Menopause not linked to worsening disability in women with MS

Menopause not linked to worsening disability in women with MS | Image Credit: © InsideCreativeHouse - © InsideCreativeHouse - stock.adobe.com.

Researchers from Monash University have found that there is no link between menopause and increased disability risk in women with multiple sclerosis (MS), publishing their findings in JAMA Neurology.¹

According to Francesca Bridge, PhD, neurologist at Alfred health, these results can reassure women transitioning into menopause and their doctors that the transition will not worsen their MS symptoms. This can be used to guide symptom management decisions, such as menopausal hormonal therapy use and lifestyle modifications.¹

“Women with MS will benefit from the holistic management of menopausal symptoms with lifestyle measures such as exercise and maintaining a healthy diet, as well as pharmacological measures,” said Bridge.¹

Assessing disability outcomes

The study was conducted to determine whether menopause impacts disability outcomes in women with MS.² Data was obtained from the MSBase registry, a processor of data from individual principal investigators.

Participants included adult women with relapse-onset MS and at least 3 Expanded Disability Status Scale (EDSS) measurements. Exclusion criteria included progressive-onset MS, non-MS diagnosis, and records not matched in the MSBase database.²

At routine clinical visits, participants completed health surveys collecting data about menopause status and age at menopause. Relevant demographic data in the database included sex, age, EDSS scores, clinical visit dates, relapse, and treatment information.²

Primary and secondary outcomes

Menopause was indicated by a period of at least 12 months following the date of last menstrual period. The first defined MS symptom indicated the age at MS onset, and baseline was considered the first recorded EDSS in MSBase.²

Disease duration was defined as the period between MS onset and last visit in MSBase. The time to confirmed disability progression (CDP) was reported at the primary outcome, determined by an increased and sustained EDSS change.²

The time to secondary progressive MS (SPMS) was reported as the secondary outcome, defined as 3-month progression in EDSS. Disability milestone attainment or last recorded visit was considered the end of the observation period.²

No independent association with menopause

There were 987 women included in the final analysis, 583 of whom were premenopausal and 404 were postmenopausal. A median age of 48.5 years was reported at menopause, while median ages at MS onset of 37.3 years and 29.2 years were reported in postmenopausal and premenopausal patients, respectively.²

CDP was reported 31.7% of premenopausal women and 56.4% of postmenopausal women. Rates of SPMS in these cohorts were 7.7% and 24.3%, respectively. However, Cox survival models considering menopause as a time-varying covariate did not link it to CDP risk, with an adjusted hazard ratio (aHR) of 0.95.²

Menopause was also not linked to SPMS with an aHR of 1.00. Instead, longer disease duration and greater baseline EDSS were linked to increased SPMS risk, while longer baseline disease duration, older age at MS onset, and greater baseline EDSS were linked to increased CDP risk.²

Implications

A nonlinear association with CDP was reported for age at MS onset in a sensitivity analysis, but this association was not identified for SPMS. Additionally, no independent associations with either disability outcome were reported for menopause. Overall, the data highlighted no association of menopause with disability progression in women with MS.²

“The study findings are particularly important for doctors including neurologists, who will now be able to give reassuring advice to their patients that menopause won’t make their MS disability worsen faster,” said Bridge.

References

1. MS does not worsen menopause symptoms: study. Monash University. September 29, 2025. Accessed October 1, 2025. https://www.eurekalert.org/news-releases/1100216.
2. Bridge F, Sanfilippo PG, Zhu C, et al. Menopause impact on multiple sclerosis disability progression. JAMA Neurol. doi:10.1001/jamaneurol.2025.3538