What Women Living With Multiple Sclerosis Need To Know

Like many other health conditions, multiple sclerosis doesn’t discriminate. Anyone can be diagnosed with this autoimmune condition, which affects the brain and spinal cord — but it’s a disease that disproportionately impacts women.

Statistics show that MS is three times more likely to affect females than males. Neurologist Marisa McGinley, DO, explains why this may be the case and how MS symptoms in women can be different from those in men.

Why MS symptoms in women differ

“We still don’t know exactly what causes multiple sclerosis, but we think it’s a combination of factors — some genetic and some environmental,” Dr. McGinley posits.

In particular, research continues to study the possible connections between MS and the hormones estrogen and progesterone. Research suggests that these sex hormones may help protect the immune system and nerve cells, which could play a role in the ways that MS develops or progresses.

Though estrogen and progesterone also factor into men’s health, they’re mostly associated with female reproductive health, working to regulate your menstrual cycle and other processes.

Other factors that may play a role in women’s MS symptoms include:

• Immune response: In general, women are more likely to develop autoimmune conditions than men, possibly due to differences in their immune systems.
• Genetics: Research shows that a specific gene called HLA-DR15 is strongly associated with MS. About 25% of people have this gene, and females are more likely to be carriers.
• Obesity: MS is a chronic inflammatory disease, and body fat (especially belly fat) is a known contributor to inflammation. Studies also suggest that obesity in childhood may be associated with developing MS, especially in women.
• Vitamin D levels: Vitamin D deficiency may play a role in autoimmune disorders like MS. A review of studies found that women whose eating habits included high levels of vitamin D were 33% less likely to have MS.

Research is ongoing into all of these factors and more.

“We may not know exactly what causes it, but at the end of the day, it’s a condition that can affect anyone, no matter your sex, age or other demographics,” Dr. McGinley says.

MS symptoms in women

In general, MS symptoms are the same between the sexes. But there are a few symptoms and experiences that are unique to females.

Sexual dysfunction

Studies show that 40% to 80% of women with MS experience some type of sexual dysfunction. The most common symptoms are:

• Orgasm problems
• Loss of libido
• Vaginal dryness
• Genital numbness

Sometimes, these symptoms are a direct result of MS lesions and the troubles they cause. But they can also be due to other factors, like MS-related fatigue, depression, bladder and bowel changes, or even medication side effects.

“These symptoms are common in women who are living with MS, but they can often go overlooked or unaddressed,” stresses Dr. McGinley. “Sexual dysfunction can have a serious impact on your relationships and your quality of life, though. It’s important to talk to your care team about your options.”

Treatments for these symptoms vary depending on what’s causing them. For example, your provider might make recommendations like using water-soluble lubricants, making changes to your medications or trying cognitive behavior therapy (CBT).

MS before your period

If it seems like your MS symptoms are worse right before your period starts, you’re not imagining things. In the two to three days beforehand, you might experience a temporary worsening of MS symptoms, like:

• Balance problems
• Depression
• Fatigue
• Heat intolerance
• Muscle weakness

That’s likely thanks to changing hormone levels — but researchers aren’t yet entirely sure. In fact, a 2024 survey of more than 5,000 people living with multiple sclerosis asked which women’s health-related research topics they felt were of the highest priority. “Menstrual cycle” was a top response for women under age 40 living with MS.

MS changes during pregnancy

Multiple sclerosis is most often diagnosed between the ages of 20 and 40. And if you’re hoping to become a parent, questions about fertility and pregnancy may be top of mind.

“Many women who are newly diagnosed with MS are at the age when they’re thinking about starting families. They want to know: Can I still have kids?” Dr. McGinley poses. “The answer is absolutely yes.”

If you had a high rate of MS relapse before getting pregnant, you’re at a higher risk of ongoing MS activity throughout your pregnancy. But research shows that for many, pregnancy is a time when MS activity slows down.

“Typically, when you’re pregnant and living with MS, your MS relapse rate progressively declines throughout the three trimesters,” Dr. McGinley says. “Then, during the postpartum period, there’s a risk of disease activity returning.”

If you want to have kids, communicate with your care team before getting pregnant. They can help you manage factors like which medications are best for you and when you’ll need to pause them to try to conceive.

MS in menopause

About 30% of people living with multiple sclerosis are women in perimenopause or menopause. Changing hormone levels during this time of life can cause symptoms that mimic or overlap those related to MS, like:

• Brain fog
• Depression and anxiety
• Fatigue
• Sleep troubles

“It can be hard to tell if these symptoms are being caused by menopause, MS or both,” Dr. McGinley points out. “But either way, they can have a big impact on how you feel and on your overall quality of life.”

There’s not enough data to say whether menopause actually worsens MS, though research shows that it’s often a time when physical and cognitive abilities start to decline. So, it’s especially important to work with your care team to manage both your MS and your menopause symptoms.

Options like hormone replacement therapy, mental health support and lifestyle changes (like modifying your eating and sleep habits) may help improve your symptoms and your quality of life.

A final word on MS in women

MS symptoms vary from person to person, across age, sex, race and other demographic factors. No two people have the same MS experience.

But there are common early signs of MS that you shouldn’t ignore. See a healthcare provider if you experience painful vision loss, facial drooping, persistent weakness or severe dizziness.

These symptoms aren’t unique to MS, and other conditions can cause them, too. But if you are diagnosed with MS, take heart in the knowledge that treatment has come a long way throughout the years.

“It’s important to understand that although this disease isn’t curable, it’s very manageable,” Dr. McGinley assures. “Our goal with treatments is to minimize symptoms and prevent as many relapses as possible so that you can go on to live the life you want to have.”