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Essential Inquiries to Ask About A number of Sclerosis

Of the nearly 1 million people living with multiple sclerosis (MS) in the United States, 74% are women. Yet there is still a lack of understanding among women of how MS affects the body.

To learn more, we spoke to Aliza Ben-Zacharia, PhD, an MS counselor, researcher, and assistant professor at Hunter College in New York City.

The interview has been edited for clarity and length.

Healthy women: What is Multiple Sclerosis (MS)?

Aliza Ben-Zacharias: MS is a disease in which myelin, the protective covering that surrounds most of the nerve fibers, deteriorates. MS damages or destroys myelin and underlying nerves in the brain, spinal cord, and optic nerves.

Healthy women: What are the Different Types of MS?

Aliza Ben-Zechariah: There are four types of MS. Clinically Isolated Syndrome (CIS) is the first episode of MS. The second type, relapsing-remitting MS (RRMS), has at least two episodes that are at least 30 days apart. Approximately 85% of people with MS have RRMS.

The other two types are known as secondary progressive MS (SPMS) and primary progressive MS (PPMS). SPMS starts out as RRMS, but then the time between relapses becomes shorter and the progression of symptoms between relapses increases. Not everyone with RRMS develops SPMS.

With PPMS, patients typically make slight progress over many years and have long plateau periods. For example, a person might have trouble walking so they start using a stick, then switch to a stroller, and finally use a wheelchair.

Healthy women: What Are Some Of The Earliest Symptoms Of MS?

Aliza Ben-Zechariah: MS affects every system in the body, and no two people have the same experience. One person may have sensory symptoms such as numbness and tingling, while another person may have blurred vision. Symptoms can also include weakness or problems with balance and coordination, difficulty walking, cognitive impairment, or sexual dysfunction.

Healthy women: How is MS treated?

Aliza Ben-Zechariah: It really depends on the type of MS and symptoms. There are many types of MS drugs, including intravenous drugs, pills, and injectable drugs. Some patients want to be aggressive with their treatment while others want to be more conservative.

Healthy women: With so many treatment options for MS available, how do you determine which is best for each patient?

Aliza Ben-Zechariah: It’s about identifying the type and symptoms, and looking at tests like magnetic resonance imaging. Managing MS symptoms is important as they affect a patient’s quality of life. The majority of women I see have RRMS, and many can manage it with disease-modifying treatment that addresses their individual symptoms.

Healthy women: Are some women more likely to get MS than others? If so, how can these women have access to care?

Aliza Ben-Zechariah: Some minorities living in the United States, such as African American women and Latin Americans, are more likely to develop MS than the same populations outside the country. These populations are often underrepresented in clinical trials, making treatment assessment difficult in all population groups.

To make care easier for all women with MS, providers can learn how to provide culturally competent care. Patients have the right to ask a medical interpreter to help them navigate treatment options.

Healthy women: Does MS Affect Reproductive Care? What should a woman with MS consider when planning a pregnancy?

Aliza Ben-Zacharias: Women with MS trying to get pregnant should speak to their care team. Healthcare providers weigh the benefits against the risks when considering how we change treatment and symptom management for a woman with MS before, during pregnancy, and beyond. It is important for us to understand a patient’s (and possibly their partner’s) care plan so that we can make any necessary changes.

Healthy women: What other conditions are women with MS at risk of developing?

Aliza Ben-Zacharias: Comorbidities (when a person has more than one health condition) really affect how we treat patients with MS. Some of my patients have autoimmune diseases such as arthritis, psoriasis, and Hashimoto’s thyroiditis.

The prevalence of depression in people with MS is very high, and I also see many postmenopausal women with osteoporosis. You also need to consider what is causing symptoms. For example, is a patient’s fatigue caused by their MS or anemia? Or if a patient is in pain, should we assume it is MS related? It is important to think about these other diseases when deciding how to treat MS.

Healthy women: What about complementary and alternative therapies for people with MS?

Aliza Ben-Zacharias: Complementary and integrative treatments can be very useful. I have often recommended acupuncture for trigeminal neuralgia, which is a severe facial pain that can occur with MS. Yoga and massage can also support well-being and promote relaxation. Supplements can also be helpful, but you must check with your MS care team before taking anything.

Healthy women: Can Lifestyle Changes Improve MS Symptoms?

Aliza Ben-Zacharias: It is so important to be active with MS. Activities like cycling and swimming can help patients feel stronger and more energetic. Physical activity can also help MS patients manage their comorbidities. For example, if a patient with MS has diabetes, exercise can treat both conditions.

Mental health is just as important as physical health. It is therefore important that patients with MS address their emotional problems. Managing stress is also important, as stress can make MS symptoms worse.

Living a healthy lifestyle is really a huge part of managing MS. Being socially active, spending time with friends and family (even if only virtually), volunteering, and continuing to work when you are able can all help you keep in touch with the world. This commitment is key to a good life with MS.

For more information, visit HealthyWomen’s MS Hub and the National Multiple Sclerosis Society.

This resource was created with the assistance of Biogen.

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