In this episode of Living Well with MS, Overcoming MS Medical Advisor Dr Jonathan White, who is an Obstetrician and Gynaecologist, welcomes Neurologist, Dr Kate Petheram, and Gynaecologist and Menopause specialist, Dr Siobhan Kirk for a round-table discussion on multiple sclerosis and menopause.

Watch this episode on YouTube here. Keep reading for the key episode takeaways.

Read the episode transcript here

Questions and Timestamps:

00:34 The importance of talking about menopause and MS.

01:33 What is menopause?

04:48 What do we know about the effect of menopause on MS?

07:12 What are the symptoms somebody may experience with menopause, that a gynaecologist can help with?

08:47 What is hormone replacement therapy (HRT)?

10:17 Is HRT safe to take with disease-modifying therapies for MS?

12:31 Can blood tests diagnose menopause?

15:02 Is HRT safe for someone who has a family history of breast cancer?

16:33 Does HRT cause people to put on weight?

19:01 Should someone start HRT because they have MS?

21:58 Will supplements or dietary changes help menopause symptoms?

23:14 What about this concept of bioidentical HRT?

24:19 Do you think somebody with MS would benefit from testosterone patches?

26:40 What's the latest research we know about the impact on hormones and menopause treatment, and the outcomes?

28:15 Are hot flushes and heat sensitivity a concern for people with MS?

29:49 What is the Mirena coil and how that may be a part of HRT?

32:23 What are the side effects of progestogen?

32:55 Does early menopause (before 40) affect the rate of progression of someone's MS, either for the better or for worse?

39:26 Topical oestrogen and bladder symptoms

Selected Key Takeaways:

There is a lot of overlap between MS symptoms and menopause symptoms.
6:42 Dr Kate Petheram:
“Because of the overlap in symptoms. There are perhaps elements which are so relevant to menopause, which we can perhaps talk about as well in terms of symptoms such as hot flushes and heat intolerance, which again may exacerbate symptoms of MS. So, there may not be a biological difference, but the symptoms of menopause and perimenopause may influence and make worse MS symptoms, which is why I believe it's so important to recognise and point women in the right direction to get the right help."

There is no evidence that Hormone Replacement Therapy (HRT) causes cancer.
15:19 Dr Siobhan Kirk:
“There is no evidence that HRT causes breast cancer. But if you're taking extra hormones, and you've got abnormal cells, then the extra hormones can promote the growth of the abnormal cells. There's no increased risk of breast cancer with use of HRT under the age of 50, for earlier menopause, because you're just replacing what the uterus should be producing.”

There is a lot of research taking place around the world on different aspects of living with MS including menopause.
34:12 Dr Jonathan White:
“It is reassuring [for] someone living with MS to know that there is just a colossal amount of research going on around the world on all sorts of aspects of living with MS. I feel like reproductive health and women's health is getting to that place slowly. There's a really big push, I can see that in the research community and I'm glad to hear that menopause and post-reproductive health is getting it too.”

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Dr Siobhan Kirk’s Bio:

Dr Siobhan Kirk is an Associate Specialist in Gynaecology and Clinical Lead for Sexual & Reproductive Health in Belfast HSC Trust.

Siobhan’s career
She is a Fellow of both the Royal College of Obstetricians & Gynaecologists and the Faculty of Sexual & Reproductive Healthcare. She is a British Menopause Society accredited menopause specialist and trainer, based in the menopause clinic in the Mater Hospital, Belfast.

She is passionate about all aspects of women’s health, is on NI RCOG and FSRH committees, and is involved in undergraduate and postgraduate teaching.

Dr Kate Petheram’s Bio:

Dr Kate Petheram is a Consultant Neurologist in Sunderland where she is currently MS lead.

Kate’s career background
Kate studied medicine in Bristol and stayed in the southwest to do her medical training in Bristol and Exeter moving to London to do Neurology jobs at St Georges and The Royal Free.

She made the move to the North East to undertake Neurology specialist training. She is a local PI for a number of observational studies. She is a member of the ABN quality committee and one of the medical advisors for the MS Society. She has recently been appointed as training programme director for the North East.

Dr Jonathan White’s Bio:

Jonathan’s Career:
Dr Jonathan White went to the University of Glasgow Medical School, graduating in 2008 (MBChB). He completed a further five years of training in Obstetrics and Gynecology and is a member of the Royal College of Obstetricians & Gynecologists (MRCOG). He works at the Causeway Hospital, Coleraine and has a special interest in early pregnancy and recurrent pregnancy loss.

In April 2022, Jonathan was awarded “Doctor of the Year” at the inaugural Northern Ireland Health and Social Care Awards. He contributed to the ‘Overcoming Multiple Sclerosis Handbook: Roadmap to Good Health’ by writing the chapter about medication.

Overcoming MS and personal life: 
Jonathan was diagnosed with RRMS in October 2015 and has been following the Overcoming MS Program ever since. Dr White assists Overcoming MS as a medical advisor and event facilitator.

He lives on the North Coast of Northern Ireland, is married to Jenny and father to Angus and Struan. His interests include the great outdoors, cycling and running (reluctantly), reading, rugby, film, and spending time with his family.