Periods and MS

Many people with MS who menstruate say their symptoms often feel worse in the days leading up to, and during, their periods. The MS symptoms most likely to be made worse are balance, fatigue, depression and muscle weakness.

Find out more about managing these symptoms:

• balance
• fatigue
• depression
• muscle weakness

If you don't have periods, you might still experience the effects of changing hormone levels on your MS. If you have a womb and ovaries it's possible to have a menstrual cycle without bleeding (this is called amenorrhea).

Read about research into hormones and MS

During your period, your temperature can rise by around one degree Celsius. That’s enough for many people to notice their MS symptoms getting worse. Once your period is over and your body returns to its normal temperature these symptoms improve.

Find out more about temperature and MS and ways to manage it

Some MS disease modifying therapies (DMTs) and symptom treatments can affect periods. These include beta interferons (a kind of DMT) and SSRIs (a kind of antidepressant).

For example, these can cause irregular periods or ‘spotting’ (light bleeding) between periods. Side-effects often improve on their own after several months of taking the treatment.

Even so, always mention any side-effects you have to your MS team so they can help you monitor them.

If MS symptoms make it harder for you to use sanitary towels, tampons or menstrual cups, you might find an alternative works well.

For example, if your period flow isn’t too heavy, period pants, designed to soak up the blood, might work for you. And some designs of menstrual cup might be easier to use than others, so it could be worth shopping around. You can find menstrual cups and period pants in chemists and online.

There are ways to try to control your periods if you are finding it difficult to manage them along with your MS. For example you might want to stop periods altogether, or make them lighter.

One option could be a hormone-based contraceptive. This could be taken as a pill, an injection or an implant under the skin. Other options could be an IUD (intrauterine device) which is placed in your womb. Or a silicon hormone ring placed high in your vagina.

You might also be able to have a medical menopause treatment. This is a temporary way to stop periods. With this, you might also need to take HRT (hormone-replacement therapy) to avoid side-effects like the weakening of your bones.

Speak to your doctor or MS team about the best options for you.

If you don’t want to have children, or you’ve completed your family, you might be able to have a permanent procedure called an ablation. This is where the inner surface of the womb is treated to stop it from bleeding. This can stop or reduce periods permanently. An ablation can’t be reversed.

Following this procedure there is a small risk of "ectopic" pregnancies - dangerous pregnancies where the developing foetus can’t survive. To avoid this, you’ll be advised to use extra contraceptives.  

Another way to permanently stop periods is to have a full or partial hysterectomy. That’s surgery to remove the womb. It doesn’t have the risk of dangerous ectopic pregnancies.

A full hysterectomy removes the ovaries as well as the womb. This brings on a sudden early menopause so you might need HRT (hormone-replacement therapy) to manage that.

Find out more about the menopause and MS

Lots of people with MS find it doesn’t affect their choice of contraception. But sometimes MS symptoms can make it harder to use barrier methods like the cervical cap, the ‘sponge’ or condoms. 

It’s good to talk to your sexual partner and doctor about the different options available to you.

Contraception and STIs

Condoms are the only contraception that reduce the risk of catching or passing on many sexually transmitted infections (STIs).

Read more about sexual health on the NHS website 

Some hormonal contraceptives (pill, injection or implant) can increase the risk of clots. And if your MS means that you can’t move around much, you might have a greater risk of blood clots. 

Speak to your doctor about it. There could be other methods that are more suitable. Your doctor might monitor you for any early signs of problems.

Women with MS can usually take the pill and other hormone-based contraceptives, just like other women. But some medications and herbal supplements can raise the chances of them not working.

The evidence suggests that hormonal contraceptives don’t increase relapses or make MS progress more quickly. 

Some studies have also looked at whether these contraceptives might delay the development of MS, or affect the chances of getting MS. But they’ve had mixed results on this and there’s not enough evidence to show an effect. We hope more studies will shed light on this.

Read about research into hormones and MS

DMTs are not thought to affect how well hormone-based contraceptives work. But some medications and herbal supplements can increase the chance of hormone-based contraceptives failing, including: 

• carbamazepine (Tegretol) which is used for spasms and pain
• phenytoin (Epanutin) which is used for severe MS-related pain 
• hypericum extract (St John’s Wort) a herbal remedy for depression

You might want to speak to your doctor or MS team about finding ways to manage your treatments and contraception.

If you take certain DMTs for your MS, it’s important to use reliable contraceptives. That’s because some DMTs could harm a developing baby. 

If you want to get pregnant, you might need to stop taking your DMT or switch to a safer one. With some DMTs you need to stop some weeks or months in advance to be sure they’re out of your system.

Your neurologist or MS nurse can discuss any precautions you’d need to take with your DMT. Speak to them before you make any changes. 

Read more about your DMT

DMTs and sperm

The DMT cladribine (Mavenclad) can interfere with the quality of sperm. This can potentially lead to problems in the baby. So you need to use condoms or other reliable contraception while taking cladribine and for 6 months after the last dose. 

There have previously been worries about the transfer of teriflunomide (Aubagio) to partners through semen. So your neurologist might also discuss precautions if you use teriflunomide.