Over half of the individuals who live with MS are female. Yet hardly any research has been done on the effects of the menopausal transition on women with MS and on their ability to think clearly. Neuropsychologist Marit Ruitenberg has received funding from the Dutch MS Research Foundation to carry out a study on this issue.
The idea for the research project didn't come from theory alone, but also from talking to women with MS. In 2024 Ruitenberg, together with a team of researchers from Leiden and Amsterdam, visited twenty locations throughout the Netherlands to talk to people with MS and their families about the cognitive symptoms. After a plenary presentation, there was the opportunity to talk in groups of ten attendees with the researchers. 'We didn't want to consider only what we thought was important, but to hear what people themselves need,' Ruitenberg explains.
One particular question kept coming up: women with MS who were getting older and developed symptoms of 'brain fog' wondered what the cause was. Was it the MS, getting older or the menopause? 'We were able to explain the age issue, but we had no answer to the question about the menopausal transition. When we started looking into it, we realised that very little research has been done on it.'
An almost ignored issue
The fact that the menopausal transitione in conjunction with MS has received little attention is part of a broader pattern. It is only in recent years that women's health has gained a more prominent position on the research agenda, after having been ignored for a long time. Hormonal fluctuations make research findings more complex, so female participants were often excluded from medical studies. 'That means you carry out research that you know is relevant for only half of the population, without knowing for sure whether it also applies to the other half,' says Ruitenberg. Insights from cardiology and the field of autism are now showing that this approach is not without consequences: symptoms sometimes show up differently for women.
Fortunately, media attention for the menopause and the influence of hormones on how we function, and funding agencies are issuing calls dedicated to research on women's health.
Cognitive symptoms: MS or actually the menopausal transition?
Many women with MS experience that their symptoms become worse during the menopausal transitione, which may have significant consequences for their work, their independence, and their social life. Cognitive problems, such as processing information more slowly and problems with visual and verbal memory, are experienced by roughly half of the people with MS. These same symptoms are also seen in healthy women in the perimenopause: around six out of every ten women report that they have difficulty thinking clearly and concentrating. For women with MS it is not yet clear whether the symptoms they experience during the menopause are due to their condition or the menopausal transitione, or are a combination of the two.
To investigate this, Ruitenberg examines the cognitive functions of women with and without MS, in different stages of their life, from before to after menopause. Participants complete questionnaires about their own cognitive functioning and mood. In addition, brain scans and blood tests are used to assess both the structure and function of the brain.
The value of working together
'People with MS have shared what is important for them based on their own experience. International researchers contribute other knowledge and expertise, and different areas within psychology look at the issue from their particular perspective,' Ruitenberg explains. 'Together this gives a more complete picture and results in research that is not only scientifically strong, but also aligned with the needs of people with MS.'
Towards better treatments
Ruitenberg hopes that, over the next four years, the research project will provide a better understanding of how the effects of the menopausal transition on cognition differ between women with and without MS. These insights will not only give women with MS a clearer picture, but will also offer leads for new treatments. 'If we have a better understanding of whether the problems with thinking are due to the clinical condition, the menopausal transition, or both, we can then initiate more specific research on finding a possible treatment,' says Ruitenberg. 'We're hoping we will ultimately improve the wellbeing of women with MS.'
