The Role of the Menstrual Cycle in Chronic Disorders of the Nervous System

  • Douglas R. Jeffery
Part of the Current Clinical Neurology book series (CCNEU)


The role of the menstrual cycle in affecting neurologic function in chronic disorders of the nervous system has received surprisingly little attention. Hormonal fluctuations are known to modify a host of physiologic and psycho-logic parameters in women. The purpose of this chapter is to review and explore the available literature on the effect of the menstrual cycle in patients with spinal cord injury (SCI) and multiple sclerosis (MS) and other autoimmune diseases. Traumatic brain injury (TBI) and stroke are other chronic neurologic conditions in which the menstrual cycle could affect neurologic function, at least on a transient basis. During the menstrual cycle, alterations in the systemic concentrations of hormones can produce direct and indirect effects on neurologic function. When superimposed upon the injured nervous system, these effects can be magnified and can result in changes in the functional abilities of patients and can worsen symptoms such as fatigue and spasticity. This is particularly true in patients suffering from MS. The time when this is most likely to occur is at the end of the cycle, when there is a sudden drop in the serum concentration of estrogen anprogesterone, and menses begins.


Multiple Sclerosis Systemic Lupus Erythematosus Traumatic Brain Injury Spinal Cord Injury Luteinizing Hormone 
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  1. 1.
    Mattox, JH. Normal Menstruation. In: Ledger WJ, Laros RK, Mattox JH (eds.), Obstetrics and Gynecology. St. Louis: C. V. Mosby, 1987, 76–88.Google Scholar
  2. 2.
    Ross GT, Vandewiel RL, Frantz AG. In Williams RH (ed.), Textbook of Endocrinology. Philadelphia: W. B. Saunders, 1981, 355–411.Google Scholar
  3. 3.
    McCluer S. Reproductive aspects of spinal cord injury in females. In: Leyson JF (ed.), Sexual Rehabilitation of the Spinal Cord-Injured Patient. Clifton, NJ: Humana, 1991, 181–196.Google Scholar
  4. 4.
    Mathews WB, Acheson ED, Batchelor JR, Weller RO. Clinical aspects. McAlpine’s Multiple Sclerosis. 1985, pp. 49–233.Google Scholar
  5. 5.
    Smith R, Studd JW. A pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle. J. Royal Soc. Med. 1992; 85: 612–613.Google Scholar
  6. 6.
    Nelson LM, Franklin GM, Jones MC. Risk of multiple sclerosis exacerbation during pregnancy and breast feeding. JAMA 1988; 259: 3441–3443.PubMedCrossRefGoogle Scholar
  7. 7.
    Poser S, Poser W. Multiple sclerosis and gestation. Neurology 1983; 33: 1422–1427.PubMedCrossRefGoogle Scholar
  8. 8.
    Thompson DS, Nelson LM, Burns A, Burks JS, Franklin GM. The effects of pregnancy in multiple sclerosis: a retrospective study. Neurology 1986; 36: 1097–1099.PubMedCrossRefGoogle Scholar
  9. 9.
    Sridama V, Pacini F, Yang SL, Moawad A, Reilly M, DeGroot LJ. Decreased levels of helper T cells. A possible cause of immunodeficiency in pregnancy. N. Engl. J. Med. 1982; 307: 352–356.PubMedCrossRefGoogle Scholar
  10. 10.
    Weinschenker BG, Hader W, Carriere W, Baskerville J, Ebers GC. The influence of pregnancy on disability from multiple sclerosis. Neurology 1989; 39: 1438–1440.CrossRefGoogle Scholar
  11. 11.
    Jansson L, Holmdahl R. Estrogen induces a potent suppression of experimental autoimmune encephalomyelitis and collagen-induced arthritic in mice. J. Neuroimmunol. 1994; 53: 203–207.PubMedCrossRefGoogle Scholar
  12. 12.
    Comarr AE. Observations of menstruation and pregnancy among female spinal cord injury patients. Paraplegia, 1966; 3: 263–272.PubMedCrossRefGoogle Scholar
  13. 13.
    Durkan JP. Menstruation after high spinal cord transection. Am. J. Obstet. Gynecol. 1968; 100: 521–524.PubMedGoogle Scholar
  14. 14.
    Cooper IS, Hoem TI. Metabolic disorders in paraplegics. Neurology 1952; 2: 332–340.PubMedCrossRefGoogle Scholar
  15. 15.
    Reame NE. A prospective study of the menstrual cycle and spinal cord injury. Am. J. Phys. Med. Rehabil. 1992; 71: 15–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Shannon M, Goetz CG. Connective tissue diseases and the nervous system, in Neurology and General Medicine: The Neurological Aspects of Medical Disorders. No. 22, 1989, pp. 389–413.Google Scholar
  17. 17.
    Estes D, Christian CL. The natural history of systemic lupus erythematosus by prospective analysis. Medicine (Baltimore) 1971; 50: 85–95.Google Scholar
  18. 18.
    Boumpas DT, Fessler BJ, Austin HA, Balow JE, Klippel JH, Lockshin MD. Systemic lupus erythematosus: emerging concepts. Part 2: dermatologie and joint disease, the antiphospholipid antibody syndrome, pregnancy and hormonal therapyGoogle Scholar
  19. morbidity and mortality, and pathogenesis. Ann. Intern. Med. 1995; 123: 42–53.Google Scholar
  20. 19.
    Lockshin MD, Reinitz E, Druzin ML, Murrman M, Estes D. Lupus pregnancy. Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy. Am. J. Med. 1984; 77: 893–898.PubMedCrossRefGoogle Scholar
  21. 20.
    Urowitz MD, Gladman DD, Farewell VT, Stewart J, McDonald J. Lupus and pregnancy studies. Arthritis Rheum. 1993; 36: 1392–1397.PubMedCrossRefGoogle Scholar
  22. 21.
    Meeham RT, Dorsey JK. Pregnancy among patients with systemic lupus erythematosus receiving immunosuppressive therapy. J. Rheumatol. 1987; 14: 252–258.Google Scholar
  23. 22.
    Ogasaware M, Aoki K, Hayashi Y. A prospective study on pregnancy risk of antiphospholipid antibodies in association with systemic lupus erythematosus. J. Reprod. Immunol. 1995; 28: 159–164.CrossRefGoogle Scholar
  24. 23.
    Moodley J, Bhoola V, Duursma J, Pudifin D, Byrne S, Kenhoyer DJ. The association of antiphospholipid antibodies with severe early-onset pre-eclampsia. SAMJ 1995; 85: 105–107.PubMedGoogle Scholar

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© Springer Science+Business Media New York 1997

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  • Douglas R. Jeffery

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