Multiple sclerosis is a predominantly female disease: about 75% of diagnosed individuals are women. This difference is significant and suggests a role of female hormones in the disease. Additionally, women go through specific hormonal periods (menstrual cycle, pregnancy, menopause) that can influence MS symptoms, including cognitive functions. Understanding these specifics allows for better adaptation of care and cognitive stimulation.

Why MS Affects More Women

The reasons for the female predominance of MS are not fully understood, but several hypotheses are put forward by scientific research. This gender difference has actually increased over the decades: the female/male ratio was about 2:1 in the 1970s and now reaches 3:1 or even 4:1 in some regions.

The Complex Role of Hormones

Female sex hormones have complex effects on the immune system and the nervous system. Estrogens can have both pro-inflammatory and anti-inflammatory effects depending on the context. Progesterone has neuroprotective properties that may explain the improvement observed during pregnancy.

These hormonal interactions explain why MS symptoms may fluctuate during the menstrual cycle, improve during pregnancy, and sometimes evolve differently after menopause. Understanding these mechanisms allows for better anticipation and management of disease variations.

The Menstrual Cycle and Cognition

Many women with MS report fluctuations in their symptoms throughout their menstrual cycle. The premenstrual period is often associated with increased fatigue, mood disturbances, and sometimes cognitive difficulties. These variations are explained by hormonal fluctuations and their impact on the brain.

The Phases of the Cycle and Their Effects

• Follicular Phase (days 1-14): After menstruation, estrogen levels gradually increase. Many women report better mental clarity and more energy during this phase.
• Ovulation (day 14): Peak estrogen levels, often associated with good cognitive performance and general well-being.
• Luteal Phase (days 15-28): Increase in progesterone. Some women experience a gradual cognitive slowdown.
• Premenstrual Phase (days 25-28): Hormonal drop often associated with worsening cognitive symptoms, fatigue, and mood disturbances.

Adapting Cognitive Stimulation to the Cycle

• Follicular Phase (after menstruation): Often a period of better cognitive performance, ideal for more demanding exercises with JOE
• Ovulation: Peak energy and mental clarity, take advantage of it to challenge yourself
• Luteal Phase: Transition, stay attuned to your condition and adjust the difficulty
• Premenstrual Phase: Prefer EDITH at an easy level if fatigue is increased, be gentle with yourself

Pregnancy and MS: A Special Period

Pregnancy is generally a favorable period for women with MS. The rate of relapses significantly decreases during the third trimester (about 70% reduction), likely due to hormonal and immune changes related to pregnancy. However, the postpartum period (the months after childbirth) is a time of increased risk for relapses.

Immune Changes During Pregnancy

During pregnancy, the immune system changes to tolerate the fetus, which is genetically half foreign. This immune tolerance has a beneficial effect on MS, which is an autoimmune disease. High levels of estrogens and progesterone also contribute to this improvement.

Cognition During Pregnancy

The famous "pregnancy brain" or "baby brain" also affects women with MS. Memory and concentration issues are common during pregnancy, linked to hormonal upheavals, fatigue, and maternity-related concerns. These difficulties are generally temporary and improve after childbirth, although the sleep deprivation of the early months may prolong them.

During my pregnancy, I continued my easy-level EDITH exercises. It was my daily moment of calm, just for me. After my son was born, I was very tired but gradually resumed. Now he is 2 years old, and I am back to my previous level, even better!

Julie, 34 years old, MS for 7 years, mother for 2 years

Cognitive Stimulation During and After Pregnancy

• First Trimester: Fatigue and nausea may limit activities. Do what you can, without pressure.
• Second Trimester: Often the best time, take advantage of it to maintain your training.
• Third Trimester: MS often improves but physical fatigue increases. Adjust the duration of sessions.
• Postpartum: Priority to rest and the baby. Gradually resume when you feel ready.

Menopause: A Transition to Support

Menopause is an important stage for women with MS. The definitive drop in estrogen can affect cognition and mood. Some studies suggest that menopause may be associated with a faster progression of disability, although the data are still debated. What is certain is that this transition period deserves special attention.

Cognitive Symptoms of Menopause

• Memory Issues: Common during the menopausal transition, affecting name recall, word retrieval, and recent events
• Concentration Difficulties: The famous "mental fog" of menopause, worsened by MS symptoms
• Sleep Disturbances: Hot flashes disrupt sleep, affecting cognitive performance during the day
• Mood Changes: Anxiety and depression, more frequent during this period, can affect cognition
• Increased Fatigue: Menopausal fatigue adds to that of MS

Cognitive Stimulation During Menopause

Menopause is a period when cognitive stimulation is particularly important. It can help compensate for the cognitive effects of hormonal decline and maintain cognitive reserve. It is also a time when it is crucial to take care of brain health for healthy aging.

When I entered menopause, I felt like my memory was deteriorating even more. I intensified my EDITH exercises, and after a few months, I felt a real improvement. I don't know if it's the exercises or hormonal adaptation, but I feel better now.

Isabelle, 52 years old, MS for 18 years

Balancing Womanhood and Cognitive Stimulation

Between professional life, family life, mental load, and managing the disease, women with MS often have a busy schedule. Finding time for cognitive stimulation may seem difficult, but this is precisely why it is important: it helps you manage everything else better by keeping your cognitive abilities at their best.

Practical Tips for Active Women

• Take Advantage of Downtime: Public transport, waiting room at the doctor’s, lunch break
• Involve the Children: Some EDITH games can become a fun family moment, children love to participate
• Get Up 15 Minutes Earlier: A calm moment before the day's hustle, just for you
• Delegate to Free Up Time: You deserve this time to take care of yourself
• Use Recovery Moments: After a nap, while the children do their homework