Commentary
Video
The Debate About Hormone Replacement Therapy During Menopause in MS: Rhonda R. Voskuhl, MD
Author(s):
The director of the Multiple Sclerosis Program at UCLA discussed the need to consider HRT among women with MS going through menopause, and how HRT can improve its negative effects. [WATCH TIME: 4 minutes]
WATCH TIME: 4 minutes
“Of course, since MS affects women [in a ratio of] 3:1 over men, this is going to be on the minds of three-fourths of the MS population. So, a very interesting debate, and a very important one…. Menopause is bad for women with MS and is bad for even healthy women—by bad I mean they have cognitive symptoms, and in MS not just cognition, but also walking [issues] and other symptoms get worse. And it’s not just symptoms—I should make a caveat of that—it’s actually disability. So in addition to saying in questionnaires that their symptoms are getting worse, more than that, actually longitudinal exams have shown that their disability by objective test is getting worse at menopause."
At MSMilan 2023, the joint ECTRIMS-ACTRIMS meeting, held October 11-13, in Milan, Italy, a “Burning Debate” session was held to discuss the 2 sides of discussion around the use of hormone replacement therapy (HRT) for women with multiple sclerosis (MS) who are going through menopause. Rhonda R. Voskuhl, MD, a professor of neurology, the Jack H. Skirball Chair, the director of the Multiple Sclerosis Program, and faculty in the Comprehensive Menopause Care Program at the University of California, Los Angeles (UCLA), was on the side for the motion.
While on-site at the meeting, Voskuhl caught up with NeurologyLive® to offer her perspective on the debate, providing insight from her years of clinical experience and several published papers on the topic. She explained the connections that have been observed between the clinical effects experienced by women going through menopause and the loss of production of the estrogen hormone. In the debate, she provided an overview of the medical understanding of this relationship and how the replacement of this hormone can negate those symptoms for women.
Additionally, she offered an in-depth look into these symptoms of menopause and how it negatively affects not just the women themselves, but their disease. It can exacerbate challenges with gait and walking, and of course, can lower cognitive function. The need to treat this issue is top of mind for many in the MS patient population, as MS disproportionately affects women compared with men, and with HRTs readily available to be repurposed in this area, Voskuhl noted that it is a solvable problem for the field—though which specific HRT is utilized is key, as estradiol’s binding properties offer more toxicity compared with the pregnancy hormone estriol, a naturally occurring and inexpensive option.
