Menopause does not modify disability trajectories in a longitudinal cohort of women with CIS and MS followed from disease onset.

Objective to evaluate the effect of menopause on disability accumulation in women followed from their clinically isolated syndrome (CIS). Methods We examined the longitudinal changes in EDSS from CIS until the last follow-up in women belonging to the Barcelona CIS prospective cohort, followed through their menopausal transition. The analysis is based on 13,718 EDSS measurements with an average of 28 EDSS per patient. Differences in EDSS trajectories between menopausal and non-menopausal women, controlling for age and disease duration were evaluated. We performed two sensitivity analyses, in women with confirmed MS and in those experiencing and early menopause. Results from 764 eligible women, 496 (65%) responded to the questionnaire and 74 (14.9%) reached menopause over follow-up. We did not find a significant inflection point in EDSS trajectories around menopause (slope change -0.009 (95%CI -0.066; 0.046). The annual increase in EDSS over the complete course of the disease was significantly higher in menopausal women (0.049 IC 95% 0.026 - 0.074) versus non-menopausal (0.019 IC 95% 0.008 - 0.031, interaction p-value 0.025). This difference was lost once controlling for age and disease duration (EDSS annual increase of 0.059 95% CI 0.025- 0.094 vs 0.038 IC 95% 0.021 - 0.057 respectively, interaction p-value 0.321). No inflection point was detected when the analysis was restricted to women with confirmed MS or with earlier menopause. Conclusion menopause is not associated with an increased risk of disability in a CIS population, considering EDSS trajectories throughout the course of the disease, together with age and disease duration.