Unpacking the Controversy of Hormone Therapy in Multiple Sclerosis: Melinda Magyari, MD

WATCH TIME: 5 minutes

"I believe multiple sclerosis (MS) is a lifelong disease. Therefore, we need to understand how sex hormones influence the disease's progression at different life stages. We should also consider examining the effects of testosterone in men with MS, as they may require support for their symptoms. While this topic is often overlooked, it remains an important aspect of MS research."

Multiple sclerosis (MS), an autoimmune demyelinating and neurodegenerative condition of the central nervous system (CNS), impacts women preferentially more than men. Menopause and the postpartum period are low estrogen states where exacerbations of MS occur in women who have the disease. Prior and ongoing research suggests a critical role for estrogen in alleviating symptoms and reversal of pathology associated with MS.¹ Although evidence is limited in terms of the benefit of estrogen therapy for women at risk for exacerbations with MS, other data shows that estrogen increases neuroprotective effects on the CNS.

Recently at MSMilan 2023, the 9th Joint ECTRIMS-ACTRIMS meeting, held October 11–13, in Milan, Italy, Melinda Magyari, MD, a neurologist in the Danish Multiple Sclerosis Center at Copenhagen University Hospital, and Rhonda R. Voskuhl, MD, the director of the Multiple Sclerosis Program at the University of California, Los Angeles, participated in a “burning debate.” The debate session focused on whether women with MS should start hormone replacement therapy at menopause, with Magyari against the motion and Voskuhl for the motion.

After the debate, Magyari, director of The Danish Multiple Sclerosis Registry, sat down with NeurologyLive® at the meeting to talk about how sex hormones influence the course of MS and shared the current evidence regarding their use in MS treatment. She also spoke about the potential benefits and risks associated with hormone therapy in MS, especially in light of cardiovascular and cancer risks. Additionally, Magyari discussed how hormone therapy can be tailored for individual patients with MS, and the factors that should be considered when recommending its use.

Click here for more coverage of MSMilan 2023.

REFERENCES
1. Christianson MS, Mensah VA, Shen W. Multiple sclerosis at menopause: Potential neuroprotective effects of estrogen. Maturitas. 2015;80(2):133-139. doi:10.1016/j.maturitas.2014.11.013