Hormone replacement in menopausal women with multiple sclerosis

In this issue of Neurology®, Bove et al.1 address whether hormone replacement therapy in the early menopausal years may be associated with better quality of life in women with multiple sclerosis (MS). There may be worsening of disabilities during menopause in women with MS,2 and functional networks of working memory circuitry are influenced by menopausal status.3 Estrogen replacement therapy administered after surgical menopause has shown beneficial effects on verbal memory,4 and a window of opportunity of estrogen treatment for neuroprotection has been proposed.5 In this retrospective analysis of data acquired from the Nurse's Healthy Study including 248 MS cases, the authors determined whether hormone use for at least 12 months was associated with better scores on the 10-item physical functioning assessment (PF10) subscale of the 36-Item Short Form Health Survey (quality of life). Surveys completed between 3 and 10 years after the final menstrual period were assessed (147 MS cases). They found that there was an association between better PF10 scores and estrogen use (mainly Premarin use; Pfizer, New York, NY). Also, duration of hormone treatment was associated with higher PF10 scores. An association between better PF10 scores and hormone use in women without MS was not found, suggesting that hormone treatment may uniquely benefit physical functioning in women with MS.