From the Ectrims site:

http://www.akm.ch/ectrims2006/

Menopause in multiple sclerosis

M. Vališ, I. Šormová, R. Taláb (Hradec Králové, CZ)

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Introduction: The effect of hormones on the course of multiple sclerosis is still one of the shady areas around this severe neurologic disease. Correct evaluation of the effect of hormones on the disease progression and appropriate indication of hormone replacement therapy is another of available therapeutic options.

Method: The analyzed sample included 16 female patients with MS who started hormone replacement therapy in postmenopausal period. The main indications was severe combined osteoporosis and symptoms of estrogen deficiency, which may sometimes be masked by MS symptoms. All patients underwent gynecologic examination and their hormone profiles were tested. Analyzed parameters included age, CGI - Clinical Global Impression and EDSS (Expanded Disability Status Scale) after the first year of therapy and the type of therapy.

Results: Analysis of therapeutic response based on global improvement in CGI showed no worsening in any of the patients, 60 % improved significantly, 20 % improved slightly and 20 % did not change. No significant effect on EDSS was detected after a year of treatment. The most common treatment used was combined HRT (estrogens and progestins) in 75 % of patients, 15 % were treated with estrogens only (patients after hysterectomy). 10 % of patients were given local therapy.

Discussion: How can menopause affect MS? Very significantly, since even in healthy women is this period often associated with a decrease in quality of life. Symptoms of climacteric syndrome appear in up to 75 % of women and more than half of female MS patients show worsening of their condition after menopause.

There are currently no reasons to hesitate with starting hormone replacement therapy in indicated cases of patients with MS, the problem is, however, that symptoms of estrogen deficiency may overlap with symptoms of MS. Analysis of CGI scores showed no worsening in any of the patients and only 20 % showed no reaction to the therapy. No significant change in EDSS was detected after a year of therapy. Treatment was very well tolerated and without any negative influence on MS.

Conclusion: Based on scientific evidence, hormone replacement therapy is currenly considered a good treatment option for climacteric syndrome and prevention and therapy of postmenopausal osteoporosis. Early start of therapy improves significantly the quality of life of patients and sometimes has beneficial effects on MS.