Caring for Women with Multiple Sclerosis Across the Lifespan

Abstract

This article summarizes what is known about the disease course in women with MS, how it differs from men, and the current state of knowledge regarding effects of reproductive exposures (menarche, childbearing, menopause) on MS-related inflammation and neurodegeneration. Recent findings regarding pregnancy-associated relapses in the treatment era, protective effects of breastfeeding, and care for women during the menopausal transition are reviewed. Then, updated recommendations to guiding women during childbearing-including pre-conception counseling, discontinuation of MS therapies, and management of postpartum relapses-are provided. Whenever possible, areas of uncertainty and avenues for future research are highlighted. From childhood through the postreproductive life stages, gender and hormonal exposures appear to shape an individual's risk for MS, as well as the experience of living with MS.

Polypharmacy in patients with multiple sclerosis: a gender-specific analysis

“…With regard to the use of antispasmodics, previous studies support our result of a significantly higher use of those drugs among men compared to women: In the study of Oreja-Guevara et al, the proportion of male MS patients with spasticity was significantly higher than the rate of male MS patients without spasticity ( p < 0.001) [27] and Windt et al described that the use of muscle relaxants was significantly higher in men than in women ( p = 0.024) [28]. So far, findings on the effects of hormonal contraceptives on the course of MS have been inconsistent, with negative, neutral, and protective effects being reported [29].…”

Women’s Health: Contemporary Management of MS in Pregnancy and Post-Partum

“…This should be performed with the assistance of a patient’s obstetrician-gynecologist whenever possible. Current DMT use should be discussed in regards to safety and optimal discontinuation timing, which is typically 5 maximal half lives of the DMT, but this time frame may vary in specific circumstances [6]. Standard prenatal medications including prenatal vitamins and folic acid supplementation is advised [6].…”

“…Current DMT use should be discussed in regards to safety and optimal discontinuation timing, which is typically 5 maximal half lives of the DMT, but this time frame may vary in specific circumstances [6]. Standard prenatal medications including prenatal vitamins and folic acid supplementation is advised [6]. Optimal Vitamin D supplementation is important to maintain throughout pregnancy, as an increased risk of MS was seen in offspring of women with low gestational Vitamin D (25(OH)D) levels of less than 30nmol/L in a Finnish study [7].…”

“…Optimal Vitamin D supplementation is important to maintain throughout pregnancy, as an increased risk of MS was seen in offspring of women with low gestational Vitamin D (25(OH)D) levels of less than 30nmol/L in a Finnish study [7]. Smoking cessation is recommended for all patients, given its impact on both MS disease activity and on pregnancy [6].…”

“…Clinical considerations: because it is prudent to optimize a patient’s chance of conception off of DMT, strategies such as substituting barrier methods for OC, waiting for ovulation cycles to resume prior to discontinuing DMT, and referrals for evaluation of fertility if pregnancy does not result after 6 months of attempt should be considered [6].…”