How do you counsel post-menopausal women interested in hormone replacement therapy as a treatment for multiple sclerosis?

Postmenopausal HRT is not established as relapse-prevention, neuroprotection, or progression therapy in MS. I do not recommend HRT to treat MS. I support HRT for bothersome menopausal symptoms when there are no contraindications, as treating sleep disruption, hot flashes, mood symptoms, urogenital symptoms, etc. may substantially improve quality of life and indirectly improve MS symptom burden.

No postmenopausal treatment, including hormone replacement, can be construed as a disease-modifying treatment for MS.

Dr. Avasarala

There is insufficient data to support HRT as a treatment for MS in the way we think about immunotherapy to prevent relapses or MRI activity. The role of menopause and progression in MS is being explored and evidence is mixed currently. We have even less data for HRT and slowing progression at this time. For this reason, I focus on women with perimenopause or menopausal symptoms, as HRT is very effective for these, and can reduce confusion on "what is MS and what is menopause?" I counsel women to...