Link Between Menopause and Faster Progression of Multiple Sclerosis in Women: UCSF Study - Video

A new study by UC San Francisco has found that menopause revs up the progression of multiple sclerosis (MS). Following menopause, patients' walking slowed down. And there were subtler changes in fine motor skills and cognitive ability.

Women account for 75% of multiple sclerosis patients, and hormones play a significant role in the course of the disease. The study followed 184 women before and after menopause. It was based on data from two UCSF studies, EPIC and ORIGINS, that seek to discover the causes of multiple sclerosis and the way it develops. Participants were evaluated each year for an average of 13 years.

Other research has reached contradictory conclusions about the role of menopause in multiple sclerosis progression. Some studies used a tool called the Expanded Disability Status Scale (EDSS) that primarily focuses on walking assessment.

In the current study, researchers used the multiple sclerosis Functional Composite (MSFC), which captures walking speed as well as other tasks. They found that following menopause, it took participants longer to complete a 25-foot-walk after accounting for age, weight and tobacco use. They also found subtler declines in dexterity and cognition.

The researchers found that a biomarker in the blood called neurofilament light chain (NfL) increased after menopause. This indicates increased degeneration of nerve cells – a hallmark of advancing multiple sclerosis – and validates the multiple sclerosis Functional Composite findings.

Just 31 of the 184 participants (17%) took estrogen therapy, not enough for researchers to be able to draw conclusion about its benefits. Research in animals suggests that sex hormones have neuroprotective effects, and one small study has tested the protective effects of testosterone in men.

“The study shows that menopause represents a unique factor in multiple sclerosis progression, even when we take into consideration the effects of aging,” said Riley Bove, MD, an associate professor of neurology at UCSF. “But we would need large, randomized trials that compare hormone treatment to a placebo before we can know the true effects of hormone therapy in a condition as complex as multiple sclerosis.”

Reference: Silverman, H. E., Bostrom, A., Nylander, A. N., Akula, A., Lazar, A. A., Gomez, R., ... & Bove, R. (2025). Association of Menopause With Functional Outcomes and Disease Biomarkers in Women With Multiple Sclerosis. Neurology, 104(2), e210228.