Urinary symptoms

One of the problems that women with MS face is that they might put almost any symptom they have down to the MS, and concern themselves less about other possibilities. As a general rule, it is important to have any significant symptom you have medically examined. Of particular importance to women is that any urinary symptoms are fully examined, for there is growing evidence that, although many such symptoms are neurological in origin, and are difficult to treat directly, many others are the result of urinary infections, which are, for the most part, treatable. Indeed, if left untreated, such infections can lead to other significant problems.

Routine tests

It is important for women with MS not to neglect other routine tests such as cervical smears and mammograms. If you are taking any immuno- suppressive drugs, such as steroids or interferon-based drugs, you should have such tests more regularly. In a suppressed immune system, it is more likely that precancerous changes will occur in the cervix, for example, and early detection is important.

HRT and the menopause

There doesn’t appear to be any evidence that menopausal changes make MS worse, but do discuss the possibilities of hormone replacement therapy (HRT) with your doctor.

The most obvious benefit of HRT is in reducing the possibility of osteoporosis (thinning of the bones) in someone with MS, who may already have mobility problems, and be in danger of falling from time to time. A combination of osteoporosis and increased likelihood of falling might result in fractures that will be difficult to manage. Whether you have HRT or not, you should have a good intake of calcium, both before and after the menopause. A daily intake of at least 1000 mg is recommended before the menopause, and 1500 mg after it. Dairy products are the easiest way to increase calcium intake, although you may obtain calcium from a range of other calcium-fortified products, or calcium supplements.
Other possible benefits of HRT may include:

• decreased vaginal dryness;
• reduced risk for colon cancer and Alzheimer’s disease;
• possible reduced risk of heart disease;
• possible benefits in certain forms of incontinence.

Disadvantages of HRT may include the continuation of periods, although usually these are light, and there is still some uncertainty about whether HRT increases the risk of breast cancer, although recent research has suggested that a slightly elevated risk occurs only after several years of use of HRT, and that the first 4 or 5 years of use are not associated with an elevated risk. In addition you may feel that HRT is yet another drug you are taking on top of others to manage various aspects of your MS.