Abstract
OBJECTIVE: To study the effect of natural menopause on multiple sclerosis clinical course.
METHODS: This was an observational, retrospective, multicentre, cohort study. Menopause onset was defined by the final menstrual period (FMP) beyond which no menses occurred for 12 months. We included multiple sclerosis (MS) patients with FMP occurred after 2005 and a recorded follow-up of at least 2 years pre-FMP and post-FMP. We excluded patients with primary progressive course, iatrogenic menopause and with other confounders that could mask menopause onset. We compared relapse-rate and expanded disability status scale (EDSS) scores pre-FMP and post-FMP, searching for possible interactions with age, disease duration, cigarette smoking and nulliparity status.
RESULTS: 148 patients were included (mean observation: 3.5 years pre-FMP and post-FMP). Most patients (92%) received disease-modifying therapies, mainly first-lines. After menopause the annualised relapse rate (ARR) significantly decreased (from 0.21±0.31 to 0.13± 0.24; p=0.005), while disability worsened (increase of mean 0.4 vs 0.2 points after menopause; p<0.001). Older age and long-lasting disease were associated with ARR reduction (p=0.013), but not with disability worsening. Cigarette smokers showed a trend to a higher disability accumulation after menopause (p=0.059).
CONCLUSION: Natural menopause seems to be a turning point to a more progressive phase of MS. Relapse rate is also reduced after menopause, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease. Cigarette smoking could speed up disability progression after menopause.
| Original language | English |
|---|---|
| Journal | Journal of neurology, neurosurgery, and psychiatry |
| DOIs | |
| Publication status | E-pub ahead of print - Jun 12 2019 |
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Impact of natural menopause on multiple sclerosis : a multicentre study. / Baroncini, Damiano; Annovazzi, Pietro Osvaldo; De Rossi, Nicola; Mallucci, Giulia; Torri Clerici, Valentina; Tonietti, Simone; Mantero, Vittorio; Ferrò, Maria Teresa; Messina, Maria Josè; Barcella, Valeria; La Mantia, Loredana; Ronzoni, Marco; Barrilà, Caterina; Clerici, Raffaella; Susani, Emanuela Laura; Fusco, Maria Letizia; Chiveri, Luca; Abate, Lucia; Ferraro, Ottavia; Capra, Ruggero; Colombo, Elena; Confalonieri, Paolo; Zaffaroni, Mauro.
In: Journal of neurology, neurosurgery, and psychiatry, 12.06.2019.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Impact of natural menopause on multiple sclerosis
T2 - a multicentre study
AU - Baroncini, Damiano
AU - Annovazzi, Pietro Osvaldo
AU - De Rossi, Nicola
AU - Mallucci, Giulia
AU - Torri Clerici, Valentina
AU - Tonietti, Simone
AU - Mantero, Vittorio
AU - Ferrò, Maria Teresa
AU - Messina, Maria Josè
AU - Barcella, Valeria
AU - La Mantia, Loredana
AU - Ronzoni, Marco
AU - Barrilà, Caterina
AU - Clerici, Raffaella
AU - Susani, Emanuela Laura
AU - Fusco, Maria Letizia
AU - Chiveri, Luca
AU - Abate, Lucia
AU - Ferraro, Ottavia
AU - Capra, Ruggero
AU - Colombo, Elena
AU - Confalonieri, Paolo
AU - Zaffaroni, Mauro
N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/6/12
Y1 - 2019/6/12
N2 - OBJECTIVE: To study the effect of natural menopause on multiple sclerosis clinical course.METHODS: This was an observational, retrospective, multicentre, cohort study. Menopause onset was defined by the final menstrual period (FMP) beyond which no menses occurred for 12 months. We included multiple sclerosis (MS) patients with FMP occurred after 2005 and a recorded follow-up of at least 2 years pre-FMP and post-FMP. We excluded patients with primary progressive course, iatrogenic menopause and with other confounders that could mask menopause onset. We compared relapse-rate and expanded disability status scale (EDSS) scores pre-FMP and post-FMP, searching for possible interactions with age, disease duration, cigarette smoking and nulliparity status.RESULTS: 148 patients were included (mean observation: 3.5 years pre-FMP and post-FMP). Most patients (92%) received disease-modifying therapies, mainly first-lines. After menopause the annualised relapse rate (ARR) significantly decreased (from 0.21±0.31 to 0.13± 0.24; p=0.005), while disability worsened (increase of mean 0.4 vs 0.2 points after menopause; p<0.001). Older age and long-lasting disease were associated with ARR reduction (p=0.013), but not with disability worsening. Cigarette smokers showed a trend to a higher disability accumulation after menopause (p=0.059).CONCLUSION: Natural menopause seems to be a turning point to a more progressive phase of MS. Relapse rate is also reduced after menopause, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease. Cigarette smoking could speed up disability progression after menopause.
AB - OBJECTIVE: To study the effect of natural menopause on multiple sclerosis clinical course.METHODS: This was an observational, retrospective, multicentre, cohort study. Menopause onset was defined by the final menstrual period (FMP) beyond which no menses occurred for 12 months. We included multiple sclerosis (MS) patients with FMP occurred after 2005 and a recorded follow-up of at least 2 years pre-FMP and post-FMP. We excluded patients with primary progressive course, iatrogenic menopause and with other confounders that could mask menopause onset. We compared relapse-rate and expanded disability status scale (EDSS) scores pre-FMP and post-FMP, searching for possible interactions with age, disease duration, cigarette smoking and nulliparity status.RESULTS: 148 patients were included (mean observation: 3.5 years pre-FMP and post-FMP). Most patients (92%) received disease-modifying therapies, mainly first-lines. After menopause the annualised relapse rate (ARR) significantly decreased (from 0.21±0.31 to 0.13± 0.24; p=0.005), while disability worsened (increase of mean 0.4 vs 0.2 points after menopause; p<0.001). Older age and long-lasting disease were associated with ARR reduction (p=0.013), but not with disability worsening. Cigarette smokers showed a trend to a higher disability accumulation after menopause (p=0.059).CONCLUSION: Natural menopause seems to be a turning point to a more progressive phase of MS. Relapse rate is also reduced after menopause, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease. Cigarette smoking could speed up disability progression after menopause.
U2 - 10.1136/jnnp-2019-320587
DO - 10.1136/jnnp-2019-320587
M3 - Article
C2 - 31189614
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
SN - 0022-3050
ER -