Women’s Health and MS

Women are up to three times more likely to get MS than men and are typically diagnosed between the ages of 20 and 40 years. The impact of MS on each person varies greatly, and there are certain health aspects that affect women and men differently. In this section, we’ll will highlight some of the more common health considerations that women living with MS may experience, along with practical tips on how to manage these issues. 

Female hormones, especially estrogen and progesterone, seem to influence the development of MS and its activity throughout a woman’s life. These hormone levels change during puberty, menstrual cycles, pregnancy, after childbirth (post-partum) and during menopause.  Each of these life stages a woman goes through can affect MS differently.

• Puberty: After puberty, MS becomes more common in girls than boys, which suggests that female hormones may play a role in increasing risk.
• Pregnancy: High hormone levels during pregnancy tend to calm the immune system. Many women with MS have fewer relapses during pregnancy, especially in the third trimester.
• Postpartum: Hormone levels drop quickly after childbirth, and this shift can lead to a temporary increase in MS relapses in the first few months after giving birth.
• Menopause: As estrogen levels drop during menopause, some women report changes in their symptoms. After menopause, there are fewer relapses, but MS symptoms can gradually worsen.

Research is ongoing to understand how hormonal changes interact with MS across a woman’s life.

MS does not usually affect a woman’s menstrual cycle regularity. However, hormone changes during the menstrual cycle can affect how some women with MS feel day to day. Many notice that symptoms like fatigue and mood changes, as well as existing symptoms of weakness, numbness, or problems with balance, can feel worse in the days before their period. This is usually short‑term and settles once the period starts. More research is needed to fully understand why these changes happen and how they relate to MS. 

Effects of drugs on the menstrual cycle 

Drugs used to treat MS do not usually affect periods. Speak with your healthcare team if you think your medication is affecting your menstrual cycle and let them know if you experience any side effects. 

Managing menstrual periods

Some women with MS find that symptom worsening with periods can become challenging. Some women with symptoms that affect hand or arm movements may find it hard to use feminine hygiene products. If periods become challenging, you may consider ways of reducing periods or even stopping them altogether, like using extended or continuous birth‑control pills, or hormone‑based intrauterine devices (known as ‘IUDs’). If you are considering this, it’s important to discuss all options with your healthcare provider.

Choosing birth control is a personal decision, and living with MS may shape what options feel right for you. Certain birth control methods can have side effects that overlap with MS symptoms. A healthcare provider can help you review your options and choose a method that is safe and practical for you. If you are not trying to get pregnant, using reliable birth control is important.

Long-Acting Reversible Contraceptives (LARCs)

Long‑acting reversible contraceptives (LARCs) include hormonal and copper intrauterine devices (IUDs). An IUD is a small, T‑shaped device placed inside the uterus by a healthcare provider. Depending on the type, it is usually kept in for 3 to 10 years. Hormonal IUDs can make periods lighter over time and in some people may affect mood, which can be more noticeable if you already experience depression or anxiety. Copper IUDs don’t use hormones and may cause heavier bleeding and cramping at first. 

Birth‑Control Pills 

Combined Pill 

The combined pill contains both estrogen and progestin and is taken once a day. Because it contains estrogen, the combined pill has a small increased risk of blood clots, and this risk is higher in women with significant mobility challenges. It can also cause nausea, breast tenderness, headaches, or mood changes. Some medications and supplements can make the pill less effective, so it’s important to tell your healthcare provider what else you’re taking.

Progestin‑Only Pill 

The progestin‑only pill, often called the mini‑pill, contains only progestin and is taken once a day at the same time each day. It can be a good option for women who cannot use estrogen. It may cause irregular bleeding and like the combined pill, the progestin-only pill can also cause mood changes. 

Vaginal Ring

The vaginal ring is a small, flexible ring that you insert yourself into the vagina. It stays in place for three weeks, then you remove it for one week. It releases the same hormones as the combined pill. Because it contains estrogen, the ring has a small increased risk of blood clots, and this risk is higher in women with significant mobility challenges. Some women also experience vaginal irritation, headaches, or mood changes. 

Transdermal Patch

The patch sticks to the skin and is replaced once a week for three weeks, followed by one patch‑free week. It works like the combined pill but doesn’t require daily dosing. Because it contains estrogen, the patch has a small increased risk of blood clots, which is important to consider for women with significant mobility challenges. It can also irritate the skin and may cause the same hormone‑related side effects as the pill, including mood changes. 

Contraceptive Implant

The contraceptive implant is a small, flexible plastic rod that a healthcare provider places just under the skin of your upper arm. It releases progestin to prevent pregnancy for up to three years. Some women notice changes in their bleeding, which may be lighter, heavier, or more irregular, along with possible mood or weight changes. 

Contraceptive injections

Contraceptive injections contain progestin and are given once every three months by a healthcare provider. Some women experience irregular bleeding, weight gain, or mood changes with this method. It can also affect bone strength, so women with mobility challenges or a history of steroid treatment may need to monitor their bone health.

Barrier Methods

Barrier methods include condoms, internal condoms (also called female condoms), and diaphragms. Condoms are worn on the penis during sex and help prevent pregnancy while also lowering the risk of sexually transmitted infections (STIs). Internal condoms work in a similar way but are placed inside the vagina before sex. A diaphragm is a soft, flexible cup that fits inside the vagina to cover the cervix and is used with spermicide, which is a gel or cream that helps stop sperm from reaching an egg. Women with MS who experience hand weakness, numbness, or coordination changes may find some barrier methods more difficult to use than others. Barrier methods can be less effective than the other methods, and it is important to use them every time.

For more detailed information about contraception visit It’s a Plan. 

Some disease-modifying therapies are linked with a higher chance of certain gynecological issues. This can happen when a medication works to reduce MS disease activity by changing or suppressing the immune system, which can also make it less effective at keeping everyday viruses controlled and vaginal bacteria in balance.

Human papillomavirus (HPV) 

HPV is a common virus spread through sexual contact. Many people clear it naturally, but sometimes it stays in the body longer and can cause changes in the cervix over time. HPV is managed through vaccination and regular cervical screening. In Canada, the vaccine is offered in elementary school, and in many provinces, the HPV vaccine is free for people up to age 26 who missed the school‑based program. In Québec, people who missed the HPV vaccine in elementary school can receive it for free until age 20. The cost and coverage of the vaccine vary across Canada, so some adults may need to pay out of pocket. People who take medications that suppress the immune system may be able to get the HPV vaccine covered through government‑funded health programs. Women should have cervical screening, through Pap tests or HPV testing, as recommended by local public health.  For more information about cervical screening speak to your healthcare provider. 

Vaginal infections

Some treatments can make yeast infections or bacterial infections more common or harder to manage. A woman may notice itching, irritation, or a change in discharge. It’s important to see a healthcare provider so that treatment options for infections can be discussed. 

Herpes simplex virus (HSV)

HSV is a common virus that stays in the body for life once someone has been exposed to it. It’s spread through direct skin‑to‑skin contact with the area where the virus is active. Many people carry the virus without symptoms, and when symptoms do occur, they come and go. This can include oral or genital cold sores. Some DMTs make it harder for the body to keep HSV inactive, which may lead to herpes flare‑ups. Antiviral medications may help reduce symptoms or prevent flare‑ups from happening as often.

Routine screening and medical appointments

Keeping up with regular medical check‑ups with a primary care provider, such as a family doctor, is an important part of staying healthy and staying up to date on routine screening. If you need accommodation or assistance for medical appointments let them know when you book the appointment. This includes making sure the medical building and equipment being used is accessible. 

• Cervical cancer screening usually starts at age 25. Most people need a test every three to five years, depending on their health and after discussing it with a healthcare provider.
• Breast cancer screening usually begins around age 50 with mammograms every two years, though some women choose to start in their 40s after discussing it with a healthcare provider. Many provinces are starting to offer this screening starting at age 40.
• Colorectal cancer screening often starts around age 50.

Nerve damage caused by MS can have an impact on sexual function, and the symptoms of MS can affect mood, interest in sex, and sexual activity. Read Intimacy and Sexuality for more information. 

Family planning is an important topic for many women living with MS. Many want to understand how MS and its treatments might affect pregnancy, breastfeeding, or the timing of starting a family. Talking with a healthcare provider can help women make choices that feel right for them. All women should be on folic acid for at least 3 months before becoming pregnant. Vitamin D should be continued with a maximum recommended dose of 4000 IU daily in pregnancy.

PREGNANCY

MS does not affect women’s ability to get pregnant. However, some medications are not safe to use during pregnancy. Depending on your MS and the treatment you are taking, your healthcare provider may suggest changing or stopping treatment before you try to get pregnant. 

Each MS medication stays in the body for a different amount of time. After you stop taking it, your body gradually clears the drug. This process can take longer for some medications than others. It’s important to talk with your healthcare provider before changing or stopping any medications, because stopping some drugs suddenly can be dangerous. Some MS medications can be continued during pregnancy, and some can be last taken a certain amount of time before becoming pregnant, paused during pregnancy, and restarted after childbirth while breastfeeding. Women should review the safety information about their medications and pregnancy or breastfeeding with their healthcare provider.  

Assisted reproductive technologies (ART)

MS does not affect fertility, but some women may have fertility problems for other reasons and use assisted reproductive technologies (ART), like in‑vitro fertilization (IVF). Some studies have shown that fertility treatments can increase the risk of MS relapses. However, more recent studies show that women with MS can safely use fertility treatments, and continuing an MS medication that’s considered safe for pregnancy during ART may help lower the risk of relapses.  Some fertility medications may be safer than others, so this should be reviewed with your healthcare provider.

What are the risks of my child having MS? 

MS isn’t directly inherited, but people can inherit genetic risk of developing MS.  The general population in North America has about a 0.1-0.3% risk of developing MS. When one parent has MS, the risk of the child developing MS is small, increasing to between 3 and 5%. 

How will having MS affect pregnancy or giving birth? 

MS does not prevent a healthy pregnancy or birth. Research shows that pregnancy, labour, and delivery outcomes in women with MS are similar to those in women without MS. Most women with MS have vaginal births, and MS on its own isn’t a reason to plan a caesarean section. Epidurals and anaesthetics are considered safe for women with MS. 

Pregnancy and relapses

Research shows that pregnancy has a protective effect on MS, with relapse rates decreasing especially in the third trimester (six to nine months pregnant). The reason isn’t fully understood, but changes in hormone levels are thought to play a role. However, in the first three months after the baby is born, the risk of relapse increases. This is thought to happen because hormones return to pre-pregnancy levels. These post-pregnancy relapses can lead to disability, so should be prevented when possible. Overall, pregnancy has no effect on the progression of MS in the long-term; instead, the effect is neutral. 

Some women with MS may need to stay on a carefully selected MS medication during pregnancy. Studies show that stopping certain DMTs before pregnancy can increase the risk of relapses during pregnancy and after birth, so an MS healthcare team may recommend continuing treatment with close monitoring. Some MS medications can be last taken a certain amount of time before becoming pregnant, paused during pregnancy, and restarted after childbirth while breastfeeding. Decisions about treatment should be made together with your healthcare provider, including planning for after your baby is born. 

MS symptoms and pregnancy 

While relapses and some MS symptoms may decrease during pregnancy, some MS symptoms can become harder to manage. For example, fatigue, balance changes, and back pain can increase as the body adapts to carrying the baby. Bladder and bowel symptoms that were present before pregnancy may also feel more noticeable. Speak to your healthcare provider about ways to manage symptoms during pregnancy. 

Medications and pregnancy 

Before you start trying for a family, you should talk with your healthcare provider about your symptoms and any medications you’re taking. Some treatments aren’t recommended during pregnancy, so your provider will want to review everything you’re on. If you become pregnant unexpectedly, it’s important to contact your healthcare provider promptly so you can go through your medications together, as stopping some treatments too quickly can pose risks to you or the baby. If you’re taking a DMT or any other medication, your MS healthcare provider can help you decide whether it’s safe to continue, whether switching makes sense, or if treatment should be paused during pregnancy. In some cases, steroids may be used during pregnancy to help manage relapses. 

PLANNING FOR AFTER THE BABY IS BORN

Giving birth can be very tiring, and it can take time to adjust to caring for a newborn. Planning for support during this period can make things easier. You may want to make a list of family and friends who can help with specific tasks, and look into local health services, community programs for new parents, and support groups. Many people find it reassuring to know what help is available ahead of time.

Breastfeeding

Breastfeeding is safe for most women with MS. It provides good nutrition for babies, and breastfeeding for at least the first 6 months, and for up to 2 years and beyond while introducing solids, is generally recommended. It can help support a baby’s immune system and offers health benefits for both mother and child. Breastfeeding does not increase the risk of MS relapses, and some research suggests exclusive breastfeeding may reduce risk of MS relapses by a small amount in the first few months after giving birth. Some women pump breastmilk and feed it by bottle, which can make it easier for others to help with feeding. It’s important to review your medications with your healthcare provider, because some may not be safe while breastfeeding. However, some MS medications are safe to take while breastfeeding. Bottle feeding of formula is also an option and can make it easier for others to help with feeding.

Preventing relapses after birth 

Women are generally encouraged to start or restart an MS medication soon after giving birth because it can help lower the risk of relapses. Researchers now know more about how different medications pass into breast milk, and certain MS medications can be taken while breastfeeding. Speak with your healthcare provider to choose the best option for you and your baby. 

Postpartum care 

The first several months after having a baby can be demanding, and women with MS may also have a higher chance of relapses during this time. Peripartum depression and anxiety can also occur and are more common in women with MS, so it’s important to pay attention to your wellbeing and reach out to your healthcare team if you have any concerns. Planning for extra help before the baby arrives can make this period easier to manage. Family, friends, and community services can all offer support. 

Read Your guide to postpartum health and caring for your baby for more information (Government of Canada).

Most women reach menopause in their late 40s or early 50s and having MS doesn’t seem to change that timing. Some menopause symptoms can feel a lot like MS symptoms, so they can overlap. Hot flashes can also worsen MS symptoms. It is important to speak with your healthcare providers about these symptoms, as there are options to help symptoms of perimenopause and menopause. For more information read Menopause and MS and Aging Well with MS.

Women have a higher risk of osteoporosis because bone loss naturally speeds up around menopause, and MS can add to that risk if mobility is limited or if someone has needed several courses of steroids. There are different ways to support bone health, including eating a balanced diet, staying active, and using supplements or medications if they’re recommended by your healthcare team. Visit Osteoporosis Canada for more information.