Multiple Sclerosis and Hormonal Replacement Therapy

Saturday, July 25, 2009, 13:42
Multiple Sclerosis
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Rick:: We’ll go to a question on the telephone, and it is from Michelle, who joins us from St. Louis. Go ahead with your question.
Michelle:: Thank you. It seems that there is a hormonal relationship, some sort of a hormonal relationship at any rate, with MS. And many women get MS in their 40s when maybe they’re in peri-menopause. And I’m wondering if hormonal replacement therapy is something that we should go on sooner rather than later if we have MS.
Rick:: Thanks very much for that question. Michelle?
Michelle:: Sure, I would be happy to answer that. I think we don’t know the answer if hormonal therapy would play a role in treating MS. Certainly the issue of some kind of hormonal tie-in with MS is certainly intriguing. There has been one study that I know of looking at the hormone of pregnancy called estriol. That study was conducted in California and looked at the role of estriol in helping in relapsing-remitting MS to slow down relapses and reduce the disease progression. So, that certainly is an intriguing question, and if we could really zone in on some of the hormonal research, I think that will be helpful in giving us more answers in the future.
Rick:: And am I right in the sense that it’s most intriguing because pregnant women have a dramatic reduction in terms of exacerbations? Is that right?
Michelle:: That’s right, Rick. There is about a 70 percent reduction in relapse rate in the last trimester of pregnancy. So, we know that there’s definitely a hormonal influence in that time, and we’d like to simulate that in real life. I don’t think we want to be pregnant indefinitely.
Rick:: Let’s take an e-mail question. It comes to us from Ruth in Los Angeles, and Ruth writes, “I’ve been on Betaseron since March of 2001. My concern is when we decide to get pregnant, what is going to happen in terms of stopping my therapy?”
Michelle:: The recommendation if you want to become pregnant and you’re on one of the current treatments is to stop the medication before conceiving. And a general recommendation that we give or that I give specifically, is that you may want to consider stopping the medication a few months before you’re ready to conceive. That’s based on the evidence with other medications that you want to have those out of the system maybe a few months before conceiving. We don’t have specific recommendations that it takes so long for the medication to be out of the body. What do you do in your practice?
Dr. Lynch:: I generally have them stop for at least a month before starting to attempt to conceive.

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