Premenstrual multiple sclerosis pseudoexacerbations: Role of body temperature and prevention with aspirin.

BACKGROUND

Many women with multiple sclerosis (MS) experience transient neurologic symptom worsening and fatigue in conjunction with the menstrual cycle. Aspirin reduces MS fatigue in some patients.

OBJECTIVE

To describe 3 women with MS who experienced stereotypic, temperature-independent neurologic symptoms and diurnal fatigue in the mid-to-late luteal phase of the menstrual cycle. Aspirin treatment prevented the symptoms.

DESIGN AND

SETTING

Case series at the Mayo Clinic outpatient MS clinics, Scottsdale, Ariz, and Rochester, Minn.

PATIENTS: Three women with relapsing-remitting MS.

INTERVENTIONS: Body temperature measurement, symptom diary, and oral aspirin.

MAIN OUTCOME MEASURES: Body temperature, Modified Fatigue Impact Scale, and evaluation of neurologic symptoms and signs.

RESULTS

Morning oral body temperature did not differ during symptomatic vs asymptomatic portions of the luteal phase (P = .55). Aspirin (650 mg twice daily) prevented symptoms but did not significantly alter the luteal phase body temperature.

CONCLUSIONS

Aspirin prophylaxis may prevent luteal phase-associated MS pseudoexacerbations. However, the observed relationship between the luteal menstrual phase and MS symptom worsening is not fully explained by thermoregulation, which implicates other hormonal or immunologic mechanisms.