Early Signs of MS in Women: What to Watch For

Multiple sclerosis is an autoimmune disease where the body damages the protective coating on nerves, leading to neurological symptoms such as muscle weakness, numbness, tingling, and vision problems. Symptoms can show up five or 10 years before a diagnosis, but they are not always easy to understand. Learn more about MS, its early signs, how hormonal differences in people born female can affect symptoms, and the lifestyle management strategies that make a difference.

In autoimmunity, it’s the body’s immune system that has turned against itself. When someone develops multiple sclerosis (MS), thought to be due to a combination of genes and environmental triggers, they can develop worsening physical and mental function that may become disabling over time. However, better diagnosis, improved treatment, and an understanding of how important healthy lifestyle habits are in disease management means that there’s reason to remain optimistic when you’re living with MS.

Understanding multiple sclerosis (MS)

The National Multiple Sclerosis Society estimates that 1 million people in the United States have been diagnosed with MS. It’s suspected that the incidence of MS may be increasing. Improved diagnosis and increased longevity may contribute to higher numbers, but more research is needed to understand this.

What is multiple sclerosis?

MS is an autoimmune condition where the body’s immune system mistakenly attacks its own tissues. In this case, the immune system damages the myelin sheath, which is the protective coating surrounding nerves, leading to common symptoms like numbness and tingling, balance issues, and cognitive problems.

Risk factors for MS in women

MS is far more common in individuals born female. In fact, three times as many women as men are diagnosed with MS, especially in females between ages 20 to 40. Hormonal factors may play a role here, but there are other risk factors at play. These include:

Genetics

Geography

Smoking

Vitamin D deficiency

Inflammation

Obesity

Given MS is autoimmune, it’s theorized that your genes set the stage and an environmental trigger “turns on” these genes, causing immune system dysregulation that puts the disease in motion. Those can be the factors mentioned above, as well as pollutants/toxins, diet, stress, and infections, among others.

Common MS symptoms in women

Symptoms of MS in women are the same as in men, and it’s important to keep in mind that MS is sometimes known as “the snowflake disease” because no one person has the same symptoms or presentation of MS. However, there are common symptoms among people, such as:

Fatigue, numbness, and tingling

Fatigue is incredibly common in autoimmune diseases, and the majority of people with MS feel run down and lack energy. This, according to the National MS Society, is known as “lassitude,” which is a state of mental and physical weariness that occurs regularly, can hit despite adequate sleep, and is more debilitating compared to normal fatigue.

In addition, due to the damage to the protective coating of nerves, you may also experience numbness and tingling, particularly in your face, body, arms, and legs. Sometimes, this is an initial sign that can be brushed off. “This is something people might ignore for a long time. They may put up with it until it becomes severe or another motor problem develops,” says Terry Wahls, MD, clinical professor of medicine at the University of Iowa Carver College of Medicine.

Bladder and bowel problems

You may find that you get up multiple times per night to pee, are peeing “all the time,” leak urine, or have to rush to the bathroom. Similarly, your bowel movements could be off, too, either causing constipation or bowel incontinence (accidentally passing stool).

Muscle weakness, stiffness, and spasms

When you feel unbalanced or uncoordinated, you might become more sedentary, and that can promote muscle weakness. In addition, damage to nerves also impacts muscle function.

Electric shock sensations (Lhermitte’s sign)

MS causes a short zipping sensation of shock down the spine, arms, and legs when bending your neck forward toward your chest, dubbed Lhermitte’s sign. It’s estimated that anywhere from 9 to 41 percent of people with MS have this symptom.

What are three warning signs of MS?

It’s not easy to know that you have MS. Sometimes, you might experience fatigue or brain fog, which are symptoms that can be indicative of a number of different conditions or lifestyle issues like burnout. Doctors may suspect MS (or want to rule it out) if you have the below warning signs.

Vision problems and MS

For about one out of five people, their first symptom of MS is optic neuritis, and about half of those with MS will experience this vision-related disorder at some point, according to research. Optic neuritis is an inflammation of your optic nerve, the nerve that sends messages from your retina to your brain, allowing you to “see.”  This nerve is coated with a myelin sheath. “Many cranial nerves affect how we move our eyeballs. People may become wobbly and uncoordinated and have a sense that their vision is not quite right, but they don’t have the vocabulary to explain what is going on with their vision,” says Wahls.

As this progresses, your vision may become less sharp or you may have eye pain. These symptoms often send people to an eye provider, where optic neuritis is diagnosed. After that, you may be referred to a neurologist if a provider suspects MS.

Cognitive and emotional symptoms

MS has what’s known as a prodrome, which are early signs or symptoms that occur prior to diagnosis. In this case, there’s the belief that the MS prodrome might occur five to 10 years before MS makes itself known. People can experience a wide variety of symptoms at this stage. A few include greater rates of anxiety, depression, migraine, and low cognitive performance, according to research. Keep in mind that cognitive and emotional symptoms happen for all sorts of reasons beyond MS (stress being one).

Balance and coordination issues

Another common initial sign of MS is motor issues, particularly poor coordination or muscle weakness, says Wahls. You might find that you can’t use your hands well or start to stumble or fall more often.

Sex-specific MS symptoms in women

It’s clear that autoimmune diseases, and MS specifically, affect individuals born females far more than males. “We don’t know exactly why. We think hormonal patterns in women may have something to do with it,” says integrative and functional medicine doctor Susan Payrovi, MD. In addition, there is likely a genetic component and lifestyle differences that make women more vulnerable. “Women face unique life circumstances. They tend to be caregivers to children and their parents, and that’s a lot of stress and burden on them. In addition, the incidence of childhood stress and trauma are quite high in many female children. This is a multifactorial soup that sets you up for more chronic disease as an adult,” she explains.

Payrovi says that she watches her patients more closely for signs of MS during two stages of life: postpartum and the menopausal transition.

Impact of hormones on MS symptoms

Although symptoms themselves are similar between males and females, females may have more variation in symptom severity due to monthly hormonal fluctuations, and hormones may also affect the onset of MS. “It’s not unusual for a woman to show her first symptoms of MS after childbirth when hormones like estrogen plummet after labor and delivery,” says Payrovi, who herself was diagnosed with MS after the birth of her first child. During this time, there is also a lack of sleep and an acute increase in stress that can set the stage for autoimmunity.

Menopause, when estrogen production plummets, is another stage of life that can affect MS symptoms. “This might be a time for new symptoms to arise or the progression of symptoms can happen a bit faster in the menopausal period, which we think has to do with the loss of estrogen protection,” says Payrovi. Complicating matters is the fact that MS and menopause can share certain symptoms, like fatigue, brain fog, and mood changes. “It can be hard to tease apart what is MS and what is menopause,” she says. (One note: Tingling, numbness, and weakness are all neurological symptoms, so doctors would want to rule out a neurological cause rather than assuming these are due to menopause.)

That said, MS can affect your life no matter what stage you’re in, especially with sexual health. Sexual dysfunction is common, as MS can affect libido due to nerve damage, as well as vaginal dryness and pain, problems with sensation and arousal, or orgasm difficulties.

Another longtime concern has been the effect MS has on fertility or concerns about becoming pregnant due to worries about how it may affect a growing fetus. However, rates of infertility (and use of fertility treatments) is similar between females with MS and those without the disease. What’s more, pregnancy can be safe for you and your baby. “We’re finding out that there are many options for women who are starting families. There is a lot of research into how the medications we use can be safe in pregnancy and breastfeeding,” says Kimberly O’Neill, MD, assistant professor in the department of neurology and the Multiple Sclerosis Comprehensive Care Center at NYU Langone Health. If you are starting or expanding your family and looking to become pregnant, talk to an MS-trained physician to ensure your treatment plan is safe for you and your future baby.

Diagnosing MS

Unfortunately, there is not one test out there to diagnose MS. Doctors will use a combination of exams to determine if you have MS. These include:

Physical exam

Neurological exam

Blood work

MRI of the brain and spinal cord to look for specific lesions

Cerebrospinal fluid analysis

Having a delay in diagnosis is common, affecting half of people with MS, research shows. (This is defined as having more than three months go by between reporting your first MS symptom to the diagnosis.) “Sometimes the diagnosis is clear-cut, and sometimes it’s not,” says O’Neill. “It can be a difficult diagnosis. Even at experienced MS centers, sometimes people get the incorrect diagnosis,” she says. Although you may initially see a primary care provider or neurologist, you should be referred to a neurologist who specializes in MS.

In addition, it’s also important to point out that in a small portion of patients, MS lesions may appear on an MRI without a diagnosis of MS. These are asymptomatic MS-like lesions, meaning that there are no accompanying symptoms of MS. This may be indicative of a prodromal state of neuroinflammation. Functional medicine providers may step in proactively with health-promotion measures, such as gut-microbiome balancing, and regular imaging scans and biomarker measurements. If you have a family member who has MS and are concerned about your health, talk to your doctor about your risk factors and if any early intervention steps should be taken.

Importance of early treatment

Early diagnosis and treatment can reduce inflammation, decrease your risk of MS flares, and delay disease progression. In addition, initiating a well-rounded management plan will support your ability to function (and participate in the things you love to do) and feel good. “Unfortunately, MS strikes a lot of people at the prime of their lives. You may have recently graduated from school, been newly married, just had kids, or started your career. You have to redesign your life [after diagnosis], and that’s not an easy thing,” says Payrovi.

Gathering your MS treatment team will help you live the best life possible. Payrovi recommends having the following professionals in your corner:

Neuroimmunologist to manage your MS

Primary care provider to manage other health conditions and keep your health in check

Physical therapy or occupational therapy

Psychological support, via a therapist or support groups

Dietitian

Integrative or functional medicine physician

Functional medicine-trained health coach

Acupuncturist

Traditional Chinese medicine practitioner

Types of MS and their progression

MS is categorized into four main types based on disease patterns and progression:

Relapse-remitting MS: Found in 70 to 80 percent of patients initially. Symptoms last one or two days before the disease goes into remission. People recover partially or fully but start to decline with each relapse.

Primary progressive: Rather than going through periods of relapse and remission, people with this type of MS have a disease that gradually worsens.

Secondary progressive: Starts out RR MS, but then begins a gradual neurological decline.

Progressive-relapsing: Gradual neurological decline with relapses.

Managing MS symptoms

The mainstay of MS treatment is disease-modifying therapies, which work on the immune system to decrease inflammation, limiting damage to the nervous system. However, there is so much more to management than taking medication.

“MS is often described as an invisible disease in that people on the outside don’t often know someone is living with MS. You can have these invisible symptoms that might make it hard to work or take care of others,” says O’Neill.

That’s why taking a holistic approach to your health is so important in MS. “We can’t erase MS off of someone’s medical history, but there are things we can do to help a person’s body heal and improve their cellular health so that their symptom burden is less, they have a better quality of life, and they can engage in things that are joyful to them,” adds Payrovi. “Our goal is to help people get back to being who they were,” she says.

Along with medical management, there are five key lifestyle areas to focus on, Payrovi recommends:

Good nutrition: Eat a plant-based diet rich in antioxidants. Aim for a plate that’s 80% colorful plants.

Stress management: Stress encourages MS progression. Do what you can to respond effectively to stress.

Regular exercise: Find time for daily movement. Physical activity is associated with reduced inflammation in MS.

Adequate sleep: Good sleep helps you stick to a healthy diet, gives you energy for activity, helps manage stress, and aids in cellular recovery.

Avoidance of toxins: Do what you can to reduce your exposure to toxins, such as using air and water filters, eating organic food, and not wearing shoes in your home. Encourage body detoxification by hydrating well (to urinate regularly), sweating via exercise or sauna therapy, and getting enough fiber in your diet to have a bowel movement daily.

Optimize vitamin D levels: D helps with immune system regulation. Talk to your neurologist about the right dose for you.

Frequently Asked Questions (FAQs)

What is typically the first symptom of MS?

One of the first symptoms many experience in MS is visual disturbance, particularly a condition called optic neuritis, or inflammation of the optic nerve. This can lead to problems with vision, eye movement, and eye pain.

What autoimmune disease is similar to MS?

Many diseases can mimic MS that providers will want to rule out during diagnosis. Those include central nervous system infections and inflammatory disorders, genetic disorders, brain tumors, nutrient deficiencies (such as B12), disc herniation, and other disorders outside of MS that attack the myelin sheath or nerves.

At what age do women show signs of MS?

The most common age for women to be diagnosed with MS is between 20 and 40.

How can I check myself for MS?

There are no self-checks that you can do for MS. However, if you notice common symptoms of MS, such as visual disturbances, balance, gait, and coordination problems, muscle weakness, bowel and bladder dysfunction, and cognitive and mood issues, talk to your doctor.

How long does MS take to disable you?

The course of MS is different for everyone. You cannot gauge the progression of your disease against another person who has MS. What is clear, however, is that research shows that the earlier you can be treated, the lower your risk of disability in the future.

How is MS diagnosed early?

If you experience symptoms of MS: fatigue, numbness and tingling, pain, dizziness, weakness, numbness and tingling, bowel and bladder dysfunction, or cognitive and mood changes, talk to your doctor. They can do an exam and run tests to diagnose MS or rule it out and consider other causes. Early diagnosis and treatment are important for preserving your function and avoiding disease progression and disability in the future.

Conclusion

Early signs of multiple sclerosis include muscle weakness, numbness and tingling, fatigue, and vision problems. MS is a chronic, lifelong condition. However, there is every reason to feel encouraged. “The outlook of individuals with MS is better than ever. People are living long, healthy lives. We have a lot to be optimistic about,” says O’Neill. A well-rounded treatment plan that combines medical intervention with a functional medicine approach, such as by working with a clinician at Parsley Health, will help support your body in remission and prevent the progression of the disease.

Key takeaways

Multiple sclerosis (MS) is an autoimmune condition where the body’s immune system attacks its myelin sheath, the protective coating around nerves, leading to symptoms such as numbness and tingling, muscle weakness, balance and coordination problems, and more.

Researchers think that hormones play a key role in the development and expression of MS, as the disease is three times more common in individuals born female compared to those born male.

Women are more likely to be diagnosed during their reproductive years. MS is most common between ages 20 and 40, and it’s often diagnosed during the postpartum period.

Treatment includes medication management as well as lifestyle support (such as adequate sleep, a balanced diet, regular exercise, and stress management). Connecting with a well-rounded care team, which may include doctors, functional medicine providers, nutritionists, physical therapists, and integrative practitioners, can help you feel better and live better with MS.