Episode 229: Estrogen and MS: How Hormones Impact Neurological Health and Symptom Management.

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Deb 1:19Hello and welcome to today’s episode estrogen and MS, how hormones impact neurological health and symptom management. I’m Dr Deb, and today we’re diving into a fascinating and complex topic, the link between hormones, specifically estrogen, and neurological health in women, particularly as it relates to MS or multiple sclerosis. Today, we’ll explore how declining estrogen levels in women may not only trigger ms, but also impact the severity and the progression of symptoms. Estrogen is more than just a reproductive hormone. It’s plays a crucial role in our immune system and the nervous system health. This intersection of hormones and neurological Health offers insights that may lead to improved management and treatments for women with Ms. So to provide some context, estrogen is a hormone that does more than govern reproductive functions. Research shows that estrogen plays a protective role in the brain, and it can reduce inflammatory responses, promote cell repair and support overall neurological function. It’s fascinating to consider estrogens far reaching impact on the nervous system, and as we’ll see, the effects are particularly relevant in the context of MS. MS is about three times more common in women than in men, and research suggests that hormonal fluctuations significantly influence both the risk and expression of MS symptoms. This gender difference points to hormones, and especially estrogen as an area worth closer examination. So let’s dive deeper into the science to understand why estrogen is such a significant factor in an in Ms. So estrogen as a neuro protector really well, it’s true, estrogen provides significant neuro protective benefits by modulating inflammation and oxidative stress in the brain, and studies have shown that estrogen can decrease levels of pro inflammatory cytokines while enhancing antioxidant defenses, creating a protective environment for neurons. Research has shown that women with higher estrogen levels tend to have lower markers of neuro inflammation, which is critical, because inflammation in the brain can lead to damage over time, and this protective effect of estrogen helps keep the brain in a healthier state, which is particularly beneficial for managing conditions like Ms. Now, estrogen has an impact that goes even further than that. It’s called myelin. So myelin is the protective sheath, or the coding around the nerves, and it’s essential for nerve communication, and estrogen plays a direct role in supporting this myelin repair. So let me explain a little bit more about myelin, because I think it’s important for us to understand if you think of your nerves as an electrical wire, we’ve all seen electrical wires that go behind the walls, right, and you pull out that wire, and if you’ve done any kind of remodeling, you may or may not have seen somebody strip away that plastic coating. Sometimes it’s yellow, sometimes it’s blue, and inside there are a couple of wires. Sometimes there’s one, sometimes there’s two, sometimes there are three, and. So think of that plastic coating as the myelin that protects your own nervous system. And what happens in MS and and sometimes other neurodegenerative diseases is that protective coating that myelin becomes disrupted or becomes damaged. And when it becomes damaged like that is when the nerves can be exposed, and when the nerves can be exposed, they can become irritated, and that’s kind of what we’re talking about with what happens on a very low scientific level with Ms. But I think everybody can understand when we’re talking about that what exactly is happening there? So estrogen, which is one of my favorite hormones, by the way, and I have been promoting hormones my entire career. I started learning about hormones when I was in my mid 20s. I worked for a reproductive endocrinologist, and became so in love with hormones, and so fascinated by them and what they can do and how they affect us. And I really believe that over the years, hormones, especially estrogen, have gotten a really horrible rap,

Deb 6:14and they didn’t need to be. So I’m a proponent of it. I do not like synthetic hormones. I really love bioidentical hormones, and you can find an episode here in the beginning of my series that goes back a couple of years, that talks about all the hormones and why I love them so much, and what’s the difference between bioidentical hormones and what’s the difference between synthetic hormones. It’s all there for you. So go back and check those out. But let’s get back to to the episode today. It’s so easy for me to get off on a tangent. I’m so sorry you guys. So estrogen stimulates the cells, and these are called oligodendrocytes, which are responsible for myelin production. Animal studies have actually shown that estrogen can increase myelin thickness and even support remyelination, a critical process for people with MS, where myelin damage is a core part of the disease, and this finding gives hope for ways to support or restore the nervous system’s function, actually in MS, and so there is a huge gender discrepancy between women who develop MS and men. It is something that affects women more commonly than men, and particularly during those reproductive years. This suggests to us that female hormones influence this disease and symptoms of MS often vary with hormonal changes such as puberty, pregnancy, menopause, leading further to the support of this idea that estrogen plays a significant role in how MS manifests and progresses. So hormonal decline can disrupt the immune system. We call it immune dysregulation. As estrogen declines during menopause, the immune system changes, and it becomes apparent. We all know that as we get older, our immune system doesn’t work as well. This is why everybody’s advertising to the elderly population to get your vaccines and to do this and to do that, there are much easier ways to stimulate the immune system than that, and I can talk about those in in a different series as well. But today I want to focus on how estrogen, the decline of estrogen, can actually lead to an immune dysregulation, increasing the risk of autoimmune activity, which can amplify MS symptoms. A study from the Journal of immunology found that postmenopausal women with MS tend to have higher levels of pro inflammatory markers, which can lead to worsening symptoms like fatigue, pain, cognitive difficulties. And this means that estrogen decline doesn’t only affect the body in general, but may also directly impact ms symptom intensity and estrogens anti inflammatory role. So estrogen naturally has an anti inflammatory property to it, and when estrogen levels drop, pro inflammatory cytokines rise, leading to increased brain inflammation, which may worsen cognitive issues and sensory disturbances in Ms. And research has published in neurology in 2020, found that women with MS who had lower estrogen levels, they showed higher inflammatory markers, correlating with more intense symptoms, and these patterns offer insight into why women may experience a surge in MS symptoms as estrogen declines. Now there’s also compelling evidence that Ms relapse rates increase during perimenopausal time, a time that marked is. Marked by fluctuating and declining estrogen levels. There was a review in the British Medical Journal that found that women in their perimenopausal age experienced a 30% increase in relapse rates, which researchers attribute largely to that estrogen drop. Now is there clinical evidence supporting hormonal replacement Yes, there is BHRT has a potential therapy in MS, and I believe other neurological diseases as well, hormone replacement therapy, or bioidentical hormone replacement therapy, has shown promise for alleviating some MS symptoms in menopausal women by stabilizing estrogen levels. So for some women, BHRT can improve symptoms like brain fog, fatigue, cognitive decline associated with Ms. And there’s another study published in Multiple Sclerosis journal that found that women receiving hormone replacement therapy reported better cognitive function, less fatigue than those who didn’t receive it. These findings offer hope for using hormone replacement therapy as a part of the MS treatment plan for women in menopause. So how does hormone replacement therapy actually work to help MS symptoms, while we know that hormones may reduce inflammation, protect the nerve cells from damage and even support myelin repair, and this combination of benefits means that women on hormone replacement therapy could experience fewer symptom flare ups and potentially a slower disease progression. In a small clinical trial published...