposite effect for some women: they notice increased fatigue, worsened bladder symptoms, heightened heat sensitivity, and more frequent or severe relapses. While not every woman with MS notices a clear hormonal influence on their symptoms, the connection is well enough established to be worth discussing with a neurologist.
Overlapping Symptoms and the Diagnostic Challenge
Fatigue is the most common symptom of both MS and perimenopause, and the two forms of fatigue can be nearly impossible to distinguish without careful observation. Cognitive difficulties, mood changes, poor sleep, heat sensitivity, bladder problems, and muscle stiffness appear in both conditions. A new symptom appearing during perimenopause may reflect a genuine MS relapse, a hormonal change, or both. Keeping a detailed symptom record that notes severity, duration, and context helps both you and your neurologist make more informed judgements about what is driving any particular symptom cluster.
Heat Sensitivity and Night Sweats
Heat sensitivity in MS, known as the Uhthoff phenomenon, means that a rise in core body temperature can temporarily worsen neurological symptoms. Hot flashes and night sweats during perimenopause raise body temperature repeatedly, often multiple times a day and night. For women with MS, this can trigger or worsen symptoms including visual changes, weakness, spasticity, and fatigue in ways that are alarming but generally temporary. Cooling strategies, such as cold water, cooling vests, air conditioning, and managing room temperature, serve double duty here, reducing both hot flash discomfort and MS symptom exacerbation.
Hormonal Therapy: Opportunities and Caution
The evidence on hormone therapy in women with MS is not yet definitive. Some observational studies suggest that hormone therapy may be beneficial for MS-related outcomes in perimenopause, possibly because of estrogen's anti-inflammatory and neuroprotective properties. Other evidence is mixed. Hormone therapy remains an option for many women with MS, though the decision should be made collaboratively between a neurologist and a menopause specialist who are both aware of each other's perspective. MS medications should also be reviewed by your neurologist when perimenopause begins, since disease activity and medication needs can shift.
Bladder, Bone, and Sleep
Bladder symptoms are common in both MS and perimenopause, and they often worsen when both are present. A specialist in pelvic floor function can help, and there are effective interventions beyond simply limiting fluids. Bone density is a concern for women with MS who are also experiencing estrogen loss, particularly if they have had steroid treatments. Resistance exercise, calcium, and vitamin D are relevant for everyone in this situation. Sleep disruption from MS spasticity or pain, combined with night sweats, creates a particularly difficult combination that may warrant a targeted sleep strategy discussed with your care team.
Building a Coordinated Care Team
Women with MS navigating perimenopause benefit most from a care team that communicates. Your neurologist, GP, and any other specialists involved in your care should ideally know about each other's assessments and plans. You are likely to need to facilitate this yourself by sharing summaries across appointments. Tracking your symptoms in detail over time, including the type, severity, and any potential triggers, gives all of your clinicians better information than recall alone. PeriPlan lets you log symptoms and identify patterns over weeks and months, which is particularly valuable when multiple conditions are contributing to a complex symptom picture.
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