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Review

Female Gender and Reproductive Factors Affecting Risk, Relapses and Progression in Multiple Sclerosis

D'hooghe M.B.a, b · D'Hooghe T.c · De Keyser J.b, d

Author affiliations

aNational Center for Multiple Sclerosis, Melsbroek, bDepartment of Neurology UZ Brussels, Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, and cDepartment of Obstetrics and Gynecology, Leuven Fertility Center, UZ Gasthuisberg, Leuven, Belgium; dDepartment of Neurology, University Medical Center Groningen, Groningen, The Netherlands

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Gynecol Obstet Invest 2013;75:73-84

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Article / Publication Details

First-Page Preview
Abstract of Review

Received: August 02, 2012
Accepted: December 05, 2012
Published online: January 18, 2013
Issue release date: February 2013

Number of Print Pages: 12
Number of Figures: 0
Number of Tables: 3

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: http://www.karger.com/GOI

Abstract

Multiple sclerosis (MS), a chronic inflammatory demyelina-ting and degenerative disease of the central nervous system, is a frequent cause of neurological disability in young adults. Female predominance has increased over the last decades. Although female gender carries a higher risk of developing relapsing remitting MS, being female and at child-bearing age also appears to provide some protection against cognitive decline and against progressive onset MS, an adverse predictive factor when considering long-term disability in MS. The risk of MS in women has been associated with an earlier age at menarche. In most studies, parity did not impact MS risk. However, the recently published association of higher parity and offspring number with a reduced risk of a first demyelinating event suggests a potential suppressive effect. Pregnancy in MS patients has been associated with a reduced relapse rate and a reduction of neurological symptoms, especially in the third trimester. Despite the increased relapse risk in the postpartum period, there is no indication of an adverse effect of childbirth on the long-term course of MS. Fertility treatment in MS has been associated with an increased relapse risk in the following 3-month period, especially when the procedure did not result in pregnancy and gonadotrophin-releasing hormone agonists were used. Altogether, there is substantial evidence to support a regulatory role of sex steroid hormones in MS. In the absence of correlations with single hormone blood levels, we can only speculate about the underlying mechanisms. In conclusion, the increased MS risk in women and the changes in relapse and progression risk in association with reproductive events suggest significant and complex interactions between immune, neuroendocrine and reproductive systems in MS.

© 2013 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Review

Received: August 02, 2012
Accepted: December 05, 2012
Published online: January 18, 2013
Issue release date: February 2013

Number of Print Pages: 12
Number of Figures: 0
Number of Tables: 3

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: http://www.karger.com/GOI


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