Sometimes It’s Hard to Be a Woman: Women’s Health Issues in MS

Living with multiple sclerosis (MS) presents a unique challenge for women. Until relatively recently, most of the medical and rehabilitation research focused on either males exclusively, or mixed populations without examining differences in gender. As an example, prior to 1990, there was only one publication that examined the unique demographics of women with functional or cognitive challenges. 

When the unique challenges, experienced by women with chronic medical conditions, were explored, it was found – on a population level – that women have increased difficulty accessing basic medical care, surgical procedures, eye glasses, dental care, prescriptions, and mental health interventions. These types of findings prompted the medical world to take notice. New lines of research produced a better understanding of the prevalence of MS among women, as well as unique considerations needed for assessment and treatment in this gender.

Previously it was thought that MS effected females to males 2:1. We now know the ratio is much higher at 4:1. This disease often strikes young adults from the ages of 15-45 years; for women - childbearing years. Furthermore, the same disease process that impacts walking, balance, sensory changes, vision, and cognition, also has a unique impact on the sexual health of women. 

Here are a few things we know about health conditions that uniquely impact women with MS:

MENTAL HEALTH

• MS can impact all stages of a women’s life both physically & psychologically.
• Depression, stress, and low self-esteem are more common among women with MS.
• Peer support and social relationships among women protect against depression, stress, low self-esteem, and promote increased independence and self-efficacy.

 SEXUAL HEALTH

• Changing family roles & responsibilities, caused by MS, may create challenges in having and maintaining intimacy.
• There is no evidence that menstruation or menopause impacts relapse rate or progression of MS.
• Between 40-85% of women experience changes in their sexual functioning including decreased genital sensation, libido or sexual interest, vaginal lubrication, and difficulty reaching orgasm.
• Despite a number of options for treatment or intervention, many medical providers don’t ask about sexual symptoms, and patients rarely talk about these changes.
• Women with physical disabilities are rarely offered contraceptive information or options.

 COMMUNICATION IS KEY!

 PREGNANCY

• Pregnancy has NOT been shown to adversely affect MS progression.
• Relapse rates of MS decline during pregnancy & pregnancy is often considered a “protective” time in a women’s life.
• MS does NOT appear to impact the risk for miscarriage, pre- eclampsia, pre-term labor, C-section, child mortality or congenital abnormalities.
• While the diagnosis of MS does not necessitate high-risk healthcare during conception/pregnancy, the symptoms of MS may require greater attention and management.
• NONE of the MS treatments are indicated or approved for use during pregnancy or breastfeeding.  However, some MS medications pose less risk than others, so please discuss specific questions or concerns with your Neurologist and OB- GYN.
• Ideally women should be off any MS treatment 1-3 months before conceiving. (Discuss with your own MD)

Understanding the unique healthcare challenges faced by women with MS has grown exponentially.  However, one of the remaining difficulties is discomfort and stigma around sexual and reproductive health. Let’s reduce this difficulty by: increasing your awareness of these conditions, helping you know what questions to ask, and learning to effectively communicate with your medical provider.