Menopause and multiple sclerosis: A scoping review of symptoms, disease course, and lived experience

Abstract

Menopause influences disease activity in women with multiple sclerosis. This scoping review mapped current evidence on menopause in women with multiple sclerosis across symptom, disease, biological, and lived experience domains. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was preregistered on Open Science Framework (DOI 10.17605/OSF.IO/H8QBM). PubMed/MEDLINE, Embase, Web of Science, Scopus, CINAHL, and PsycINFO were searched for studies between January 1, 2018, and April 29, 2025. Two reviewers independently screened records with third-party adjudication. Eligible studies included women with multiple sclerosis (peri-, menopausal, or postmenopausal) and examined menopause-related outcomes. Data were synthesized descriptively across four domains: symptomatology, disease course, biological mechanisms, and quantitative patient perspectives. Of 7862 records, 19 studies were included, of which 18 were observational (cross-sectional, retrospective, longitudinal) and one a feasibility trial of menopausal hormone therapy. Menopause definitions varied (≥12 months amenorrhea, self-reported, biological, or analytic/time-varying). Most participants had relapsing-remitting multiple sclerosis with mild to moderate disability. Relapse activity declined after menopause, whereas indices of neurodegeneration and functional decline worsened. Symptoms often intensified and overlapped with aging. No studies captured patient perspectives using qualitative or mixed-method designs and relied solely on patient-reported outcomes. Evidence suggests menopause may accelerate multiple sclerosis progression, with reduced inflammation but greater neurodegeneration and symptom burden. Research is constrained by heterogeneity in accounting for age, inconsistent menopause definitions, and lack of qualitative studies. Clinicians should recognize overlapping menopausal and multiple sclerosis symptoms to inform individualized care. Future priorities include standardized menopause definitions and age-specific analytic frameworks in future mechanistic and qualitative MS research.