MS and Menopause share many of the same symptoms
Key points: MS and Menopause share many of the same symptoms.
Fatigue, brain fog, anxiety, poor sleep and heat sensitivity. This overlap can make it difficult for women to know what is driving changes in their body and mind. Understanding the connection may help you have more informed conversations with your healthcare team.
As World MS Day approaches, I keep coming back to one striking fact: women are around three times more likely to develop multiple sclerosis than men.
MS is, overwhelmingly, a women’s disease.
Yet one of the biggest issues affecting women with MS — hormones, perimenopause and estrogen loss — still feels strangely under-discussed.
Can hormones affect MS symptoms?
Researchers are still learning exactly how hormones interact with MS, but several patterns continue to emerge.
Estrogen appears to play a role in:
- immune regulation
- brain and nervous system function
- cognition and memory
- mood and mental health
- sleep regulation
- bone strength
- cardiovascular health
One of the most interesting clues comes from pregnancy.
Relapse rates in MS often decrease during late pregnancy, when estrogen levels are high, before increasing again after birth.
Researchers believe this may point toward estrogen having immune-modulating and neuroprotective effects.
At the same time, many women report worsening symptoms during perimenopause and menopause.
But given how many women live with MS, it’s surprising how little mainstream discussion there still is around the overlap.
The Confusing Symptom Overlap of MS and Menopause
What are researchers saying about estrogen and MS?
Two key articles had me enthusiastic about this topic recently.
UCLA neurologist, Dr Rhonda Voskuhl, wrote a very clearly titled study All women with multiple sclerosis should start hormone replacement therapy at menopause unless contraindicated: Yes
No uncertainty there.😀
Professor Rhonda Voskuhl’s research
Dr Rhonda Voskuhl has spent years studying the relationship between sex hormones and multiple sclerosis.
One of the observations driving her work is that many women with MS experience fewer relapses during late pregnancy, when estrogen levels are naturally very high.
Her research suggests estrogen may have:
- anti-inflammatory effects
- immune-modulating effects
- possible protective properties within the brain and nervous system
Voskuhl’s work has helped push the idea that sex hormones are not “separate” from neurology, but may actively influence disease activity and symptom experience in women with MS.
The Norwegian article: lowering the threshold for discussion
Another recent article published in May 2025 in the Norwegian medical journal Tidsskrift for Den norske legeforening. No, I don’t speak Norwegian, the paper was in English 😆
The authors argue that doctors may need a lower threshold for discussing menopausal hormone therapy (MHT) with women who have MS.
The authors noted that:
- women with MS may experience worsening symptoms during perimenopause and menopause
- estrogen appears to affect the immune system and nervous system
- menopause may influence cognition, mood, sleep and quality of life
- women with MS also face elevated risks around bone health and cardiovascular disease
The article essentially argues that menopause should not be treated as a “side issue” in women with MS, because hormonal changes may significantly affect wellbeing and symptom burden.
The authors don’t suggest menopausal hormone therapy is appropriate for every woman. Rather, they argue women with MS deserve:
- greater clinical awareness of the overlap between menopause and neurological symptoms
- informed conversations
- individualised risk-benefit discussions
Let me just say, brava brava brava!
Reading these papers, I’m nodding my head in agreement
Around 2022, I became convinced my MS was rapidly worsening, even after years of keeping it in control with lifestyle.
Brain fog had moved in permanently. I was anxious all the time — about everything. After decades of thriving in high-stress enviroments, I couldn’t handle any stress anymore. And I felt permanently overwhelmed.
I left a well-paid job because I no longer felt able to cope cognitively or emotionally.
I saw a GP who said ride it through.
Looking back now, I suspect at least part of what I was experiencing may also have been hormonal change happening alongside MS.
I have to say, I was glad when my periods stopped (at age 44), I was happy! They were just inconvenient. A friend later suggested a specialist GP with expertise in women’s issues. I didn’t connect my frequent dark thoughts with hormones at all.
When I booked an online telehealth appointment, I was prescribed MHT (the more up to date terminology than hormone replacement therapy). The script included an estradiol gel to smear on the upper arms each morning, and a small prometrium tablet before I go to sleep. The shift felt surprisingly profound.
The clarity of my thoughts was the first thing I noticed. “I’m back!”
Within days, I was sleeping deeply again. The relentless anxiety around tiny problems eased dramatically. My brain felt sharper. I had ideas again, good ones, and I could make connections. It was easier to laugh and step into happiness.
My first proper sleep felt more like being retrieved from the seabed.
I’m not saying estradiol ‘fixed my ms’. It didn’t, but it erased a whole lot of things getting in the way. It has definitely improved my quality of life.
There may be good reasons, such as hormone-related breast cancer or a history of blood clots, that mean it’s not recommended for you.
n my case, there weren’t any reasons not to try MHT. Not everyone in the same basket.
But taking MHT did make me realise how many women may be blaming themselves — or assuming their MS is progressing — without recognising the possible role hormones may also be playing.
If you feel like you’re doing all the right things in terms of lifestyle and taking an effective medical therapy, it’s helpful to consider there’s another reason why it might feel like your symptoms are getting worse, even if they aren’t/
Synergistic effects of lifestyle
By the way, Dr Rhonda Voskuhl, the UCLA neurologist, goes on to describe the synergistic effects of adding exercise to MHT.
On the Rosie Acosta podcast, Dr Voskuhl mentions she is a jogger, and that running or exercising to the point where it’s hard is good for your brain and your heart. It produces brain-derived neuritrophic factor (BDNF), which is vital for brain growth, elasticity and protection.
To not have a treatment for the brain in menopause isn’t just a women’s problem.
“This is a big problem for all of society,” Dr Voskuhl said.
