• Damiano Baroncini, Pietro Osvaldo Annovazzi, Nicola De Rossi, Giulia Mallucci, Valentina Torri Clerici, Simone Tonietti, Vittorio Mantero, Maria Teresa Ferrò, Maria Josè Messina, Valeria Barcella, Loredana La Mantia, Marco Ronzoni, Caterina Barrilà, Raffaella Clerici, Emanuela Laura Susani, Maria Letizia Fusco, Luca Chiveri, Lucia Abate, Ottavia Ferraro, Ruggero Capra, Elena Colombo, Paolo Confalonieri, and Mauro Zaffaroni.
• Multiple Sclerosis Centre, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy damianobaroncini@gmail.com.
• J. Neurol. Neurosurg. Psychiatr. 2019 Nov 1; 90 (11): 1201-1206.

ObjectiveTo study the effect of natural menopause on multiple sclerosis clinical course.MethodsThis was an observational, retrospective, multicentre, cohort study. Menopause onset was defined by the final menstrual period (FMP) beyond which no menses occurred for 12 months. We included multiple sclerosis (MS) patients with FMP occurred after 2005 and a recorded follow-up of at least 2 years pre-FMP and post-FMP. We excluded patients with primary progressive course, iatrogenic menopause and with other confounders that could mask menopause onset. We compared relapse-rate and expanded disability status scale (EDSS) scores pre-FMP and post-FMP, searching for possible interactions with age, disease duration, cigarette smoking and nulliparity status.Results148 patients were included (mean observation: 3.5 years pre-FMP and post-FMP). Most patients (92%) received disease-modifying therapies, mainly first-lines. After menopause the annualised relapse rate (ARR) significantly decreased (from 0.21±0.31 to 0.13± 0.24; p=0.005), while disability worsened (increase of mean 0.4 vs 0.2 points after menopause; p<0.001). Older age and long-lasting disease were associated with ARR reduction (p=0.013), but not with disability worsening. Cigarette smokers showed a trend to a higher disability accumulation after menopause (p=0.059).ConclusionNatural menopause seems to be a turning point to a more progressive phase of MS. Relapse rate is also reduced after menopause, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease. Cigarette smoking could speed up disability progression after menopause.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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