Menopause Not Associated With Disease Progression in MS
Menopause was not found to drive disease progression in multiple sclerosis (MS) in women at midlife. Results from the longitudinal cohort study were published in JAMA Neurology.
“Whilst reproductive ageing may be additive to the effects of somatic ageing, our study does not support menopause as the leading factor for disability progression in older women with MS,” wrote Francesa Bridge, MBBS, Department of Neuroscience, School of Translational Medicine, Monash University, and co-authors.
To assess whether menopause increased the risk of confirmed disability progression or secondary progressive MS, researchers utilized prospective clinical data collected through the MSBase Registry. Data was extracted from MSBase on July 2, 2023, and analyzed from January 2023 through February 2025. Female participants were recruited from 8 neuroimmunology specialist centers in Australia from 2018 to 2021.
Total participants comprised 1468 women 18 years or older who responded to dedicated retrospective women’s health surveys. A subgroup of 987 women with relapse-onset MS, 3 or more Expanded Disability Status Scale (EDSS) measurements recorded, and reported menopausal status were included in the primary analysis. Secondary analysis included 209 women with 1 or more EDSS measurements noted in the MSBase database predate and postdate of menopause onset.
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Researchers used crude and adjusted Cox proportional hazards models to assess the influence of menopause on progressive disability milestones. They adjusted analyses for age at MS onset, baseline disease duration, baseline EDSS scores, baseline relapse, and high-efficacy disease-modifying therapy. All results were modeled as a time-varying covariate. The main outcome for primary analysis was time to 6-month confirmed disability progression (CDP). The secondary outcome was time to secondary progressive MS (SPMS). Secondary inflection point analysis assessed longitudinal changes in EDSS in women who received follow up throughout their menopausal transition.
Primary analysis included 583 premenopausal and 404 postmenopausal women with MS, with a median age at menopause of 48.5 years. After multivariable adjustment, menopause was not associated with higher risk for CDP or SPMS (hazard ratio, 0.95; 95% CI, 0.70-1.29; P = .70 and hazard ratio, 1.00; 95% CI, 0.60-1.67; P = 1.00), respectively. In the secondary analysis, “menopause did not represent an inflection point in EDSS worsening following multivariable adjustment.”
“The menopausal transition can be challenging for many women,” Dr Bridge said in a press release. “This study gives women with MS one less thing to be concerned about. This study will guide the health/clinical management of women with MS through the menopausal transition.
“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.”
Limitations of the study include the use of self-reported menopausal status, inability to adjust for other factors influencing hormonal concentration, and use of a summative clinical measure (the EDSS) to describe the overall severity of disability in people with MS.
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