To Örebro University

Introduction: As the prevalence of multiple sclerosis (MS) in older adults rises, the importance of recognising and addressing specific needs and challenges faced by people with MS (PwMS) undergoing age-related sex hormone changes and hypogonadism is becoming increasingly evident.

Objectives/Aims: To provide evidence-based, practical recommendations and expert perspectives that address gaps in literature and guidelines on age-related sex hormone changes and hypogonadism in PwMS.

Methods: A multidisciplinary steering committee (SC) of 15 international experts identified 18 key clinical questions across six themes: climacteric symptoms in women with MS; impact of MS on the climacteric stage; impact of menopause on MS disease activity and progression; treatment and management of climacteric symptoms in women with MS; late-onset hypogonadism in men with MS; and patient-centred care. A total of 18 clinical recommendations were drafted, informed by evidence from a systematic literature review and expert opinion from the SC. These were voted on by the SC and an extended faculty of 23 healthcare professionals, from 16 countries, including two nurses and one patient association representative. Consensus was reached when ⩾75% of respondents expressed agreement with a score of 7–9 on a 9-point scale.

Results: Consensus was reached for all 18 recommendations following a single voting round, with 14 reaching consensus at 90–100% and four at 80–90%. The strength of recommendations ranged from 8–9. Clinical recommendations are provided on the: potential overlap of symptoms and exacerbation of MS symptoms during the climacteric stage; requirements for preventive care and screening during the menopausal transition; potential for, and a paucity of data on, differential efficacy and tolerability of MS medications in menopausal/post-menopausal women; complex causal interplay between hormonal and/or immunological changes and natural ageing in PwMS switching to a more progressive phase of disease; consideration of behavioural/lifestyle interventions alongside pharmacological treatments; effects of hormonal treatments on MS symptoms; and management of late-onset hypogonadism in men with MS.

Conclusion: These recommendations were based on a robust consensus approach and present a valuable framework for improved patient care. The consensus programme results emphasise the need to address critical gaps in our understanding and management of individuals with MS undergoing age-related sex hormone changes and hypogonadism.