Weill Institute for the Neurosciences, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, USA.
Curr Neurol Neurosci Rep. 2018 May 23;18(7):36. doi: 10.1007/s11910-018-0846-2.
Caring for women with multiple sclerosis (MS), whose first symptoms typically begin during the childbearing years, requires a comprehensive approach to management across a range of reproductive exposures, and beyond through menopause.
This article summarizes what is known about the disease course in women with MS, how it differs from men, and the current state of knowledge regarding effects of reproductive exposures (menarche, childbearing, menopause) on MS-related inflammation and neurodegeneration. Recent findings regarding pregnancy-associated relapses in the treatment era, protective effects of breastfeeding, and care for women during the menopausal transition are reviewed. Then, updated recommendations to guiding women during childbearing-including pre-conception counseling, discontinuation of MS therapies, and management of postpartum relapses-are provided. Whenever possible, areas of uncertainty and avenues for future research are highlighted. From childhood through the postreproductive life stages, gender and hormonal exposures appear to shape an individual's risk for MS, as well as the experience of living with MS.
患有多发性硬化症（MS）的女性的首发症状通常出现在生育期，因此需要在一系列生殖暴露和绝经后采取综合管理方法。
本文总结了 MS 女性的疾病进程、其与男性的差异，以及目前关于生殖暴露（初潮、生育、绝经）对 MS 相关炎症和神经退行性变影响的认识。本文还回顾了治疗时代与妊娠相关的复发、母乳喂养的保护作用以及绝经过渡期间女性的护理。然后，提供了关于生育期间指导女性的更新建议，包括孕前咨询、MS 治疗的停药以及产后复发的管理。只要有可能，就突出了不确定的领域和未来研究的方向。从儿童期到生殖后期，性别和激素暴露似乎会影响个体患 MS 的风险，以及 MS 的患病体验。
