Table 1.
Summary of author recommendations for neurologists and other health care professionals.
| Topic | Recommendation |
|---|---|
| Reproductive | |
| Management of symptoms | HT can alleviate vasomotor and other symptoms associated with menopause. HT with a combination of estrogen and progestin is recommended to decrease endometrial and breast cancer risk in postmenopausal women with or without MS (54, 89–91). |
| Bladder symptoms | |
| Consider intravesical botulinum toxin and pelvic floor therapy as options for symptomatic treatment of bladder impairment, especially in women for whom HT or anticholinergics are contraindicated (86). Comprehensive evaluation of bladder function including stress and urge incontinence as well as retention. |
|
| Exogenous hormone use | Exogenous hormones could impact disease course/severity via effects on neuroprotection and inflammation, although research is limited, specifically in an aging population (11–13, 92, 93). |
| Immunological | |
| Infections | Monitor for increased risk of infections, regardless of whether patients are treated with DMTs (94). |
| Comprehensive care | |
| Cancer | Ensure appropriate cancer screening per guidelines, e.g., mammogram, cervical cancer screening, colonoscopy (95). Women with disabilities, including MS, are less likely to get screening (possibly due to clinician biases and more burdensome medical care) (70). |
| Coordinating care with neurologists and other HCPs | Collaborate and communicate with the patient's primary care provider and other HCPs caring for the patient. |
| Neurological | |
| Cognitive impairment | Cognitive evaluation and, if warranted, rehabilitation to improve upon the cognitive domains impaired in MS (96). To date, there are no proven benefits of HT on cognition (76, 78). |
| Psychological | |
| Psychotherapy | Use comprehensive treatment approaches to manage symptoms associated with psychological changes during menopause (97). |
| Regional and societal differences in the experience of menopause | |
| Menopausal status | Consider differences based on racial, ethnic, cultural, or geographical factors, including the age of MS onset and the different experiences of menopausal symptoms (87, 88, 98). |
DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale; HCP, health care professional; HT, hormone therapy; MRI, magnetic resonance imaging; MS, multiple sclerosis.