title: Patients report worse MS symptoms after menopause: findings from an online cohort.
abstract: BACKGROUND
  Many women with multiple sclerosis (MS) are postmenopausal, yet the impact of menopause on MS symptoms is unknown.
  
  
  OBJECTIVE
  To investigate patient-reported impact of menopause in a large online research platform, PatientsLikeMe (PLM).
  
  
  METHODS
  A detailed reproductive history survey was deployed to PLM members, and responses were linked to PLM׳s prospectively collected patient-reported severity score (MS Rating Scale, MSRS). The MSRS has previously shown good correlation with physician-derived EDSS scores.
  
  
  RESULTS
  Of the 513 respondents, 55% were postmenopausal; 54% of these reported induced menopause. Median age at natural menopause was 51. Surgical menopause occurred at an earlier age (p<0.001) and was associated with more hormone replacement therapy use (p=0.02) than natural menopause. Postmenopausal status, surgical menopause, and earlier age at menopause were all associated with worse MSRS scores (p≤0.01) in regressions adjusting for age, disease type and duration.
  
  
  CONCLUSIONS
  Postmenopausal patients in this study reported worse MS disease severity. Further, this study highlights a utility for online research platforms, which allow for rapid generation of hypotheses that then require validation in clinical settings.
authors: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women׳s Hospital, Brookline, MA 02445, USA; Harvard Medical School, Boston, MA 02115, USA; Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, NRB168, Boston, MA 02115, USA. Electronic address: rbove@partners.org.
authors: R
authors: R
authors: Bove
authors: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women׳s Hospital, Brookline, MA 02445, USA; Harvard Medical School, Boston, MA 02115, USA; Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, NRB168, Boston, MA 02115, USA; Massachusetts General Hospital Biostatistics Center, Boston, MA 02114, USA. Electronic address: bchealy@partners.org.
authors: B C
authors: BC
authors: Healy
authors: Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, NRB168, Boston, MA 02115, USA. Electronic address: secor.elizabeth@gmail.com.
authors: E
authors: E
authors: Secor
authors: PatientsLikeMe, Inc., Cambridge, MA, USA. Electronic address: tvaughan@patientslikeme.com.
authors: T
authors: T
authors: Vaughan
authors: PatientsLikeMe, Inc., Cambridge, MA, USA. Electronic address: bkatic@patientslikeme.com.
authors: B
authors: B
authors: Katic
authors: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women׳s Hospital, Brookline, MA 02445, USA; Harvard Medical School, Boston, MA 02115, USA; Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, NRB168, Boston, MA 02115, USA. Electronic address: tchitnis@rics.bwh.harvard.edu.
authors: T
authors: T
authors: Chitnis
authors: PatientsLikeMe, Inc., Cambridge, MA, USA. Electronic address: pwicks@patientslikeme.com.
authors: P
authors: P
authors: Wicks
authors: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women׳s Hospital, Brookline, MA 02445, USA; Harvard Medical School, Boston, MA 02115, USA; Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, NRB168, Boston, MA 02115, USA. Electronic address: pdejager@rics.bwh.harvard.edu.
authors: P L
authors: PL
authors: De Jager
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology* / Q000523:psychology*; D009862:Online Systems; D017698:Postmenopause / Q000502:physiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Estrogen; Hot flashes; Menopause; Multiple sclerosis; Online communities; Patient-powered research networks