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Does Hormone Replacement Therapy Help Multiple Sclerosis? - M

Does Hormone Replacement Therapy Help Multiple Sclerosis?

Reviewed by Michael Hua, Pharm D
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What Is Multiple Sclerosis?

Muscle spasms, numbness, imbalance, lacking mobility, cognitive decline—these are just a few of the most worrisome symptoms of multiple sclerosis. And, even though there are at least a million people living with MS in the United States, this is a disease that is not yet well understood or treated.

Recent research has been dedicated to better understanding the link between sex hormones and the development of multiple sclerosis, as well as how these hormones may slow the progression of the disease. Here is a closer look at MS, how the disease differs between men and women, and how hormone replacement therapy may have a part to play in treatment.

The central nervous system (CNS), which is made up of the brain and spinal cord, controls information between the brain and body. Multiple sclerosis (MS) is an autoimmune disease that disrupts the important signals between the body and brain because important elements within the CNS are detrimentally affected.

Essentially, when a person has MS, the body's immune system attacks the protective layer of material that surrounds nerve fibers, which is referred to as myelin. In turn, the person with MS can deal with a long list of life-altering symptoms.

There are four recognized types of multiple sclerosis, including:

  • Clinically Isolated Syndrome (CIS) - One instance of an MS episode characterized by trademark neurological symptoms

  • Relapsing-remitting MS (RRMS) - Ongoing relapses of neurological symptoms amid periodic remissions

  • Secondary progressive MS (SPMS) - RRMS that has escalated to a more severe situation with more frequent episodes of neurological symptoms

  • Primary progressive MS (PPMS) - The most progressive form of MS; usually characterized by active episodes of symptoms and symptom progression

The symptoms of MS can vary from person to person and may even vary according to gender. However, the general symptoms include

  • Muscle symptoms, such as spasms, numbness, imbalance, weakness, tremors, or difficult mobility

  • Vision problems, such as pain in the eyes, vision loss, blurred or double vision, and involuntary movement of the eyes

  • Bowel and bladder issues, such as trouble urinating, urinary urgency, incontinence, constipation, or frequent infections

  • Numbness, pain, and tingling in the limbs or different parts of the body

  • Sexual function problems

  • Problems with speech or swallowing

  • Symptoms related to brain function, such as memory loss, depression, mood swings, and lacking attention span

Multiple Sclerosis Symptoms in Females

Research indicates that women are as much as three times as likely to get a multiple sclerosis diagnosis as men. Further, their symptoms may vary due to changes in or instability in relation to hormone levels. For example, patients with MS seem to have fewer issues during the latter half of pregnancy and even for several months after giving birth, which is thought to be related to changes in female hormone levels. In addition, women with MS seem to develop more inflammatory brain lesions than men.

Multiple Sclerosis Symptoms in Males

Men may be less likely to be diagnosed with MS, but they are at a greater risk of experiencing higher levels of neurodegeneration than women. Some research suggests that this is due to the female hormone estrogen that women naturally produce because it does show some neuroprotective qualities. Men may also be more likely to experience cognitive decline or cognitive symptoms than women.

There is no definitive answer to what actually causes MS. Research has been underway for several years to better understand the disease and what triggers the problem in the body. While there is no clear cause, researchers have managed to point out a few factors that could be to blame, such as:

  • Exposure to certain bacteria or viruses, such as the Epstein-Barr virus

  • Geographic location; MS is more prevalent in regions that get less sunlight

  • Potential gene mutations; MS does seem to be more likely if an individual has a family member with MS

Since MS is an autoimmune disease, immune system dysfunction plays a huge role in what brings about the damage to the CNS. However, why the immune system develops this problem to start with is still unclear.

Sex hormones have been suspected to play a role in MS development for some time due to the fact that pregnant women have fewer disease symptoms in later pregnancy. There are actually several references that yield further insight into how the primary sexual hormones like testosterone and estriol have a connection to MS.

Hormone receptors actually affect immune cells; they can actually encourage or deter inflammatory responses in immune cells. This may explain why females have fewer episodes of neurological symptoms during and immediately after gestation but may have heightened MS symptoms after menopause when female reproductive hormones wane. The differences in how MS affects different genders also allude to the fact that sex hormones play a role in the disease.

The four sex hormones that have been clinically proven to have a direct effect on the immune system include estrogen (estrone, estradiol, and estriol), progesterone, prolactin, and androgen (testosterone). Research has shown that two sex hormones in particular—estrogen and testosterone—are most influential in MS development and symptoms. One study found that women with MS had lower testosterone levels than what would be considered normal for healthy women and were more likely to experience brain tissue damage. Likewise, men with MS were more likely to have higher estradiol levels.

Multiple sclerosis treatment protocols have traditionally been all about managing symptoms and taking steps in an effort to slow the progression of symptoms. For example, corticosteroids are often used to deter nerve inflammation, and interferon beta medications are often used to reduce the frequency of neurological episodes. Infusion treatments, physical therapy, and several other prescription medications are commonly used.

Based on the findings that sex hormone levels play a role in MS, recently there has been a greater focus on managing MS with the use of hormone replacement therapy (HRT). HRT for MS can look quite different depending on whether the patient is male or female and what hormonal deficiencies may be at play.

Estriol for Multiple Sclerosis in Women

Multiple studies have been carried out to show that estriol may be an effective treatment for women with multiple sclerosis, even though the research is considered preliminary. In 2018, researchers found that women treated with estriol experienced improved cognitive performance during testing. Data shows that estrogens, including estriol, offer a number of neuroprotective effects and may decrease the damage to myelin in the CNS.

Remyelination, which is the process of myelin regeneration in the CNS, is slowed or impeded in people with MS. Therefore, once these protective tissues surrounding nerves are damaged, the myelin may not reach a state when it is effectively repaired or regenerated. Some studies have shown that re-myelination may be more prevalent in women during pregnancy, which is when estriol levels are highest. This finding has spurred a great deal of research into estriol therapy for people with MS.

Testosterone for Multiple Sclerosis in Men

Around 40 percent of men who have been diagnosed with MS have low testosterone. Further, lower testosterone levels have been shown to correlate with worsened cognitive and physical conditions among males. Therefore, testosterone replacement therapy has emerged as an obvious treatment for men with MS.

A small pilot study on 10 men with relapsing-remitting MS showed that testosterone replacement improved cognitive performance and slowed brain atrophy. However, further studies need to be done to better understand the mechanisms, risks, and outcomes of the treatment.

While there is still a great deal to learn about just how closely sex hormones may be linked to MS, many patients are already experiencing improved quality of life with HRT for MS. If you are interested in the latest treatment for multiple sclerosis, be sure to talk to your doctor about HRT or contact us at Harbor Compounding Pharmacy for more information. m\Make sure to visit our Bioidentical HRT for Women or Bioidentical HRT for Men pages to find out Harbor Compounding Pharmacy can personalize HRT therapy for you.

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