Managing Perimenopause With Multiple Sclerosis
Perimenopause and MS together can be challenging to navigate. Learn how hormonal shifts affect MS symptoms and how to manage both conditions.
The Connection Between Hormones and MS
Multiple sclerosis is a neurological condition in which the immune system attacks the protective myelin sheath around nerve fibres, disrupting signals between the brain and the body. It affects more women than men, and hormones play a meaningful role in how the disease behaves across a woman's life. Many women with MS notice that their symptoms fluctuate with their menstrual cycle, and pregnancy, a high-oestrogen state, often brings a reduction in relapse rates. Perimenopause, with its characteristic drop and fluctuation of oestrogen, represents the reverse of that pattern. For some women, this hormonal change corresponds with a shift in their MS activity or symptom experience. Understanding the relationship between oestrogen and neurological function helps explain why perimenopause deserves careful attention from both the woman with MS and her neurologist.
Symptoms That Are Hard to Untangle
Multiple sclerosis and perimenopause share a striking number of symptoms. Fatigue is central to both. Cognitive difficulties, often described as brain fog or trouble concentrating, appear in both conditions. Bladder urgency and incontinence are common in MS and also occur during perimenopause due to changes in urogenital tissue. Mood disturbance, sleep disruption, and heat sensitivity are all features of both. The practical problem is that a woman with MS entering perimenopause may not know which condition to attribute a new or worsening symptom to. She may assume it is MS progression when it is actually a hormonally driven change, or she may dismiss a genuine MS relapse as a perimenopause symptom. This is why detailed symptom tracking and open communication with all members of your medical team matters so much. Logging symptoms in an app like PeriPlan helps build a record of what is changing over time and when.
Heat Sensitivity in Perimenopause and MS
Heat sensitivity is particularly relevant for women managing both conditions. Many people with MS experience what is known as Uhthoff's phenomenon, where a rise in body temperature temporarily worsens neurological symptoms such as vision changes, weakness, or fatigue. Hot flashes during perimenopause cause sudden and involuntary increases in body temperature, sometimes multiple times per day. This means hot flashes can directly trigger or worsen MS symptoms in heat-sensitive women. Managing this overlap requires proactive strategies. Staying cool through lightweight clothing, a cool sleeping environment, cold water on the wrists or neck during a hot flash, and avoiding exercise in hot conditions are all practical measures. Discussing the frequency and severity of hot flashes with your neurologist, not just your GP, is worthwhile because they affect your neurological wellbeing directly.
Hormones, HRT, and MS
The question of whether hormone replacement therapy is appropriate for women with MS is one that many women bring to their doctors, and the answer is not straightforward. There is no evidence that HRT causes MS to worsen, and some research suggests that oestrogen may be neuroprotective, meaning it could theoretically offer some benefit for the nervous system. However, HRT is not a treatment for MS, and the decision about whether it is appropriate depends on individual circumstances including MS type, disease activity, other medications, and cardiovascular risk. If you are experiencing significant perimenopause symptoms that are affecting your quality of life or making your MS harder to manage, this is a legitimate conversation to have with your GP and your neurologist together. Bringing a symptom log showing the relationship between hormonal symptoms and your MS activity can help make the case for why this needs to be assessed properly.
Fatigue Management for Both Conditions
Fatigue in MS is a neurological symptom that is distinct from general tiredness and does not always improve with rest. During perimenopause, sleep disruption from night sweats and hormonal changes adds a second source of exhaustion on top. Managing this effectively requires strategies tailored to both conditions. Pacing, which means planning activity and rest in balanced intervals rather than exhausting yourself and then recovering, is a well-established approach in MS rehabilitation and translates well to perimenopause management too. Good sleep hygiene, a cool bedroom, and addressing night sweats where possible help protect the quality of whatever sleep you get. Being honest with yourself and others about energy limits on particular days is not giving up. It is intelligent management of a complex physiological situation.
Exercise With MS During Perimenopause
Exercise benefits both MS and perimenopause. For MS, regular physical activity supports mobility, mood, fatigue management, and bladder function. For perimenopause, it supports bone density, cardiovascular health, mood, and sleep. The challenge is that MS-related disability, fatigue, spasticity, or balance difficulties may limit the type and intensity of exercise that is realistic on any given day. Water-based exercise is particularly popular among women with MS because the cool environment prevents overheating while the buoyancy supports joints and movement. Seated strength exercises, walking, yoga adapted for MS, and cycling are other commonly used options. The key is to work with your physiotherapist to develop an approach that is appropriate for your current MS status rather than following a generic perimenopause fitness plan. PeriPlan allows you to log workouts and track your activity over time, which helps you identify patterns in what supports or depletes you.
Looking After Your Mental Health
The psychological load of managing a chronic neurological condition through a significant life transition is substantial. Women with MS already carry higher rates of depression and anxiety than the general population, and perimenopause adds its own hormonal contribution to mood. Feeling overwhelmed, grief about what MS has taken, anxiety about what perimenopause might bring, and frustration at an unpredictable body are all understandable responses to a genuinely difficult situation. Psychological support, whether through a therapist familiar with chronic illness, a peer support group, or mindfulness-based practices, makes a real difference. It is also worth noting that some medications used in MS management can interact with mood, and some perimenopause treatments can affect mood too, so keeping your whole team informed about how you are doing mentally gives them the information they need to help you effectively.
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