At some point between their late 40s and early 50s, most women will start to experience the first signs of menopause. During this life transition, estrogen levels in the body decline. Menstrual cycles become unpredictable and eventually stop.

While menopause can bring a welcome respite from your monthly periods, it can also usher in new symptoms like hot flashes, vaginal dryness, and interrupted sleep. For women with multiple sclerosis (MS), it may be hard to tell the difference between symptoms of MS and signs of menopause.

Some women find their MS gets worse once their menstrual cycles end.

If you’re in your late 40s or early 50s and you have MS, it can be hard to tell whether you’re in menopause or you’re experiencing an MS flare. Symptoms of the two conditions can look very similar.

Symptoms common to both menopause and MS include:

  • fatigue
  • bladder problems
  • lack of interest in sex or trouble getting aroused
  • vaginal dryness
  • trouble concentrating
  • sleep problems
  • mood swings
  • depression

If you’re not sure whether you’re entering menopause or your MS worsens, see a gynecologist. A blood test can check levels of estrogen and other hormones to confirm if you’re starting menopause.

Some research has investigated whether MS could affect when a woman first starts to experience symptoms of menopause. A 2018 study found that women with MS started menopause at the same age as women without this condition.

However, in the study, women who took a corticosteroid drug or interferon beta-1b to treat their MS went into menopause slightly earlier. This was a small study, and more research is needed to confirm the effects of MS and its treatments on menopause age.

MS symptoms like weakness, fatigue, and depression can get worse during menstrual periods. That’s why menopause can be a relief to some women with MS. One small study showed that women had fewer relapses after menopause, although their disease continued to progress.

On the other hand, up to half of postmenopausal women surveyed said their symptoms got worse. Plus, hot flashes can intensify MS symptoms because people with MS are more sensitive to heat.

One study found that MS progresses more quickly after menopause. This was true even after the authors accounted for factors that could speed MS progression, like low vitamin D levels and smoking.

The worsening of MS may have to do with the drop in estrogen after menopause. Younger women with MS who have surgery to remove their ovaries also find their disease gets worse after the procedure.

The hormone estrogen seems to protect against MS symptoms. Many women find that their symptoms improve during pregnancy, and then return after they deliver.

Taking estrogen may help slow MS during and after menopause. Estrogen has a protective effect on the nervous system. It reduces inflammation, and it could protect nerves from the damage that causes MS symptoms.

In one study published in the journal Neurology, postmenopausal women with MS who went on hormone therapy reported better physical function than those who didn’t take hormones. A phase II study of 164 women with MS showed that taking estrogen in addition to the MS drug glatiramer acetate reduced relapse rates compared to an inactive pill (placebo).

Larger studies are needed to confirm whether taking hormone therapy during menopause actually helps reduce MS symptoms. Because bone density loss is also a problem in women with MS, hormone therapy could offer the added benefit of reducing osteoporosis risk.

Every woman experiences menopause — and MS — differently. You might find that your symptoms improve during menopause. If they worsen, talk to your neurologist.

If menopause symptoms like hot flashes aggravate your MS, get help from your gynecologist. Hormone therapy helps with menopause symptoms, and it might also improve your MS.