Man! I Feel Like a Woman
In the iconic words of Shania Twain, “the best thing about bein' a woman, is the prerogative to have a little fun”, but did you know that the mere fact of being a woman puts us at a far higher risk for developing Multiple Sclerosis? It’s true! The female-to-male ratio among MS patients is approximately 3:1. It’s not all bad news for us ladies though. While men are less likely to develop MS, if they do, they have a worse prognosis. Men tend to not recover as fully from MS relapses, they experience higher rates of brain volume loss, they score worse on disability measures, such as the Expanded Disability Status Scale (EDSS), and they are more likely to transition from Relapsing Remitting MS to Secondary Progressive MS. Being male is an independent risk factor for worse disability progression. So, what’s the deal here? Why are women far more likely to develop MS? And why are men more likely to be afflicted by a more severe disease course when they do develop MS? And, perhaps more importantly, is there anything that we can learn from these known differences in MS presentations based on sex?
One obvious difference between men and women is hormones. There’s lots of evidence that hormones play a role in the development and disease course of MS.
In animal models, testosterone shows anti-inflammatory as well as neuroprotective properties. Perhaps greater exposure to testosterone on the part of men could account for some of the reduction in the rate of MS in men compared to women.
Studies have shown that female sex hormones, such as estrogen, may increase the risk of developing MS. This is supported by the fact that MS is more common in women of childbearing age (20-40 years old), when estrogen levels are highest. Other studies have shown that the use of oral contraceptives or hormone replacement therapy may reduce the risk of developing MS in women.
MS disease activity generally decreases during pregnancy, most significantly in the last trimester. During pregnancy there are immune changes, including rising hormone levels that promote an immunotolerant state. But many women with MS experience relapses shortly after giving birth. The relapse rate actually increases above baseline for a few months postpartum before returning to pre-pregnancy levels.
Most studies report a decrease in MS disease activity during breastfeeding. A recent systematic review and meta-analysis concluded that breastfeeding is likely protective against postpartum relapses. However, the degree of disease suppression during breastfeeding is at this point unclear. There has been some speculation that breastfeeding might be as effective as some Disease Modifying Therapies (DMTs). I find this particularly interesting, because my first known MS attack of Optic Neuritis presented exactly two weeks after I stopped nursing my son.
Some women living with MS observe changes in their symptoms based on their menstrual cycle. I’ve had a Mirena IUD the entire time that I’ve been diagnosed with MS, so I can’t say that I’ve noticed this correlation.
Another potential explanation for the gender differences in MS is genetics. It has been shown that there is a higher risk of developing MS in families with a history of the disease. Studies have also identified specific genetic variations that are more common in individuals with MS. However, the extent to which genetics contributes to the gender differences in MS is unclear.
Dr. Shannon Dunn is a scientist at the Keenan Research Centre at St. Michael’s Hospital in Toronto. She is researching the mechanisms of development of autoimmunity in MS, including how various independent MS risk factors, including female sex, enhance the autoimmune process to initiate MS. When I attended my most recent appointment with my neurologist, Dr. Dunn was recruiting for a couple of her studies. I signed up to donate some blood to this research. My neurologist laughed when he mentioned the study and I told him that I had already sent the research team an email, having seen the brochure in the waiting room. He knows that I am always happy to contribute to research, having previously donated a bit of cerebrospinal fluid to one of his studies and having signed up for multiple trips to Iowa in support of Dr. Wahls’ latest research.
I find participating in MS research empowering. We don’t know what causes MS, and we don’t have a cure. If I can do something to help lead to answers, I want to participate. It is my greatest fear that my son or another blood relative will be impacted by MS, and this fear drives me to do what is in my power to improve the landscape for those who follow. I am grateful for those who participated in earlier MS research, because an MS diagnosis isn’t as scary in the 2020s as compared to even just a couple decades ago. I mean, I still don’t recommend it, but at least there are some decent treatment options available these days. MS is a complex and still poorly understood disease, and researchers are constantly working to find new ways to treat and manage it. Participating in research allows those of us living with MS to contribute to this effort and potentially improve our own health and the health of others with the disease. It’s rewarding to serve even a small part in the ground-breaking research being conducted by the scientific community, and to feel like you are making a difference in the lives of others. Perhaps Dr. Dunn’s research will shed light on the differences in MS presentations based on sex, and that may contribute to future treatments, preventions, and (in my wildest dreams) a cure.
I have MS. Man, I feel like a woman! (You’re welcome for this little ear worm!)
P.S.
I am participating in my second annual MS Walk on Sunday May 28, 2023. This year the event will be conducted in-person at the Southshore Community Centre in Barrie. While the event itself is a 5km walk, I plan to also do my own 10km run on the day prior on the Thornton-Cookstown section of the Trans Canada Trail as part of my fundraising efforts. If you would like to join for the run or walk, let me know. I welcome the company! You are invited to join my team, MS Life Among the Clouds.
Please consider donating to support me/my team and this very worthy cause. MS is “Canada’s Disease”, as Canada has one of the highest rates of MS in the world. 1 in 385 Canadians live with MS. By donating, you are supporting the world’s leading researchers (including Dr. Dunn!) in discovering the cause, treatments, and cure for MS.
To join my team and/or donate: https://msspwalk.donordrive.com/index.cfm?fuseaction=donordrive.participant&participantID=24442
Thank you in advance to everyone who supports me in my fundraising efforts. Your support truly means the world to me!
