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

Objective and HypothesisPremenstrual worsening has been often reported by patients with multiple sclerosis (MS). Worsening of premenstrual symptoms caused by hormonal influences has been reported in the MS patients. But there have been no quatitative study regarding premenstrual worsening and there have been few studies for reasons. In diseases such as MS, which there has been limited evidences regarding the etiology and the triggers, detection of the variables in the menstrual period, which defined relatively easy, has a great potential to shed light to the disaese. In the present study, we aimed to detect whether there was deterioration in premenstrual period of patients with MS. If so, we also aimed to measure the observed deterioration and the relationships between demographics, physical and hormonal variables.Material and MethodsWe included 44 patients with MS, who were diagnosed according to McDonald criteria, and 14 healthy controls. For two consecutive cycles, cases have been evaluated on the basis of neurogical functions in the premenstrual and ovulation phase. In each examination blood samples were obtained for detection of level of gender hormones (FSH, LH, E2, Progesteron). In the first and the fourth examinations we applied Multiple Sclerosis Functional Composite (MSFC), Auditory Consonant Trigram (ACT) and Face Symbol Test (FST). In all examinations Expanded Disability Status Scale (EDSS) was accounted and fatigue impact scale (FIC), fatigue severity scale (FSC), Multiple Sclerosis International Quality of Life (MUSIQoL), cognitive visual analog scale (VAS) was applied.ResultsPatients with MS showed poor performance in all used measurements than healthy controls. Premenstrual period was worse based on cognitive aspects than the ovulation period in both MS patients and healthy controls. It was more evident in patients with MS. In premenstrual period, although healthy group showed no physical detoriaton, patients worsened significantly when compared to ovulation period. In premenstrual period, both MS patients and healthy controls deteriorated on the basis of fatigue and quality of life. Patients treated with immunomodulatory agents had better cognitive and physical performance than those had not used.ConclusionIn our study the patients with MS was found to be worse on cognition, physical performance, fatigue and quality of life when compared with healthy group. In premenstrual period, cognitive functions, physical performance, fatigue, quality of life deteriorated in patients with MS. Healthy people seemd to be detoriated on cognition measured with Paced Auditory Serial Additional Test. In evaluation of fatigue, fatigue impact scale found to be more effective than fatigue severity scale.Key WordsMultiple sclerosis, menstrual cycle, premenstrual worsening, disability