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Hormones and MS: 8 Facts To Know

Posted on June 3, 2024

Hormones — when you think of the term, you probably picture a moody teenager going through puberty. But these chemical messengers are responsible for controlling your metabolism, growth, mood, and sleep throughout your life. In fact, they’re known to play a role in multiple sclerosis (MS) relapses and remissions for some people. Some of the drugs you may take to treat your MS are actually lab-made hormones.

This article will explore eight facts about hormones, the role they play in the body, and how they influence MS. We’ll also discuss how doctors use hormone therapy and steroids to treat MS and relieve your symptoms. To learn more about your specific MS treatment plan, talk to your doctor or neurologist (nervous system specialist).

What Are Hormones?

Hormones are chemical messengers that circulate through the body to regulate several functions. Throughout your body, there are several glands or structures that make and release hormones. These glands are collectively known as the endocrine system.

When you think of hormones, you likely think of sex hormones — such as estrogen and testosterone. The ovaries make estrogen and testosterone in women. In men, the testes produce testosterone. Dozens of other hormones play important roles as well, including:

  • Progesterone — Prepares the uterus for fertilization and the breasts for milk production and breastfeeding
  • Cortisol (corticosteroids) — Affects many body processes and is an anti-inflammatory hormone made by the adrenal glands
  • Thyroid hormone — Regulates your energy levels and metabolism
  • Prolactin — Controls milk production and influences levels of sex hormones
  • Vitamin D — Functions as a hormone with roles in regulating the immune system and endocrine system

Everyone makes these hormones at different levels. It’s important to note that hormone levels rise and fall throughout the day and over time as you age. Certain health conditions can also affect the ability to control hormone levels.

Now that you have a better understanding of what hormones are, let’s explore how they’re related to MS. Below are eight key facts about hormones and MS.

1. Higher Estrogen Levels Are Associated With Milder MS Symptoms

Did you know that women are three times as likely to develop MS as men? Doctors and researchers aren’t sure why, but they believe it may be connected to sex hormones. While both women and men have estrogen and testosterone, women usually make much more estrogen.

Estrogen levels rise and fall throughout menstrual cycles (periods), pregnancy, and menopause. Interestingly, MS symptoms also flare and resolve as estrogen levels fluctuate. This is why many researchers believe estrogen may play a role.

For example, the National Multiple Sclerosis Society explains that many people notice their MS symptoms get worse before and during their period. Individuals who take hormonal birth control (oral contraceptives) tend to have milder MS symptoms around their period.

2. Lower Estrogen Levels Are Associated With Worsening MS Symptoms

As women age, their estrogen levels naturally fall as their bodies stop producing the hormone. Eventually, they go into menopause — the time when their menstrual cycle stops. Common menopausal symptoms include:

  • Hot flashes
  • Fatigue
  • Sleep problems
  • Trouble thinking and concentrating, known as cognitive impairment
  • Mental health conditions, including depression and anxiety
  • Loss of bladder control
  • Weak or thinning bones (osteoporosis)

MS can also cause symptoms similar to menopause, and they may continue to get worse over time. For example, hot flashes from menopause may make heat sensitivity from MS worse.

Overall, research is mixed as to whether low estrogen levels from menopause make MS symptoms worse. Some studies have found that nearly half of women reported MS symptoms worsening after menopause. However, other studies say MS symptoms actually get better as estrogen levels drop. Doctors and researchers need to continue studying the effects of menopause on MS to learn more.

To help relieve menopause symptoms, doctors can prescribe hormone replacement therapy (HRT). People in menopause can take estrogen and/or progesterone to boost their hormone levels. Some studies have found that HRT also helps improve MS symptoms like cognitive impairment and fatigue.

3. Pregnancy and Breastfeeding May Influence MS Symptoms

During pregnancy, the body makes more estrogen. The chances of an MS relapse during the second and third trimesters of pregnancy drop by as much as 70 percent. This is when estrogen levels are highest. Doctors believe this is because the immune system is calmer than usual during pregnancy to stop it from attacking the fetus.

However, there is a threefold increase in the risk of MS relapse within six months of giving birth. These postpartum relapses may be due to changes in hormone levels as they readjust to prepregnancy levels.

4. Men With MS Tend To Have Lower Testosterone Levels

According to MS Australia, men tend to develop MS less often than women. Researchers think this may be because testosterone — the primary male sex hormone — helps protect against autoimmune diseases.

Testosterone interacts with immune cells to dampen the immune system’s activity. This hormone can also cross the blood-brain barrier and protect neurons (nerve cells) from inflammation and damage.

Testosterone can also interact with the thymus. This gland is responsible for making new immune cells. Higher testosterone levels may lead to immune tolerance and stop the immune system from attacking healthy cells and tissues. This may be the reason why men have autoimmune diseases less often, including MS.

Some reports have shown that men with MS may be more likely to have hypogonadism or low testosterone levels. One small study published in the journal Multiple Sclerosis looked at 96 men with relapsing-remitting MS (RRMS) and found more than 1 in 3 had hypogonadism. The study authors also found that lower hormone levels resulted in more severe MS symptoms.

One study of women with RRMS and women without MS, published in the Journal of Neurology, Neurosurgery, and Psychiatry, found MS was associated with lower testosterone levels. The report also showed that women with the lowest hormone levels had the most lesions, as seen with magnetic resonance imaging (MRI).

5. Prolactin Levels Are Higher During MS Relapses

Studies have found that prolactin levels in the blood are higher in people with MS during relapses. Some scientists have suggested that prolactin may play a role in the development of MS. People with clinically isolated syndrome (CIS, a condition that in some people develops into MS) are more likely to eventually be diagnosed with MS if they have higher prolactin levels. This research may eventually prove valuable as a way to predict which people with CIS are more likely to develop MS.

6. Too Little or Too Much Vitamin D Can Be a Problem With MS

Researchers have described vitamin D as a hormone or prohormone — a hormone in an early, unfinished form that’s mostly inactive. Low levels of vitamin D are associated with the development of MS, and there have been many studies looking into whether vitamin D supplements can help with MS. However, it’s also possible to overdose vitamin D, which can lead to muscle weakness, fatigue, and bladder problems. Higher doses of vitamin D don’t seem to prevent MS relapses. If you take vitamin D supplements for MS, it’s best to have your doctor supervise the dosage to prevent complications.

7. Thyroid Hormone May Play a Role in MS Treatment

In MS, the immune system mistakenly attacks myelin — the fatty coating found on nerve cells in the central nervous system (CNS). When myelin is destroyed, nerve cells can no longer properly send electrical signals. This is known as demyelination, which is the main cause of MS symptoms like nerve problems and muscle weakness.

Some studies suggest that thyroid hormone plays a role in myelin production. Researchers in one study looked at mice with demyelination to mimic MS. They found that treating the mice with a drug that mimics the actions of thyroid hormone improved myelination and symptoms.

Doctors have started clinical studies to test whether treatment with a synthetic form of thyroid hormone can help treat MS in humans. A small study of 20 people with MS found that the treatment is safe to use. All the participants had stable disease and didn’t experience a relapse during the study. Some participants also had MS symptom improvement. However, it is important to note that this was a short study with only 20 people. Researchers need to run longer studies with more participants in the future to determine how effectively thyroid hormone can treat MS.

8. Corticosteroids Are Hormones That Help Treat MS

Our bodies naturally make steroid hormones like cortisol in response to stress. These aren’t the same steroids some athletes use to build muscle. Instead, cortisol helps control inflammation, metabolism, and cognition.

Doctors prescribe corticosteroids or lab-made versions of steroid hormones to treat autoimmune diseases. Steroids like methylprednisolone are best for controlling inflammation during MS relapses. A short course of these medications may help relieve more severe relapse symptoms like mobility and vision problems.

Corticosteroids work well to treat MS, but they can come with unwanted side effects. Your doctor will likely only prescribe steroids for three to five days.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 212,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you noticed a connection between your MS symptoms and hormonal fluctuations? Do you have other questions about how hormones influence multiple sclerosis? Share them in the comments below, or start a conversation on your Activities page.

    Posted on June 3, 2024
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    Kiran Chaudhari, M.B.B.S., M.D., Ph.D. is a specialist in pharmacology and neuroscience and is passionate about drug and device safety and pharmacovigilance. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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