Table 4.

Recommendations to identify and manage the menopause in women with MS.

Provide guidance for women with MS who are menopausal	Offer hormone replacement therapy to women with MS who are experiencing menopause
	Refer women to a healthcare professional with expertise in menopause if treatments do not improve their menopausal symptoms or they have ongoing troublesome side effects
Suggestions for managing symptoms of the menopause and MS-related symptoms simultaneously	Hot flushes: Wear layers of light clothing which can be removed easily if necessary; use a handheld fan or cooling spray; avoid potential triggers such as caffeine, alcohol, smoking and spicy foods; exercise regularly; and have cold drinks.
	Night sweats: Sleep in a cool and well-ventilated room; Keep a cold drink by the bedside; take a cool or lukewarm shower; put a towel on your bed if necessary; wear light clothing to bed; try a cooling mattress topper or pillow
	Low mood: Make sure you are getting enough sleep; exercise regularly; participate in relaxing activities such as yoga or meditation; talk about your feelings; do something you enjoy every day.
	Reduced sex drive: Talk to your partner about how you are feeling; take it slow and make more time for foreplay; try to relax by doing some breathing exercises or practising mindfulness.

MS, multiple sclerosis.