Impact of natural menopause on multiple sclerosis: a multicentre study

Damiano Baroncini, Pietro Osvaldo Annovazzi, Nicola De Rossi, Giulia Mallucci, Valentina Torri Clerici, Simone Tonietti, Vittorio Mantero, Maria Teresa Ferrò, Maria Josè Messina, Valeria Barcella, Loredana La Mantia, Marco Ronzoni, Caterina Barrilà, Raffaella Clerici, Emanuela Laura Susani, Maria Letizia Fusco, Luca Chiveri, Lucia Abate, Ottavia Ferraro, Ruggero CapraElena Colombo, Paolo Confalonieri, Mauro Zaffaroni

Research output: Contribution to journalArticle

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 languageEnglish
JournalJournal of neurology, neurosurgery, and psychiatry
DOIs
Publication statusE-pub ahead of print - Jun 12 2019

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Menopause
Multicenter Studies
Multiple Sclerosis
Recurrence
Smoking
Menstruation
Masks
Parity
Tobacco Products
Cohort Studies
Observation

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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 journalArticle

Baroncini, D, Annovazzi, PO, De Rossi, N, Mallucci, G, Torri Clerici, V, Tonietti, S, Mantero, V, Ferrò, MT, Messina, MJ, Barcella, V, La Mantia, L, Ronzoni, M, Barrilà, C, Clerici, R, Susani, EL, Fusco, ML, Chiveri, L, Abate, L, Ferraro, O, Capra, R, Colombo, E, Confalonieri, P & Zaffaroni, M 2019, 'Impact of natural menopause on multiple sclerosis: a multicentre study', Journal of neurology, neurosurgery, and psychiatry. https://doi.org/10.1136/jnnp-2019-320587
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. / Impact of natural menopause on multiple sclerosis : a multicentre study. In: Journal of neurology, neurosurgery, and psychiatry. 2019.
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title = "Impact of natural menopause on multiple sclerosis: a multicentre study",
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.",
author = "Damiano Baroncini and Annovazzi, {Pietro Osvaldo} and {De Rossi}, Nicola and Giulia Mallucci and {Torri Clerici}, Valentina and Simone Tonietti and Vittorio Mantero and Ferr{\`o}, {Maria Teresa} and Messina, {Maria Jos{\`e}} and Valeria Barcella and {La Mantia}, Loredana and Marco Ronzoni and Caterina Barril{\`a} and Raffaella Clerici and Susani, {Emanuela Laura} and Fusco, {Maria Letizia} and Luca Chiveri and Lucia Abate and Ottavia Ferraro and Ruggero Capra and Elena Colombo and Paolo Confalonieri and Mauro Zaffaroni",
note = "{\circledC} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
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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 -