Hormone levels affect MS – ECTRIMS 2016
European Committee for Treatment and Research in MS (ECTRIMS), London UK, September 14-17, 2016 – Hormones have long been suspected of playing a role in MS, which would help to explain why MS differs in women and men – women are more likely to develop MS, but men with MS often have a more aggressive disease course.
Changes in hormone levels are most apparent during pregnancy. Relapses are less common during pregnancy – most notably in the third trimester (months 7-9) – then often flare up once the baby is born. An increase in relapses doesn’t appear to increase a woman’s risk of greater disability later in life (Bsteh and colleagues. PLoS One 2016;11:e0158978). But is the opposite true – do fewer relapses during pregnancy provide any long-term benefit?
This is a controversial question. A 10-year study presented at ECTRIMS suggests that pregnancy does lower the risk of long-term disability (Jokubaitis and colleagues. ECTRIMS 2016; abstract P322. Published in Ann Neurol 2016;80:89-100). The study analysed data for 1,830 women, including 296 women who had become pregnant. People in the study spent more than 80% of their time on an MS therapy over the 10-year period. Women who became pregnant had less disability. In fact, pregnancy was about 4 times more “potent” in reducing the risk of disability than standard MS medications.
Hormone levels are also altered by oral contraceptives (OC). A separate study found that women who had taken OCs before being diagnosed with MS had fewer relapses compared to women who had never taken OCs (Bove and colleagues. ECTRIMS 2016; abstract P320). Women who continued to take OCs after diagnosis also had fewer relapses, but the effect was less pronounced. In addition, OC use (past or current) was associated with a lower risk of worsening disability over the 8-year study period.
Many women report that their MS gets worse during their menstrual period (a problem they share with women with other autoimmune disorders). A recent U.S. survey found that about 17% of women with MS felt that their MS symptoms got worse during their period (Kavak and colleagues. ECTRIMS 2016; abstract P323). Other studies have found that about 40% of women experience worse symptoms or relapses around their period (Zorgdrager & De Keyser. Eur Neurol 2002;48:204-206). Part of this may be explained by a higher body temperature (taking Aspirin can help), but much of this effect is believed to be caused by changes in hormone levels or immune function (Wingerchuk & Rodriguez. Arch Neurol 2006;63:1005-1008).
A concern raised by the new study was that women with worse symptoms during menstruation were more likely to have some degree of disability, suggesting that hormonal changes during menstruation may actually be causing harm. A further concern was that women who felt worse after menopause were twice as likely to have had worse symptoms during menstruation when they were younger. It may be that some women with MS are especially sensitive to hormone effects, but this will require further study.
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