Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): A systematic review and meta-analysis

Abstract

Abstract Background: Menopause is a physiologic phase in women’s lives. Finding regarding MS course through menopause is diverse and we designed this systematic review and meta-analysis to estimate impact of menopause on relapse rate, and disability status. Methods: PubMed, Scopus, EMBASE, Web of Science, google scholar were systematically searched by two independent researchers on January 1st 2023. They also evaluated conference abstracts and references of the references. Data regarding the total number of participants, first author, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded. Results: A literature search revealed 1024 records, after deleting duplicates we had 660 records. Twenty-one full texts were evaluated, and finally four studies remained for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of menopause ranged between -1.04, and -0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15)(I2=73.6%, P=0.02). Mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. the SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change estimated as 0.56(95% CI: 0.38, 0.73)(I2=0, P=0.4). Conclusion: The result of this systematic review and meta-analysis show that menopause cause a decrease in relapse rate, unlike an increase in disability status.