That time of the month
That time of the month
An explanation why MS symptoms get worse during the second half of the menstrual cycle
“Prof G, why do I get so fatigued around the time of my period and why do I get recurrent numbness and pins and needles in my leg, which clears up after my period?”
I have explained to you that in MS damaged demyelinated and thinly remyelinated axons or nerve fibres have a tendency to block with fatigue and small changes in body temperature. The latter is usually with a raised body temperature (exercise of fever) but some pwMS notice changes in their symptoms when they are cold.
After ovulation, a woman’s body temperature rises by ~0.4℃ (range = 0.3 to 0.6℃) which in someone with MS is enough to cause a temperature-dependent conduction block. In addition, the process of menstruation involves a mild systemic inflammatory reaction that may exacerbate fatigue. I refer to this as catamenial fatigue.
Catamenial = relating to or associated with menstruation
Over the years I have had several female patients with MS who have reported using aspirin, non-steroidal anti-inflammatories (ibuprofen, naproxen) or paracetamol (acetaminophen) to self-manage these two periods of their cycle.
If you suffer from catamenial fatigue you may want to try one of these agents, which almost certainly work by lowering body temperature. Please note many of these medications are available over-the-counter (OTC).
General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust. The advice is intended as general advice and should not be interpreted as being personal clinical advice. If you have problems please tell your own healthcare professional who will be able to help you.
Thank you! I was diagnosed in 1980 and was 27. I reported this same phenomena to my primary care and neurologist every visit. And everyone looked at me like I was slightly off balance. In fact many of my early neurologists told me that some of the symptoms I presented with had nothing to do with my MS. It’s nice to know that your explanation makes a lot of medical/scientific sense out of a confusing phenomena that many women have been waved off through the years.
How does the hormone cycle add to this Prof G? When I was first diagnosed I asked Dr Turner if I could have a hysterectomy as the monthly impact of periods during relapses and recovery were really significant - It felt like I was going back in symptom recovery by several months at each menstruation. I ended up self managing by taking the progesterone only pill for the first time in my life and that helped. Also how will the peri/menopause affect pwMS? Sorry I realise big questions! Thank you