Sex effects across the lifespan in women with multiple sclerosis

Kristen M. Krysko, Jennifer S. Graves, Ruth Dobson, Ayse Altintas, Maria Pia Amato, Jacqueline Bernard, Simona Bonavita, Riley Bove, Paola Cavalla, Marinella Clerico, Teresa Corona, Anisha Doshi, Yara Fragoso, Dina Jacobs, Vilija Jokubaitis, Doriana Landi, Gloria Llamosa, Erin E. Longbrake, Elisabeth Maillart, Monica MartaLuciana Midaglia, Suma Shah, Mar Tintore, Anneke van der Walt, Rhonda Voskuhl, Yujie Wang, Rana K. Zabad, Burcu Zeydan, Maria Houtchens, Kerstin Hellwig

Research output: Contribution to journalReview articlepeer-review


Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating central nervous system disorder that is more common in women, with onset often during reproductive years. The female:male sex ratio of MS rose in several regions over the last century, suggesting a possible sex by environmental interaction increasing MS risk in women. Since many with MS are in their childbearing years, family planning, including contraceptive and disease-modifying therapy (DMT) counselling, are important aspects of MS care in women. While some DMTs are likely harmful to the developing fetus, others can be used shortly before or until pregnancy is confirmed. Overall, pregnancy decreases risk of MS relapses, whereas relapse risk may increase postpartum, although pregnancy does not appear to be harmful for long-term prognosis of MS. However, ovarian aging may contribute to disability progression in women with MS. Here, we review sex effects across the lifespan in women with MS, including the effect of sex on MS susceptibility, effects of pregnancy on MS disease activity, and management strategies around pregnancy, including risks associated with DMT use before and during pregnancy, and while breastfeeding. We also review reproductive aging and sexual dysfunction in women with MS.

Original languageEnglish (US)
JournalTherapeutic Advances in Neurological Disorders
StatePublished - 2020


  • breastfeeding
  • multiple sclerosis
  • pregnancy
  • sex differences
  • sex hormones
  • women

ASJC Scopus subject areas

  • Pharmacology
  • Neurology
  • Clinical Neurology


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