Impact of Menopause in Patients with Multiple Sclerosis: Current Perspectives

Lorena Lorefice,1 Maurizio Nicola D’Alterio,2 Davide Firinu,3 Giuseppe Fenu,4 Eleonora Cocco1 1Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 2Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; 3Clinical Immunology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 4Department of Neurosciences, ARNAS Brotzu, Cagliari, ItalyCorrespondence: Lorena Lorefice, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, Cagliari, 09126, Italy, Email lorena.lorefice@hotmail.itAbstract: Given the aging population, with a peak age-specific prevalence that is shifting beyond the age of 50, several women currently living with MS are very close to menopause. Menopause is usually characterized by several specific symptoms with adverse impacts on different aspects of a woman’s quality of life, such as fatigue, and cognitive, mood and bladder disorders, which overlap with symptoms of MS. Generally, after this biological transition, women with MS appear to be subject to less inflammatory activity. However, several studies have reported an increase of disability accumulation after menopause, suggesting that it is a turning point to a more progressive phase of the disease. This may be attributable to the hormonal and immunological changes associated with menopause, with several effects on neuroinflammation and neurodegeneration increasing due to the immunosenescence of aging. This review summarizes the hormonal and immunological changes associated with menopause, detailing the effects on MS symptoms, outcomes, and the aging process. Furthermore, possible interventions to improve patients’ quality of life are evaluated. In fact, it is increasingly necessary to improve the global mana