Dealing with menopause is hard enough without having MS. In this Newsletter Prof G goes through the pros and cons of HRT (hormone replacement therapy) for managing menopause in women with MS.
Glad to hear that some readers of the Newsletter have been getting second opinions on the advice I have given. Fortunately, it has been congruent with my advice.
It is very important to check facts and get second and third opinions and check other sources. the only way you be confident about what is for real and what is fake is to do due diligence on the contents.
Thank you so much for this post. For the last 18 months my MS seems to have worsened. I have had many problems similar to the case you describe. Perimenopause started for me at age 44 with sleep disturbance being the main symptom and this has had a huge effect on my MS. HRT has numerous benefits on bone health, brain health and in preventing cardiovascular disease(see BHF website). Life with MS is hard enough and certainly perimenopause has made it a million times harder. HRT has really helped. As Neurologists more of you need to be informed about this and how it impacts your MS patients. Please note transdermal HRT does not increase the risk of DVT/PE. Breast cancer risk is increased only slightly after the age of 51 on HRT. This risk is far lower than being obese or drinking>3units of alcohol daily. I would signpost your patients and (doctors) to the “My menopause doctor” website. Get them to download the free Balance app so they can monitor their symptoms and print off the diary to show their GP and discuss HRT with them. Too many women are put on antidepressants to manage menopause when they don’t work for this. Blood tests are often normal in perimenopause. It’s a patients symptoms that count in making the diagnosis. It’s not just about hot flushes and night sweats. Fatigue, anxiety, depression, bladder symptoms, osteoarthritis, fibromyalgia and headaches can all be due to oestrogen deficiency and treated with HRT.
Huge thanks - this is a topic that I’ve brought up/questioned with various medical professionals for the last 10+ years!! Always to be told the same - ‘not enough research ....’ My ms has definitely deteriorated in the last 10 or so years (during menopause) and whether or not my menopause is to blame — ?? I have asked about HRT too and been told ‘no’ (without reason, investigation, etc)
So, I do think your research should be sent to Every professional connected to ms, so HRT can at least, be considered
49 and menopausal from Berkshire here (sounds like a bad bio on a dating site) I am on Vagifem® 10 mcg pessary thingumy's twice a week and it seems okay. I'm not flushing too much and no more of a nutter than I've always been (I think) please sign me up for the MS-selfie information gathering work
Thank you for this extremely helpful and timely post. I am 53 and my spMS diagnosed in 1992. My sleep, moods and reducing abilities I have put down to MS but as I am menopausal maybe that’s more the reason. I will make an appointment with my GP. I just presumed it was a funding issue why GP’s don’t mention HRT!
A hot topic! I am 45 and peri. I have a family history of ductal (not hormonal) breast cancer. I also have high bp and Cholesterol (all being treated with medication, exercise and diet). Hence, I am reluctant to go on HRT. I am lately suffering from an additional symptom of anxiety, I am already on 2x30mg of Duloxetine and am not even sure if it is as a consequence of having MS or if it is due to being peri. Pls help?
Thanks for this article! Also interesting reading the comments. I am 50 and perimenopausal with many different symptoms. Also have RRMS and treated with Ocrevus since my diagnosis a few years ago. Have tried to get HRT twice from my female GP (I just assumed she would be more sympathetic than a male!) and trying again...I have Osteoporosis already. She wants me to have a blood test for my hormones but I understand that they vary day to day anyway. I just need to persevere I guess!
Thanks for posting. Hot flushes raise temperature and my MS has always been affected by raised temperature. Pfizer stopped making many HRT meds due to lack of demand over the last 15 years because of the cancer scare etc. My HRT med was very low dose & I have tried to find a similar low dose progesterone without success. The pharmaceutical companies need to start making a wide selection of HRT meds again as every woman responds differently to them. It's not 'one size fits all'. I told my Neurologist and GP many times that HRT improved my MS but they just smiled patronisingly. Unless I wave research papers in front of them, it's not taken seriously. Sigh.....
Dear Prof G, how long would wwMS stay on HRT and when is it beneficial to start, is it perimenopause or once periods have ceased or can you also start post menopause? Are GP’s more likely to prescribe/refuse at one of these stages? Thank you
Many thanks for this information, it's really useful! Would your advice be the same to someone recently diagnosed just after the menopause with highly active RRMS (which may have been clinically silent pre-menopause, I'm not sure whether it is completely new)? Can you see any downsides to starting HRT in this scenario at a point where one of the highly effective DMTs seems to be working?
Thank you for this…very timely for me too. I’m 53, diagnosed 14 years ago (had it for 20). I am about to contact my GP about started HRT as my limbs and joints ache and due to the osteoporosis risk and the protection HRT can provide. Ignored the menopausal symptoms for a while as it’s easy to put every health issue down to MS. Thanks for dealing with this issue, have never found much written about it.
I am 57 and diagnosed with MS 18 months ago, pretty much the same time as my periods stopped and the hot flushes set in. My GP has offered me HRT but I was very uncertain and needed to do more homework on the subject. I think I will now return to my GP and take up his offer. It was the breast cancer risk which worried me as I have a history of breast cysts. Reading this and other studies have made me see despite this I will be on a fairly level playing field but it will hopefully play an important part my my MS management. Thank you for this information.
Thank you so much for this. I'm quite angry as what was benign MS really kicked off with the menopause 8 years ago and my neurologist wasn't interested. I have a great Gp who gave me HRT when I asked after doing a bit of research 3 years after my menopause started.. The oral treatment was great but discontinued, I have tried natural treatments with no luck. Now on patches not as good as oral but safer I feel. It seems that most neurologists are overwhelmed and can only cope with following a protocol. What a shame.
Wow! Thanks for some excellent advice. 5 years ago I was diagnosed with PPMS at 49 at around the same time i was informed by my GP i was going through the menopause. I didn’t consider HRT as apart from occasional hot flushes and night sweats i had thought the cancer and cardiovascular risks outweighed any benefit. My neurologist certainly didn’t make any suggestions of HRT. Then i read an article of yours about HRT and benefits for MS a few years ago and thought i had missed the boat, thinking that HRT had to be taken at the beginning of the menopause. Today i spoke with my GP with a print out of your menopause article in my hand ready to argue my case but she was in agreement theat i should be prescribed with it. Yay!!!! Can’t wait to start!
Menopause most definitely exacerbated ms symptoms, heat fatigue and hot flushes are a fresh hell. Started HRT and ms symptoms seem a lot better a few months in…things are looking up. I feel positive. I’m less tired, mentally more switched on too. GP was extremely helpful via a 25 minute phone call, a great source of information.
This popped up on my Twitter feed was interested to read about it. I became peri-menopausal about 5 years ago, my cycle was all over the place, then I had my first relapse (diagnosed as CIS). I was on medication to stop blood flow at the time. I put up with the bad cycle, long period, no periods etc. Then after 2 and a half years I had a second relapse/ possibly a third. I was diagnosed with RRMS on Nov 2019. My cycle really affected my MS symptoms and I could barely function. In 2020, after discussions with my MS team, my GP agreed to put me on HRT. It has made a huge difference! I’m also on DMT too, so feeling that I’m hopefully on top of this MS monster for the time being.
Glad to hear that some readers of the Newsletter have been getting second opinions on the advice I have given. Fortunately, it has been congruent with my advice.
It is very important to check facts and get second and third opinions and check other sources. the only way you be confident about what is for real and what is fake is to do due diligence on the contents.
Thank you so much for this post. For the last 18 months my MS seems to have worsened. I have had many problems similar to the case you describe. Perimenopause started for me at age 44 with sleep disturbance being the main symptom and this has had a huge effect on my MS. HRT has numerous benefits on bone health, brain health and in preventing cardiovascular disease(see BHF website). Life with MS is hard enough and certainly perimenopause has made it a million times harder. HRT has really helped. As Neurologists more of you need to be informed about this and how it impacts your MS patients. Please note transdermal HRT does not increase the risk of DVT/PE. Breast cancer risk is increased only slightly after the age of 51 on HRT. This risk is far lower than being obese or drinking>3units of alcohol daily. I would signpost your patients and (doctors) to the “My menopause doctor” website. Get them to download the free Balance app so they can monitor their symptoms and print off the diary to show their GP and discuss HRT with them. Too many women are put on antidepressants to manage menopause when they don’t work for this. Blood tests are often normal in perimenopause. It’s a patients symptoms that count in making the diagnosis. It’s not just about hot flushes and night sweats. Fatigue, anxiety, depression, bladder symptoms, osteoarthritis, fibromyalgia and headaches can all be due to oestrogen deficiency and treated with HRT.
Huge thanks - this is a topic that I’ve brought up/questioned with various medical professionals for the last 10+ years!! Always to be told the same - ‘not enough research ....’ My ms has definitely deteriorated in the last 10 or so years (during menopause) and whether or not my menopause is to blame — ?? I have asked about HRT too and been told ‘no’ (without reason, investigation, etc)
So, I do think your research should be sent to Every professional connected to ms, so HRT can at least, be considered
Thanks again
Keep well /safe
Hi Prof G
49 and menopausal from Berkshire here (sounds like a bad bio on a dating site) I am on Vagifem® 10 mcg pessary thingumy's twice a week and it seems okay. I'm not flushing too much and no more of a nutter than I've always been (I think) please sign me up for the MS-selfie information gathering work
Tracy Doust
Thank you for this extremely helpful and timely post. I am 53 and my spMS diagnosed in 1992. My sleep, moods and reducing abilities I have put down to MS but as I am menopausal maybe that’s more the reason. I will make an appointment with my GP. I just presumed it was a funding issue why GP’s don’t mention HRT!
A hot topic! I am 45 and peri. I have a family history of ductal (not hormonal) breast cancer. I also have high bp and Cholesterol (all being treated with medication, exercise and diet). Hence, I am reluctant to go on HRT. I am lately suffering from an additional symptom of anxiety, I am already on 2x30mg of Duloxetine and am not even sure if it is as a consequence of having MS or if it is due to being peri. Pls help?
Thanks for this article! Also interesting reading the comments. I am 50 and perimenopausal with many different symptoms. Also have RRMS and treated with Ocrevus since my diagnosis a few years ago. Have tried to get HRT twice from my female GP (I just assumed she would be more sympathetic than a male!) and trying again...I have Osteoporosis already. She wants me to have a blood test for my hormones but I understand that they vary day to day anyway. I just need to persevere I guess!
Thanks for posting. Hot flushes raise temperature and my MS has always been affected by raised temperature. Pfizer stopped making many HRT meds due to lack of demand over the last 15 years because of the cancer scare etc. My HRT med was very low dose & I have tried to find a similar low dose progesterone without success. The pharmaceutical companies need to start making a wide selection of HRT meds again as every woman responds differently to them. It's not 'one size fits all'. I told my Neurologist and GP many times that HRT improved my MS but they just smiled patronisingly. Unless I wave research papers in front of them, it's not taken seriously. Sigh.....
Dear Prof G, how long would wwMS stay on HRT and when is it beneficial to start, is it perimenopause or once periods have ceased or can you also start post menopause? Are GP’s more likely to prescribe/refuse at one of these stages? Thank you
Many thanks for this information, it's really useful! Would your advice be the same to someone recently diagnosed just after the menopause with highly active RRMS (which may have been clinically silent pre-menopause, I'm not sure whether it is completely new)? Can you see any downsides to starting HRT in this scenario at a point where one of the highly effective DMTs seems to be working?
Thank you for this…very timely for me too. I’m 53, diagnosed 14 years ago (had it for 20). I am about to contact my GP about started HRT as my limbs and joints ache and due to the osteoporosis risk and the protection HRT can provide. Ignored the menopausal symptoms for a while as it’s easy to put every health issue down to MS. Thanks for dealing with this issue, have never found much written about it.
I am 57 and diagnosed with MS 18 months ago, pretty much the same time as my periods stopped and the hot flushes set in. My GP has offered me HRT but I was very uncertain and needed to do more homework on the subject. I think I will now return to my GP and take up his offer. It was the breast cancer risk which worried me as I have a history of breast cysts. Reading this and other studies have made me see despite this I will be on a fairly level playing field but it will hopefully play an important part my my MS management. Thank you for this information.
Thank you so much for this. I'm quite angry as what was benign MS really kicked off with the menopause 8 years ago and my neurologist wasn't interested. I have a great Gp who gave me HRT when I asked after doing a bit of research 3 years after my menopause started.. The oral treatment was great but discontinued, I have tried natural treatments with no luck. Now on patches not as good as oral but safer I feel. It seems that most neurologists are overwhelmed and can only cope with following a protocol. What a shame.
Wow! Thanks for some excellent advice. 5 years ago I was diagnosed with PPMS at 49 at around the same time i was informed by my GP i was going through the menopause. I didn’t consider HRT as apart from occasional hot flushes and night sweats i had thought the cancer and cardiovascular risks outweighed any benefit. My neurologist certainly didn’t make any suggestions of HRT. Then i read an article of yours about HRT and benefits for MS a few years ago and thought i had missed the boat, thinking that HRT had to be taken at the beginning of the menopause. Today i spoke with my GP with a print out of your menopause article in my hand ready to argue my case but she was in agreement theat i should be prescribed with it. Yay!!!! Can’t wait to start!
Menopause most definitely exacerbated ms symptoms, heat fatigue and hot flushes are a fresh hell. Started HRT and ms symptoms seem a lot better a few months in…things are looking up. I feel positive. I’m less tired, mentally more switched on too. GP was extremely helpful via a 25 minute phone call, a great source of information.
This popped up on my Twitter feed was interested to read about it. I became peri-menopausal about 5 years ago, my cycle was all over the place, then I had my first relapse (diagnosed as CIS). I was on medication to stop blood flow at the time. I put up with the bad cycle, long period, no periods etc. Then after 2 and a half years I had a second relapse/ possibly a third. I was diagnosed with RRMS on Nov 2019. My cycle really affected my MS symptoms and I could barely function. In 2020, after discussions with my MS team, my GP agreed to put me on HRT. It has made a huge difference! I’m also on DMT too, so feeling that I’m hopefully on top of this MS monster for the time being.