ACTRIMS 2026 | Sex differences in MS: disease presentation and the impact of physiologic hormonal phases

Yeah, so as you mentioned, there definitely have been demonstrated sex-specific differences in many of the demyelinating diseases, including MS, not just in actual susceptibility or demographics, we know there’s a greater female predominance in the MS population. And this also translates to differences in presenting symptoms. So, for example, MS females tend to present with more sensory or visual symptoms and males with motor symptoms. And there’s also demonstrated sex differences in kind of disease activity and progression with women kind of more, more frequent relapses and inflammatory activity and males with greater disability accumulation and brain atrophy. We also know, too, that there are obviously several physiologic hormonal phases, such as pregnancy and menopause, that can also modulate disease activity. So pregnancy has been shown to have a reduction in relapse rates. And menopause is interesting because also there is a decrease in relapse rate, but also greater disability accumulation. So clearly there’s some strong interaction between the actual sex hormone levels and disease activity. However, studies have kind of looked at these changes as a correlation, but not that many have actually measured the sex hormone levels. So, there have been some, and they tended to either show no difference, or if any difference, it tended to be kind of decreased level of sex hormones in the MS population. This even led to the design of a clinical trial looking at hormone replacement therapy alongside disease-modifying treatment in the treatment of MS, however these results were pretty inconclusive.

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