Hell Hath No Fury Like A Hormonal Woman...

     I’ve decided it’s about time someone open up the floor for a discussion about menstrual cycles and Multiple Sclerosis.  After all, nobody else seems to be talking about it that much, so why not?  And, as for you men out there who might be reading this, get over it!  We have to suffer through YOUR commercials on erectile dysfunction (or the catch word phrase, “ED”) every night on the television…I imagine you can make it through a blog about menses just this one time!

     This morning I awoke to find myself in a pool of blood, looking something like Sissy Spacek in the movie, “Carrie”…only it wasn’t pig’s blood covering me, but my own menstrual blood!  At first, I thought I’d either been shot in my sleep or hemorrhaging from my aorta.  Yes, my thinking does get quite dramatic in times of stress or disorientation!

     The next thing that crept into my mind was, “Great.  Now I’ve ruined a nice set of 600 count Egyptian cotton sheets!”  I crawled out of bed and carefully made my way into the bathroom, wondering why this gush was happening to me now?  After all, I haven’t had this type of period flow since I was a hormonally distraught teenager.  Why now?

     As I sat soaking my body and my ruined set of sheets in a warm tub, my mind hazily drifted from thoughts about peri-menopause, Multiple Sclerosis, hormone replacement therapies, steroid use and action on menses, and a host of other topics specifically related to the female body.  I realized I knew nor had I read very little about thesetopics and decided this morning was a good time to do a bit of research to educate myself.  Perhaps with a little knowledge, I might be able to avoid another menstrual lahar and spare myself some sleep and early morning drama in the future!

     I assumed there would be quite a bit of material to peruse on the Internet about this topic…after all, more women than men are affected with Multiple Sclerosis and we ALL have menstrual cycles at one time or another in our female lives.  I thought surely there have been many studies and abstracts written on this subject to enlighten me.  Girl, was I wrong!

     Every brief abstract and reference I found on the subject of MS and Menses all acknowledged there was little information about the topic and MORE STUDY WAS NEEDED.  I began to wonder why if every scientist out there was shouting more study is needed, why on earth “more study” is not being done?  I certainly have ideas about why we lack research on this topic, but I won’t bore you with my political/feminist/male-dominated world/Eve as temptress/”the curse” ideas…you get the picture already anyway!

     Most all MS scientists and doctors accept there IS some correlation between hormonal fluctuations in women and the role these hormones play in influencing symptomology in women with Multiple Sclerosis.  Doctors know pregnant women often see a remission of MS symptoms during pregnancy, but there is a higher potential “rebound” of those symptoms to reoccur just months after child birth.  Most all women with MS know and/or experience a worsening of symptoms during their premenstrual phase, whether this is “scientifically” substantiated or not.

     Having been someone who has never had a predictable and “normal” menstrual cycle in my life, MS has given me some crude ability to now predict my periods with a fairly accurate measure…I GET AN INCREASE IN MY MS SYMPTOMS 3-5 DAYS BEFORE MY PERIOD.  I experience an increase in fatigue, pain, weakness, sometimes difficulty walking, and spasticity in my calves.  It’s my signal I’m either headed for a major relapse or about to experience a menstrual period…I always “hope” for the period, actually!  This has happened like clockwork every time I experience a hormonal shift, monthly or not.  When I was a teen, I suffered horrible PMS…now I just have the other “MS” with my periods… 

     This isn’t rocket science, folks…so why ISN’T more “science” focusing on these matters, especially topics such as menstruation and Multiple Sclerosis?  Why can’t we seem to get past our insecurities and embarrassments in this society and do some meaningful research in areas that affect purely the female gender?  How long must we as women suffer at the hands of the biblical Genesis and take a back row seat to male fertility and “ED”?  Who among us really gives a crap if “he” can get it up when we’re bleeding like a sieve from our peri-menopausal periods or completely disinterested in sex because of our MS???

     In an effort to share with you what small morsels of information are available about hormones, menses, and MS, I am including a few links and plagiarized information from various sites to assist you in your own information gathering.  Since no one seems to be too interested in this topic, I’m nottoo worried my cut and paste plagiarism will attract much attention…

    

FROM THE NATIONAL MULTIPLE SCLEROIS SOCIETY SOURCEBOOK:

 http://www.nationalmssociety.org/Sourcebook-Menstrual.asp

MS is a disease that is more prevalent in premenopausal women than in other groups. While it is not entirely clear what effects hormonal changes have on neurologic symptoms in MS, it has long been observed that certain other disorders such as epilepsy or migraine headaches are worse just before and during the menses.

Many Report Symptoms Worsen Within a Week of Menses
To see if there is, in fact, a correlation between neurologic symptoms in women with MS and the menstrual cycle, researchers at an MS clinic distributed a questionnaire to female patients. Of the 149 women with MS who answered the questionnaire, 70% reported that their MS symptoms seemed to change at a regular time in their cycle. Most of those who reported a change indicated that the change, usually involving a worsening of their symptoms, occurred within one week of onset of menses. Weakness, imbalance, fatigue and depression were the symptoms most frequently reported to worsen. Other self report studies have replicated these data. More recently, MRI studies done in women at different times of the menstrual cycle indicate that disease activity as measured on MRI may vary according to differing hormonal environment.

These findings have all come from small, uncontrolled studies, and much more research is needed to characterize the relationship between MS and the menstrual cycle.

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http://www.mscare.org/cmsc/images/pdf/07Houtchens%20.pdf

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The Premenstrual Period and Exacerbations in Multiple Sclerosis
Anneke Zorgdrager, Jacques De Keyser

Department of Neurology, University Hospital Groningen, The Netherlands

Address of Corresponding Author

European Neurology 2002;48:204-206 (DOI: 10.1159/000066166)

Abstract

The aim of this study was to assess whether an association exists between the premenstrual period and exacerbations of multiple sclerosis (MS). The subjects were 56 premenopausal patients with relapsing MS and a regular menstrual cycle. Data over the previous 2 years were gathered from a structured MS database and a comprehensive questionnaire. 42% had exacerbations starting in the premenstrual phase. Within this group the proportion of premenstrual exacerbations was significantly higher than in the remaining period of the menstrual cycle, and in 45% all exacerbations had started during the premenstrual phase. There was no relationship with the premenstrual syndrome, and there was no protective effect of oral contraceptives. Our results suggest that the premenstrual period triggers exacerbations in a subgroup of females with MS.

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ASK THE EXPERT
Questions answered by
Ronald Barentsen, MD, PhD, Netherlands
Chairman of the OBGYN.net Menopause Advisory Board

Question: Can you provide me with any information or known contraindications for a lady with multiple sclerosis prescribed hormone replacement therapy?

Answer:

There is an extreme shortage of literature on this topic; but the current concept is that MS is no contraindication for HRT. The only relevant abstract in Medline comes here:
Author: Sandyk R.
Institution: NeuroCommunication Research Laboratories, Danbury, CT 06811, USA.
Title: Estrogen's impact on cognitive functions in multiple sclerosis.
Source: International Journal of Neuroscience. 86(1-2):23-31, 1996 Jul.
Abstract:It has long been suspected that hormonal factors contribute directly and indirectly to the etiology and pathogenesis of multiple sclerosis (MS). The susceptibility of MS is higher in women than in men and women are even more susceptible to hormonal influences when onset occurs at an early or delayed age. Pregnancy has a short-term favorable effect on the course of the disease but there is an increased rate of relapse during the post-partum period. In addition, women often report premenstrual exacerbation of their symptoms with remission during menses. These findings suggest that in women estrogens may exert a stabilizing effect on the clinical manifestations of MS. The role of estrogens is supported also by observations of a higher incidence of cognitive impairment in women than men with MS. A 50 year old man with a remitting progressive MS experienced profound deterioration in cognitive functions during withdrawal from estrogen therapy which was initiated for the treatment of amenorrhea. Improvement in cognitive functions occurred shortly after she restarted therapy with an estrogen/progesterone preparation and was maintained during long term therapy. Serotonin (5-HT) mechanisms have been implicated in memory functions and estrogens modulate these functions through an interaction with 5-HT2 receptors in the cerebral cortex and limbic system. It is suggested that estrogen withdrawal induces impairment in cognitive functions through dysregulation of 5-HT2 receptor activity and 5-HT neurotransmission. These findings suggest that estrogens have a beneficial influence on cognitive functions in MS patients and that hormonal supplementation might be advised in menopausal and postmenopausal MS patients for the prevention of cognitive deterioration.