Effect of hormonal changes on the neurological status in the menstrual cycle of patient with multiple sclerosis

Premenstrual worsening has been often complained by patients with multiple sclerosis (MS). However, there is no quantitative study in the literature regarding premenstrual worsening and there are only a few studies for its reasons. In diseases such as MS, which there are limited evidence about the etiology and the triggers, detection of the variables in menstrual period, which is defined relatively easy, has a great potential to shed light to the disease. In the present study, we aimed to detect whether there was a deterioration in premenstrual period of patients with MS and to measure the observed deterioration and the relationships between demographics, physical and hormonal variables.

This study included 44 patients with MS, who were diagnosed according to McDonald criteria, and 14 healthy controls. For two consecutive cycles, cases were evaluated on the basis of neurological functions in the premenstrual and ovulation phases. In each examination, blood samples were obtained for detection of the levels of sex hormones (FSH, LH, E2, Progesterone). In the first and the fourth examinations, we applied Multiple Sclerosis Functional Composite (MSFC).

Patients with MS showed poor performance in all used measurements than the healthy controls. Premenstrual period was worse based on cognitive aspects than the ovulation period in both MS patients and healthy controls. This was more evident in patients with MS. Patients treated with immunomodulatory agents had better cognitive performance than those were not given these agents.

In our study, the patients with MS were found to be worse in cognition, and physical performance when compared with the healthy group. In premenstrual period, cognitive functions, and physical performance deteriorated in patients with MS. Healthy people seemed to be deteriorated on cognition measured with Paced Auditory Serial Addition Test.