Researchers do not know what triggers multiple sclerosis (MS). Once it develops, the disease causes the immune system to destroy a type of tissue called myelin that insulates nerve fibers.
Without enough myelin, it is difficult for the nerves to transmit and receive signals properly.
MS randomly affects nerves in the brain, spinal cord, and eyes, meaning that it can cause a wide range of unpredictable physical, mental, and emotional symptoms that vary from person to person.
In this article, we discuss some of the most common symptoms of MS and explain why women might experience symptoms somewhat differently. We also cover diagnosis and treatment.
Image credit: Stephen Kelly, 2019
MS in women
According to the National Multiple Sclerosis Society (NMSS), at least two or three times more women than men receive a diagnosis of MS.
Overall, MS seems to affect men and women similarly. However, a doctor cannot predict which symptoms someone with MS will get, the severity of the symptoms, or the progression of the disease.
The reason for this is that the disease attacks the myelin randomly, and the nerves that it affects can differ from person to person.
Although men and women with MS often experience similar symptoms, certain factors, such as menstruation, pregnancy, and menopause, may influence MS symptoms in women.
Symptoms of MS in women
The symptoms of MS in women are similar to those in men, but they can include additional issues due to hormonal changes.
MS can also affect female sexual health and bladder function differently.
MS symptoms in women include:
1. Vision problems
For many people, a vision problem is the first noticeable symptom of MS.
MS can cause various vision problems, which include:
- blurred vision
- poor color vision or contrast vision
- painful eye movement
- blindness in one eye
- a dark spot in the field of vision
People with MS develop vision problems either because their optic nerves become inflamed or because they have nerve damage in the pathways that control visual coordination and eye movement.
While vision problems due to MS can be scary, most either resolve without treatment or are highly treatable.
2. Numbness
Numbness in the face, body, arms, or legs is another common symptom of MS, and it is often one of the earliest symptoms of the condition.
The numbness can range from mild and barely noticeable to severe enough that it interferes with everyday activities, such as holding objects and walking.
Most periods of numbness from MS resolve without medication and do not become permanently disabling.
3. Fatigue
Fatigue is a common symptom of MS.
About 80 percent of people with MS experience fatigue or unexplained exhaustion.
Sometimes, the cause of fatigue relates to another symptom of MS. For example, people with bladder dysfunction may sleep poorly because they have to wake throughout the night to go to the bathroom.
People with MS who have nocturnal muscle spasms may not sleep well, leaving them feeling tired during the day. MS can also increase the risk of depression, which can cause fatigue.
Another type of fatigue that seems to be unique to MS is called lassitude. A person’s fatigue may be lassitude if it:
- occurs daily
- worsens as the day goes on
- happens in the morning, even after a good sleep
- worsens with heat or humidity
- interferes with daily activity
- is unrelated to physical impairments or depression
4. Bladder problems
Bladder problems affect at least 80 percent of people with MS. These issues occur when scars on the nerves impair nerve signaling that is necessary for the function of the urinary sphincters and bladder.
MS can make it difficult for the bladder to hold urine and may reduce the amount that it can store, causing symptoms such as:
- more frequent or urgent urination
- hesitancy starting urination
- frequent overnight urination
- being unable to empty the bladder
- being unable to hold urine or having urine leaks
5. Bowel problems
Many people with MS experience bowel problems, such as:
Bowel problems can make other MS symptoms worse, especially bladder problems, muscle stiffness, and involuntary muscle spasms.
Researchers think that people with MS have problems controlling their bowels because of the neurological damage that the condition causes. Some people with MS may also have trouble controlling their bowels when they are constipated.
6. Pain
Some research suggests that 55 percent of people with MS experience clinically significant pain, while 48 percent live with chronic pain. Women with MS may be more likely than men to experience pain as a symptom of this condition.
Acute MS pain seems to be due to problems with the nerves that help transmit sensations in the central nervous system.
Some of the acute pain symptoms that have an association with MS include:
- Trigeminal neuralgia, a stabbing pain in the face that people may confuse with dental pain.
- Lhermitte’s sign, a short sensation resembling an electric shock that moves from the back of the head down the neck and spine, usually after bending forward.
- The MS hug, a stabbing, squeezing, painful, or burning sensation around the torso or in the legs, feet, or arms.
Some of the symptoms that people with chronic MS pain may report include:
- burning
- aching
- pins and needles
- prickling
Many people with MS also experience chronic pain as a secondary effect of the condition. For example, it could be due to:
- compensating for gait changes
- muscle stiffness, cramps, and spasms
- incorrect use of mobility aids
- muscle changes from mobility loss
7. Cognitive changes
More than 50 percent of people with MS experience changes in cognition, which means that they may sometimes have trouble:
- processing new information
- learning and remembering new information
- organizing information and problem-solving
- focusing and maintaining attention
- properly perceiving the environment around them
- understanding and using language
- doing calculations
The cognitive symptoms of MS are typically mild to moderate and only affect a few aspects of cognition.
In rare cases, people with MS may experience disabling cognitive problems.
8. Depression
For people with MS, clinical depression is a common symptom.
Clinical depression is one of the most common symptoms of MS. Depression is more common in people with MS than in people with other chronic health conditions.
While almost everyone experiences periods of sadness or grief, clinical depression refers to depressive symptoms that last for a minimum of 2 weeks.
Some of the symptoms of clinical depression include:
- loss of interest in everyday activities
- increase in appetite or appetite loss
- sadness
- irritability
- insomnia or excessive sleep
- fatigue
- feelings of guilt and worthlessness
- difficulty thinking or concentrating
- behavioral changes
- thoughts of death or suicide
Clinical depression can also worsen other MS symptoms, including:
- fatigue
- pain
- cognitive changes
9. Muscle weakness
Many people with MS experience muscle weakness. This symptom is due to damage to the nerve fibers that help control muscles.
People with MS may also experience muscle weakness because a lack of use has led their muscles to become deconditioned over time.
MS-related muscle weakness can affect any part of the body. It can be especially challenging for people with MS to walk and stay mobile when muscle weakness affects their legs, ankles, and feet.
10. Muscle stiffness and spasms
MS can cause spasticity, which is muscle stiffness and involuntary muscle spasms in the extremities, especially the legs.
Some of the signs and symptoms of spasticity include:
- tightness in or around the joints
- painful, uncontrollable spasms in the arms and legs
- lower back pain
- hips and knees that bend and become difficult to straighten
- hips and knees that stiffen while close together or crossed
11. Dizziness and vertigo
Some people with MS experience dizziness and the sensation of being lightheaded, woozy, weak, or faint.
Less commonly, they experience vertigo, which makes it feel as though a person or their surroundings are spinning.
MS may cause vertigo by damaging the pathways that coordinate the spatial, visual, and sensory input that the brain needs to maintain balance in the body.
The symptoms of vertigo include:
- balance problems
- motion sickness
- nausea and vomiting
- being lightheaded
- a spinning sensation
12. Sexual problems
People with MS often experience sexual problems and may find it difficult to get aroused or have an orgasm.
MS may reduce natural vaginal lubrication, potentially making sexual intercourse painful for women.
The disease can also cause sexual problems by damaging nerves in the sexual response pathways that connect the brain and the sexual organs.
People with MS can also experience issues with sex as a result of other MS symptoms, such as:
- muscle spasms and stiffness
- mood or self-esteem changes
- fatigue
13. Emotional changes
MS can cause a wide range of emotional symptoms and changes, including:
- mood swings
- periods of uncontrollable laughter or crying
- irritability
- grief
- worry, fear, and anxiety
- distress, anger, or frustration
The condition is unpredictable, often has fluctuating symptoms, and can become disabling, all of which can be scary for someone.
MS can also cause emotional changes by damaging the nerve fibers in the brain. Some of the medications that people take to manage MS can cause mood changes too.
For example, corticosteroids can have many emotional side effects, including:
- anxiety
- irritability
- agitation
- tearfulness
- restlessness
- fear
14. Difficulty walking
People with MS can develop problems with gait, or how they walk, because of several factors. MS symptoms that affect how a person walks include:
- muscle stiffness and spasms
- numbness or other sensory problems in the hips, legs, ankles, or feet
- fatigue
- muscle weakness
- loss of balance
15. Hormonal effects
There is some evidence to suggest that MS can affect women differently than men due to hormonal changes, including those that occur during:
Menstruation
More research is necessary to draw firm conclusions, but the NMSS state that some studies have found that women with MS have worse symptoms within a week of starting their period.
Studies that used an MRI have also shown that MS disease activity may change according to the different hormonal levels during menstruation.
Pregnancy
Pregnancy can reduce the risk of MS symptom flare-ups, especially during the second and third trimesters.
Researchers think that pregnancy has a protective effect against MS by raising the levels of compounds that help reduce inflammation and the effects of the disease.
Women who are pregnant also have naturally higher levels of circulating corticosteroids, another type of immunosuppressant.
Although pregnancy can temporarily reduce some MS symptoms, flare-ups tend to return in the first 3 to 6 months postpartum. However, in the long term, there is no proven link between pregnancy and a higher risk of disability.
While being pregnant can temporarily reduce the risk of flare-ups, pregnancy also puts a lot of physical stress on the body, which can make certain symptoms of MS worse.
In addition, some of the medications that people use for MS are not safe to take during pregnancy and can worsen symptoms.
Anyone with MS who is pregnant or planning to become pregnant should discuss their medications with their doctor.
Some MS symptoms that pregnancy often exacerbates include:
- fatigue
- gait problems
- bladder and bowel problems
Menopause
MS symptoms may worsen after menopause, possibly because declining estrogen levels adversely affect disease progression.
However, it is difficult to tell whether MS symptoms worsen because of menopause or just as a natural result of aging or the progression of the condition.
Much more research is necessary to understand the relationship between menopause and MS symptoms.
Rarer symptoms
While the symptoms above are the most common, MS affects everyone differently. Less common symptoms of MS include:
Outlook
MS is an autoimmune disease that randomly affects parts of the central nervous system, resulting in unpredictable physical, cognitive, and emotional symptoms.
Although MS tends to affect more women than men, it usually causes similar symptoms. However, women may experience variations in their symptoms due to hormonal changes, such as those that take place during menstruation or menopause.
Vision problems and random localized numbness are often the first symptoms of the condition. Depression, bladder problems, cognitive changes, and pain are also among the most common symptoms of MS.
There is no cure for MS, but different drugs and complementary therapies can typically help manage symptoms or even slow the progression of the condition.
Anyone experiencing concerning symptoms should see a doctor for a proper diagnosis.
