Impact of sex on multiple sclerosis therapy

Multiple sclerosis (MS) is a female predominant disease. The prototypic affected individual is a young woman of childbearing age. This article emphasizes the current thinking about this disease, using a sex-based approach. It begins with a review of male vs. female differences in the nervous system and immune system, as well as a general discussion of sex hormones. The demographic and clinical impact of sex on MS prognosis and symptoms is covered. Pregnancy, the best studied sex-based condition, is reviewed and includes updated counseling information on fertility and assisted reproductive technology. MS issues in less well studied areas involving puberty, the menstrual cycle and menopause are also presented. The impact of sex on the MS therapeutic response is considered. The final section covers MS considerations in males. This up to date review provides a comprehensive and succinct approach to sex considerations in MS.