Menstrual cycle fluctuations in multiple sclerosis symptomatology

Abstract

Recent increases in awareness of women's health issues have highlighted the importance of addressing how hormonal changes impact health status. One aspect of current research is addressing how symptomatology of chronic illnesses is affected as a function of menstrual cycle phase. Multiple sclerosis (MS), a heterogeneous disease which disproportionately is diagnosed in premenopausal women, was selected for examining the influence of menstrual cycle phase on symptom severity. MS is a notoriously unpredictable disease, with diversity in both inter- and intra-individual disease course. This investigation quantified changes in the severity of physiological, cognitive, and affective symptoms of MS, both as a function of disease subtype and menstrual cycle phase. Women with relapsing-remitting, primary-progressive, secondary-progressive, and progressive-relapsing MS were primarily recruited through the Western NY/Northwestern PA chapter of the National Multiple Sclerosis Society, as well as through websites devoted to MS. One hundred fifty-two participants completed the Women's Health Survey, the Fatigue Severity Scale, the Modified Beck Depression Inventory, the MS Self-Efficacy Scale, and the Menstrual Attitude Questionnaire. Identical packets were completed one week prior to the anticipated beginning of the next menstrual cycle, as well as one week after the completion of this cycle. Participants' self-reported MS types were verified with consent to obtain their disease subtype from their physician. Results indicated that the distribution of participants with relapsing-remitting MS closely approximates that of this population, which is approximately 70%. The majority of participants were married and employed. Significant effects were produced for participants' scores on the MS Self-Efficacy Scale, as a function of menstrual cycle phase; women evidenced higher scores on this instrument during their postmenstrual period. Only one subscale of the Menstrual Attitude Questionnaire, the denial of any effect of menstruation, produced significant differences as a function of disease subtype and menstrual cycle phase. Differences were not obtained for measures of fatigue and depression, with the exception of women reporting involvement in a relationship having lower Modified Beck Depression Inventory ratings in the postmenstrual phase of their cycles. These results may enhance psychosocial adjustment to MS, given that they provide more specific information regarding fluctuations in symptom severity as a function of disease subtype and menstrual cycle phase.