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The Impact of Hormonal Stages of Life in Women with Multiple Sclerosis, A Survey Study: The Menstrual Cycle
Journal article   Peer reviewed

The Impact of Hormonal Stages of Life in Women with Multiple Sclerosis, A Survey Study: The Menstrual Cycle

Kristin A. Johnson, Lyndsey E. DuBose, Anna A. Shah and Brett W. Fling
Archives of physical medicine and rehabilitation
04/13/2026
DOI: 10.1016/j.apmr.2026.04.004
PMID: 41985831

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Abstract

Objective To characterize the impact of the menstrual cycle on disease symptoms, physical functions, and instrumental activities of daily living (IADLs) in American women with multiple sclerosis (MS). Design Cross-sectional study. Setting Community. Participants Sample of 343 naturally menstruating American women with MS recruited from regional and national MS databases. Interventions None. Main Outcome Measures Frequency and timing of menstrual cycle effects on MS symptoms, physical functions, and IADLs. Results Over 85% of survey participants reported an exacerbation of MS disease symptoms or difficulty with physical functions or IADLs during at least one phase of the menstrual cycle. Fatigue, pain, cognitive difficulty, and muscle weakness were the most common MS symptoms to worsen across the menstrual cycle. Most participants reported greater difficulty performing IADLs like household duties and socializing during at least one menstrual cycle phase. Moreover, 39% of participants reported greater difficulty walking and 70% of participants indicated limited ability to exercise during at least one menstrual cycle phase. Most symptoms or functions were worse in the pre-menstrual and menstrual phases. Among those who experienced adverse effects of the menstrual cycle, 71% had not discussed these effects with their healthcare providers (rehabilitation specialists, neurologists). Conclusions This cross-sectional snapshot suggests most American women with MS experience worsening of disease symptoms, physical functions, and IADLs across the menstrual cycle. Rehabilitation specialists may better address the needs of women with MS by engaging in conversations and offering strategies to address the impact of the menstrual cycle. This study addresses the expressed needs of patients by characterizing the impact of the menstrual cycle in women living with MS. This study also incorporates a holistic approach by addressing the impact of the menstrual cycle not only on MS disease symptoms but on physical functions and IADLs.
 Exercise Multiple Sclerosis medical communication menstrual cycle neurorehabilitation

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