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Aging Ovaries May Signal Progression of MS

February 23, 2016

A new study suggests that ovarian aging is associated with a reduction in gray matter volume and a higher rate of disability in MS patients. Jennifer S. Graves, MD, from the University of California, San Francisco (UCSF), School of Medicine, reported that lower levels of anti-Müllerian hormone (AMH), a marker of fertility, may herald the onset of disability.

"The advantage of a marker like AMH is that it's starting to capture this biological transition in a very early stage, even before women have perimenopausal symptoms and before they develop progressive disease," she said. "This biomarker could let you know if there are imminent changes in the biology of the disease, and this could help you determine if it's time to change the focus of treatment."

She continued on to note that men see much faster or earlier progression in the disease, but at age 50 women tend to catch up to them quickly, interestingly corresponding to the perimenopausal period.

The study presented here included 412 women with MS and 180 healthy controls from a longitudinal cohort at UCSF. Median age was approximately 44 years, median disease duration was 6 years, and median Expanded Disability Status Scale score (EDSS) was 1.5.

The women had up to 10 years of follow-up, including scoring on the Multiple Sclerosis Functional Composite (MSFC) and the EDSS along with periodic MRI. Their AMH levels were measured on stored plasma samples from baseline, year 3, year 5, and years 8 to 10.

Investigators found a strong association between AMH levels and decline in the two main disability scales (EDSS & MSFC). There was also a strong correlation between decline in ovarian reserve and the two scales.

When asked how this information might be applied clinically, Dr. Graves said that women wanting to become pregnant might be treated with agents with an established safety record, then could shift to higher efficacy treatments when entering the perimenopausal period, where the onset of disability may be looming.

Dr. Graves maintained that women who enter menopause early may be at risk for earlier progression, based on her data. "Early development of ovarian decline could lead to earlier onset of secondary progression," she said.