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This Swedish nationwide registry study of 7,623 women with multiple sclerosis aged 40-60 years found that hormone replacement therapy (HRT) was associated with a 30% lower risk of reaching sustained moderate disability (EDSS 4.0) but showed no significant association with severe disability progression (EDSS 6.0) or disease relapses. The findings suggest HRT does not worsen MS outcomes and may offer modest protective effects against moderate disability, though no clear dose-response relationship was observed and menopausal status was not directly measured.
Why it matters
These results provide reassurance to women with MS considering HRT for menopausal symptoms, as they suggest HRT does not increase relapse risk or accelerate severe disability. However, the lack of verified menopausal status data and the modest benefit at only one disability threshold means clinicians should interpret these findings cautiously until confirmed in additional studies with more complete menopausal characterization.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Evidence on menopausal hormone replacement therapy (HRT) and disability progression in women with multiple sclerosis (MS) is limited, particularly in the era of high-efficacy disease-modifying therapy. We estimated the association between systemic HRT and sustained disability progression and recurring relapses in a contemporary national cohort. Methods: In a nationwide Swedish registry-based cohort, we followed women with MS aged 40 to 60 years entering from 2006 through 2024, with follow-up through 2025, under a new-user design. Systemic HRT was modeled as time-varying current use and quarterly oral-equivalent dose categories. Outcomes were sustained Expanded Disability Status Scale (EDSS) 4.0, sustained EDSS 6.0, and recurring relapses. Cox models adjusted for baseline covariates and time-varying age and disease-modifying therapy (DMT) class. Results: Among 7,623 women, 1,192 (15.6%) initiated HRT. Current HRT use was associated with a lower hazard of sustained EDSS 4.0 (adjusted hazard ratio [aHR] 0.70, 95% confidence interval [CI] 0.51 to 0.96) but not sustained EDSS 6.0 (aHR 0.80, 95% CI 0.55 to 1.16) or recurring relapses (aHR 1.00, 95% CI 0.74 to 1.36). Dose categories showed no consistent gradient. Raising the cohort-entry age floor to 50 years gave a consistent EDSS 4.0 estimate (aHR 0.62, 95% CI 0.40 to 0.95). Conclusions: HRT was not associated with increased relapse risk or severe disability progression. The lower hazard of sustained EDSS 4.0 was not mirrored at EDSS 6.0 and showed no dose gradient. Given menopausal status was unmeasured, replication in cohorts with verified menopausal status is required for clear clinical interpretation.
Source: Hormone Replacement Therapy and Disability Progression in Women with Multiple Sclerosis