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Why are three out of four people who develop MS women?

Multiple sclerosis (MS) is a disease that commonly strikes at the prime of people’s lives, when most of us expect to be able to immerse ourselves in careers, start or add to a family, or just live life to the fullest. MS is a disease where the immune system attacks the coating around the nerve fibres – myelin – disrupting the electrical signals from the brain and spinal cord to the rest of the body. With over 25,000 people diagnosed in this country, MS is the most commonly acquired neurological condition affecting young Australians, and it is also three times more common in women than in men. The reason why this is so, is an enduring mystery of MS research. 

Research has revealed several reasons why some people get MS and others don’t. Genetics is one factor, and environmental factors such as whether or not someone is a smoker or has adequate vitamin D levels is another. A prior infection with Epstein Barr Virus which causes glandular fever, also changes the level of risk. The contributions of different factors varies for each individual with MS. 

But why more women? One area of research that may reveal the secret is genetics. While much is known about the genetic risk of MS, the sex chromosomes, the X and Y, are only being looked at now. It may be that gender specific differences in genetics are driving the difference. While it will be fascinating to see what this work uncovers, it will only be part of the story. 

The number of women that are affected by MS has increased over the last 50 years or so, and genetics evolve much more slowly than that, meaning that environmental factors must also be involved. Other suggested factors tie in with the risk factors of MS, changes to sun exposure or vitamin D levels over the last 50 years particularly in women or changes in the rates of smoking among females. 

One strong group of suspects are sex hormones, which in women are mainly oestrogen and progesterone. When MS occurs in children, boys and girls are affected equally, but it is after puberty that the number of females diagnosed sharply rises. After menopause, the risk of developing MS in men and women is again similar. This may be linked to the relative levels of sex hormones in women changing through the course of their lives. It is even possible that the sex hormones interact with other risk factors. Current Australian research is examining how sex hormones could change the immune response to the Epstein Barr virus. 

Pregnancy can also change the course of a women’s MS. During the second and third trimesters, there is a 70% reduction in relapse rates compared to before pregnancy. However, there is also an increased risk of having a relapse after the baby is born, with women three times more likely to have a relapse in the 3-6 months immediately after giving birth. This is thought to be due to the dampening of the mother’s immune system that occur during pregnancy, to ensure that the mother’s immune system does not attack the growing foetus. 

Other research has shown that the male and female immune systems react differently to the threat of infection and the female system may have more trouble switching off after a threat has passed – leading to autoimmunity, such as that seen in MS. Other autoimmune diseases such as lupus are also far more common in women.   

Large well controlled research studies are still needed to understand this fundamental difference between men and women in MS. Understanding the reasons underlying this phenomenon is important, as they may lead to the discovery of new mechanisms that underpin MS and unlock new treatment avenues for everyone.  

MS Australia is a Community Partner of Jean Hailes for Women’s Health Week 2022.

Visit MS Australia’s Women’s Health Week 2022 – MS, good health and wellbeing for more information.

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Jean Hailes Women’s Health Week is the biggest week in Australia dedicated to good health and wellbeing for women, girls, and gender-diverse people.

In collaboration with our state and territory multiple sclerosis (MS) Member Organisations, MS Australia is delighted to have again partnered with Jean Hailes for Women’s Health.

More information about Women’s Health Week 2022 – MS, good health and wellbeing, can be found here.

Women with MS are first and foremost women.

For some women with MS, their general health, a change or issue can impact their condition. Conversely, their MS may impact on their health or an aspect of health exclusive to women such as menopause.

For women living with MS, good health management will help to prevent co-morbidities/other conditions and minimise relapses.

Check me out – health checks at every age

It is important for all women to look after their health through all stages of life and check out any niggles which may be of concern.

Early diagnosis of MS can make a huge difference in terms of treatment and management. We know that time matters in MS and early diagnosis maximises brain health.

MS is a difficult condition to diagnose as there are a wide range of symptoms, and no two people experience MS in the same way.

MS symptoms can be variable and unpredictable, a one-off occurrence, can come and go or change in severity over time.

MS symptoms can be experienced in different parts of the body, depending on which part of the brain, optic nerve or spinal cord is affected. Some symptoms of MS are invisible, meaning people can’t visibly see that someone is experiencing a symptom.

Menopause matters – menopause and perimenopause

Women with MS should chat with their healthcare team to find out how their condition may impact or be impacted by menopause and/or perimenopause.

A significant change in female hormones occurs during menopause. Studies have found that symptom management and choice of MS therapy should be tailored during menopause to account for fatigue and pseudo-MS exacerbations triggered by hot flashes, which can be more prominent.

Menopause and hormone replacement therapy (HRT)

Traditionally it has been thought that symptoms of MS worsen during menopause, although this is difficult to distinguish from the natural progression of disease with age. HRT is a treatment given to help alleviate the symptoms of menopause. HRT usually consists of oestrogen and progesterone, hormones that women stop producing at menopause. Newer studies have reported that women with MS who are treated with hormone replacement therapy saw an improvement of MS symptoms including fatigue and cognitive impairment and have a higher quality of life, but further research is needed.

Pelvic power – pelvic floor health and pelvic pain

Many women with MS experience some form of bladder or bowel issues at some stage. Continence refers to the ability to control bladder or bowel function, and incontinence is the loss of this control. Incontinence is a common symptom for people with MS – although the severity and longevity vary from person to person. For some this may be short-term with a relapse, and for others the problems can be more long-term.

Studies show that pelvic floor exercises and training can help in MS and have been found to significantly improve strength and endurance of the pelvic floor. Significantly, the function of the pelvic floor muscles of people with MS can be improved with a tailored training program from an exercise physiologist or physiotherapist.

With the right information and support pelvic power can be attained, to help women with MS maintain a healthy and active lifestyle.

Mind health – mental wellbeing and brain health

It is important to optimise health and wellbeing in MS and understand the factors to maximise which can include for example smoking cessation, caring for mental health, diet, gut bacteria and more.

Managing stress and mood changes are important for brain health for people living with MS as these factors can affect brain function and increase fatigue for people with MS. Ways to manage these may include taking walks outside, connecting with friends or family, or seeking professional help when needed.

For women with MS, looking after your mind health – mental wellbeing and brain health is vital and will help with other aspects of your condition.

Depression (one aspect of mental health) is common in MS. Around half of people diagnosed with MS will have a depressive episode at some stage – three times higher than for the general population. Identifying depression and seeking early treatment is key to successful management.

With the right information and support, depression, stress-management and other mental health challenges can be managed effectively to maintain a healthy and active lifestyle and optimise mind health.

Move and improve – physical activity and your health

Higher levels of aerobic fitness are associated with faster information processing and preserved brain tissue volume. Being as active as possible can help to preserve brain health in people with MS. Discuss with your healthcare team the recommended exercise guidelines for women with MS – as MS is different for everyone, a tailored program is the way to go.

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If you’re living with MS and want information about health checks, menopause or perimenopause, pelvic issues, mind health and/or physical activity, speak with your neurologist, MS Nurse or GP.

More information about Women’s Health Week 2022 – MS, good health and wellbeing, can be found here.

 

 

Julia Morahan

Dr Julia Morahan, Head of Research, MS Australia

Dr Julia Morahan oversees the research funding and coordinating activities of the organisation. This includes the competitive grant program, national MS research collaborations and commissioned research projects. She also oversees the communication of the latest MS research activities to stakeholders, donors and the broader MS community.
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Why are three out of four people who develop MS women?