To explore how menopause and biological ageing interact in MS, focusing on inflammatory activity, disability progression, symptom burden, and clinical management.
Key Findings:
Current evidence does not support menopause as a clear inflection point for relapse activity or MRI-defined inflammation.
Larger studies do not demonstrate a distinct effect of menopause on EDSS progression after accounting for age.
Reproductive ageing may be associated with increased neuroaxonal vulnerability, but findings are limited.
Symptom burden frequently worsens in midlife due to overlapping effects of hormonal changes, comorbidities, and ageing.
Evidence for menopausal hormone therapy in MS is limited; it may improve symptoms but its impact on disease course remains uncertain.
Interpretation:
Menopause is better understood as part of broader biological ageing, interacting with symptom burden, comorbidity, and reduced physiological reserve.
Limitations:
Heterogeneity in study design, menopause definitions, and outcome measures.
No formal systematic review or meta-analysis was attempted due to variability in studies.
Conclusion:
A menopause-aware approach to MS care is needed to avoid misattribution and optimize management in an ageing, predominantly female population.
