Research Summary

Menopause Not Linked to Increased Disability Progression in Women with Multiple Sclerosis

Kate Young

Key Highlights

  • Menopause was not linked to an increased risk of confirmed disability progression or transition to secondary progressive multiple sclerosis (SPMS).
  • Analysis of nearly 1000 women with relapse-onset MS found no inflection point in disability worsening associated with menopause.
  • Findings suggest menopause is not a primary driver of MS progression in midlife women.

In this large longitudinal cohort study of women with multiple sclerosis (MS), researchers found that menopause did not increase the risk of disability progression or the development of secondary progressive MS. The study indicates that menopause itself is not a major determinant of disease progression in women at midlife.

Most women with MS will experience menopause during their disease course, yet the influence of reproductive aging on MS trajectory has remained uncertain. Clarifying whether menopause contributes to disease worsening is essential to inform prognosis and management strategies for women living with MS.

This retrospective cohort study utilized data from the international MSBase Registry, focusing on women treated at eight Australian neuroimmunology centers between 2018 and 2021. Of the 1468 participants aged 18 years or older who completed women’s health surveys, 987 met criteria for the primary analysis, which required relapse-onset MS, at least three Expanded Disability Status Scale (EDSS) assessments, and reported menopausal status. Researchers applied crude and adjusted Cox proportional hazards models to examine menopause as a time-varying covariate, accounting for age at MS onset, disease duration, baseline disability, relapse history, and use of high-efficacy disease-modifying therapies.

Among 583 premenopausal and 404 postmenopausal participants, the median age at menopause was 48.5 years. After multivariable adjustment, menopause was not associated with higher risks of confirmed disability progression (hazard ratio [HR], 0.95; 95% CI, 0.70-1.29; P = .70) or SPMS (HR, 1.00; 95% CI, 0.60-1.67; P = 1.00). In a secondary analysis of 209 women with longitudinal EDSS measurements before and after menopause, no inflection point in disability worsening was observed.

“While reproductive aging may be additive to the effects of somatic aging, these results do not support menopause as the leading factor for disability progression in older women with MS,” the authors concluded.

Reference:
Bridge F, Sanfilippo PG, Zhu C, et al. Menopause impact on multiple sclerosis disability progression. JAMA Neurol. Published online September 29, 2025. doi:10.1001/jamaneurol.2025.3538