AIM Sex hormones have been suggested to have neuroprotective effects in the natural history of multiple sclerosis (MS), particularly in animal studies. The aim of the present review was to retrieve and systematically synthesize the evidence on the effect of menopause and hormonal replacement treatment (HRT) on the course of MS. METHODS A systematic literature search was conducted in the databases MEDLINE (accessed through PubMed), Scopus, clinicaltrials.gov and Cochrane Controlled Register of Trials (CENTRAL). Eligible studies were all those that included women with MS and reported on at least one of the following: a) disability and MS relapse rate before and after menopause, b) serum sex hormone concentrations, c) sexual function, d) age at menopause onset. Effects of HRT on MS clinical outcomes were also assessed. RESULTS Of the 4,102 retrieved studies, 28 were included in the systematic review. Of these, one reported the age at menopause for both controls and women with MS and found no difference between the two groups. There was no difference in the rates of relapse before and after menopause (risk ratio 1.21, 95 % confidence interval 0.91-1.61, p = 0.218). Two intervention studies reported beneficial effects of estrogen therapy on women with MS; however, the majority of women were premenopausal. Three studies addressed the issue of sexual dysfunction in women with MS, but information on hormonal parameters was limited. CONCLUSIONS The age at menopause is not associated with the presence of MS. The evidence on a potential causal effect of estrogen depletion on disability is inconclusive; still, relapse rate seems not be associated with menopause. The effect of HRT on the natural course of the disease remains to be defined.

中文翻译：

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多发性硬化症女性的更年期：系统评价

AIM 性激素被认为在多发性硬化症 (MS) 的自然病程中具有神经保护作用，尤其是在动物研究中。本综述的目的是检索和系统综合关于更年期和激素替代治疗 (HRT) 对 MS 病程影响的证据。方法 在 MEDLINE（通过 PubMed 访问）、Scopus、clinicaltrials.gov 和 Cochrane 对照试验注册中心（CENTRAL）数据库中进行了系统的文献检索。符合条件的研究是所有纳入 MS 女性并报告以下至少一项的研究：a) 绝经前后的残疾和 MS 复发率，b) 血清性激素浓度，c) 性功能，d) 更年期开始的年龄. 还评估了 HRT 对 MS 临床结果的影响。4的结果，检索到 102 项研究，其中 28 项被纳入系统评价。其中，一项报告了对照组和 MS 女性的绝经年龄，发现两组之间没有差异。绝经前后的复发率没有差异（风险比 1.21，95% 置信区间 0.91-1.61，p = 0.218）。两项干预研究报告了雌激素治疗对 MS 女性的有益影响；然而，大多数妇女都处于绝经前。三项研究解决了 MS 女性的性功能障碍问题，但有关激素参数的信息有限。结论 绝经年龄与 MS 的存在无关。关于雌激素耗竭对残疾的潜在因果影响的证据尚无定论；尽管如此，复发率似乎与更年期无关。