Sex effects across the lifespan in women with multiple sclerosis

Author:

Krysko Kristen M.1ORCID,Graves Jennifer S.2,Dobson Ruth34,Altintas Ayse5,Amato Maria Pia67,Bernard Jacqueline8,Bonavita Simona9,Bove Riley10,Cavalla Paola11,Clerico Marinella12,Corona Teresa13,Doshi Anisha14,Fragoso Yara1516,Jacobs Dina17,Jokubaitis Vilija1819,Landi Doriana20,Llamosa Gloria21,Longbrake Erin E.22,Maillart Elisabeth23,Marta Monica24,Midaglia Luciana25,Shah Suma26,Tintore Mar25,van der Walt Anneke1819ORCID,Voskuhl Rhonda27,Wang Yujie28,Zabad Rana K.29,Zeydan Burcu30,Houtchens Maria31,Hellwig Kerstin32ORCID

Affiliation:

1. Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 675 Nelson Rising Lane, Suite 221, San Francisco, CA 94158, USA

2. Department of Neurosciences, University of California San Diego, UCSD ACTRI, La Jolla, CA, USA

3. Preventive Neurology Unit, Wolfson Institute of Preventive Neurology, Queen Mary University of London, London, UK

4. Department of Neurology, Royal London Hospital, London, UK

5. Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey

6. Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy

7. IRCCS Don Gnocchi Foundation, Florence, Italy

8. Department of Neurology, Oregon Health Science University, Portland, OR, USA

9. Department of Advanced Medical and Surgical Sciences, University of Campania, “Luigi Vanvitelli”, Naples, Italy

10. Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco CA, USA

11. Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy

12. Department of Clinical and Biological Sciences, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy

13. Clinical Laboratory of Neurodegenerative Disease, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico

14. Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK

15. Multiple Sclerosis & Headache Research Institute, Santos, SP, Brazil

16. Departamento de Neurologia, Universidade Metropolitana de Santos, Santos, SP, Brazil

17. Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

18. Department of Neuroscience, Monash University, Melbourne, VIC, Australia

19. Department of Neurology, Alfred Health, Melbourne, VIC, Australia

20. Department of Systems Medicine, Multiple Sclerosis Center and Research Unit, Tor Vergata University and Hospital, Rome, Italy

21. Neurologia Integral, Tlalpan, Mexico City, Mexico

22. Department of Neurology, Yale University, New Haven, CT, USA

23. Department of Neurology, Pitie Salpetriere Hospital, Paris, France

24. Neurosciences and Trauma Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

25. Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital, Barcelona, Spain

26. Department of Neurology, Duke University, Durham, NC, USA

27. Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA

28. Department of Neurology, Johns Hopkins University, Baltimore, MD, USA

29. Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA

30. Department of Radiology, Mayo Clinic, Rochester, MN, USA

31. Department of Neurology, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

32. Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany

Abstract

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating central nervous system disorder that is more common in women, with onset often during reproductive years. The female:male sex ratio of MS rose in several regions over the last century, suggesting a possible sex by environmental interaction increasing MS risk in women. Since many with MS are in their childbearing years, family planning, including contraceptive and disease-modifying therapy (DMT) counselling, are important aspects of MS care in women. While some DMTs are likely harmful to the developing fetus, others can be used shortly before or until pregnancy is confirmed. Overall, pregnancy decreases risk of MS relapses, whereas relapse risk may increase postpartum, although pregnancy does not appear to be harmful for long-term prognosis of MS. However, ovarian aging may contribute to disability progression in women with MS. Here, we review sex effects across the lifespan in women with MS, including the effect of sex on MS susceptibility, effects of pregnancy on MS disease activity, and management strategies around pregnancy, including risks associated with DMT use before and during pregnancy, and while breastfeeding. We also review reproductive aging and sexual dysfunction in women with MS.

Funder

National Multiple Sclerosis Society

Publisher

SAGE Publications

Subject

Neurology (clinical),Neurology,Pharmacology

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