Managing MS Across Life's Seasons: Why Women Need Personalized Care at Every Stage

Women with multiple sclerosis (MS) need individualized care strategies that adapt to their changing needs during pregnancy, menopause, and different reproductive life stages. Since women are two to three times more likely to develop MS than men, understanding how hormonal changes and life transitions affect disease management has become crucial for optimal outcomes.

Why Do Women with MS Face Different Challenges at Each Life Stage?

The complexity of managing MS in women stems from how the disease interacts with natural hormonal fluctuations and major life events. "One of the most rewarding aspects of being an MS neurologist is embarking on a long-term journey with each patient through the seasons of her life. Caring for women with MS requires attention to shifting priorities and the evolving balance of risks and benefits of treatment over time," said April Erwin, MD, a neurologist at Rocky Mountain MS Clinic.

During the reproductive years, women with MS tend to have higher relapse rates, making disease control with high-efficacy disease-modifying therapies (DMTs) a primary focus. However, treatment decisions must also account for pregnancy planning, contraception needs, and postpartum relapse risks.

How Does Pregnancy Affect MS Management?

Research has shown that relapse risk generally decreases during pregnancy but increases significantly in the postpartum period. Most DMTs are paused during pregnancy to minimize fetal exposure, which requires careful planning and proactive treatment restart after delivery.

"Research led by and focused on women has completely changed how we treat MS during pregnancy. In the past few years, we have received updated guidance and recommendations for treating MS before, during, and after pregnancy," explained Katrina Bawden, MSN, MSCN, FNP-C, an MS nurse at Rocky Mountain MS Clinic.

The advances in pregnancy-related MS research have included prospective studies and real-world registries that provide longitudinal data, allowing neurologists to make more informed treatment decisions during this critical period.

What Considerations Matter During Menopause and Later Life?

As women with MS enter perimenopause and menopause, their care focus shifts dramatically. Hormonal changes during this period often affect overall symptom burden, leading to discussions about hormone replacement therapy when no contraindications exist.

Key factors that influence treatment decisions during midlife and beyond include:

• Immunosenescence Effects: The natural aging of the immune system affects how the body responds to treatments
• Medical Comorbidities: Additional health conditions become more common and must be factored into treatment plans
• Safety vs. Efficacy Balance: The focus shifts from relapse prevention alone to long-term safety and preserving function and independence
• Symptom Management: Addressing vasomotor symptoms, sleep and cognitive changes, fatigue, and urinary, bowel, and sexual health concerns

During later life stages, MS intersects with the natural aging process, requiring renewed attention to mental health concerns, social support, and coping mechanisms. This is also when clinicians reassess the appropriateness of immunomodulatory therapy and maintain awareness of possible polypharmacy to improve safety and quality of life.

The individualized approach extends beyond medical considerations to lifestyle factors. Treatment selection must account for practical needs such as flexibility for frequent travel, infection risk concerns for mothers with young children, and personal preferences regarding medication administration and side effects.

"From my clinical experience, lifestyle and family planning are two of the most important considerations when caring for women with MS across different life stages. The goal is to choose treatment options that not only effectively manage disease activity, but also fit seamlessly into a woman's life," noted Bawden.