MS or Menopause? How to Tell the Difference and Get Relief

Is the brain fog you're experiencing part of your MS, or is it menopause? What about the sudden increase in fatigue?

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Managing menopause is tough on its own. Living with MS is no walk in the park either. But when do the two overlap? It can feel like your body is sending you mixed signals with no clear roadmap for how to manage it all. You might not know which symptoms are coming from where, or what to do about them. 

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When MS and menopause overlap, it can feel like your body is speaking two different languages at once. Let me help you decode what's happening and show you practical ways to feel better—starting today!

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By the way, have we met? Hi, I’m Dr. Gretchen Hawley, a physical therapist and MS-certified specialist. I’m the creator of The MSing Link, an online program and book designed to help people with MS improve their mobility, strength, and confidence through targeted, research-backed strategies.

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I’m passionate about making life with MS feel more manageable, and over the years, I’ve helped thousands of clients take real steps toward feeling stronger and more in control of their symptoms.

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It’s True – Menopause and MS ARE Connected!

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Did you know that women are up to three times more likely to be diagnosed with MS than men? According to the National MS Society, nearly 75% of people diagnosed with MS are women. Hormones play a huge role in that difference. Estrogen, in particular, has a protective effect on the nervous system, and when hormone levels begin to dip during menopause, it can cause MS symptoms to flare or worsen.

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If you're curious about how MS specifically affects women, check out my detailed guide on 10 MS Symptoms in Women That Shouldn't Be Ignored.

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Before menopause, women with MS tend to progress more slowly than men. But once menopause hits, that changes. Research shows that postmenopausal women often "catch up" to men in terms of disability progression, which is why it's so important to understand what your hormones are doing and how they might be influencing your MS.

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Hormonal changes during menstruation, pregnancy, and menopause can make MS symptoms like fatigue, brain fog, or bladder problems feel worse. These shifting hormones can throw your body out of balance, and when estrogen levels drop, your MS symptoms might feel stronger or harder to manage than usual.

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Why Aren’t More Doctors Talking About This?

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Believe it or not, about 30% of people living with MS in the U.S. are either perimenopausal or menopausal—and yet, this stage of life is rarely discussed in MS care. Hormonal changes can significantly affect MS symptoms, but many women don’t know what’s happening or who to ask.

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Many women feel caught in a frustrating loop:

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• Your OB/GYN says, "That's a neurology issue."
• Your neurologist suggests, "Talk to your primary care doctor."
• Your primary care provider recommends, "Maybe ask your MS specialist?"

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Sound familiar? You deserve better coordination in your care. For more in-depth discussion on this topic, check out my video interview below with MS-certified nurse Cherie Binns.

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Is It MS or Menopause? 5 Questions to Ask Yourself

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When symptoms hit, ask yourself:

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1. Is this new or worse? New symptoms might indicate a relapse or hormonal shift, while existing symptoms that fluctuate could point to hormonal influence.
   
   
2. How long has it lasted? MS relapses typically last more than 24-48 hours without improving with rest. Menopause symptoms often come and go more quickly (sometimes within minutes).
   
   
3. When does it happen? Notice any patterns? Hormone-related symptoms like hot flashes or mood swings often follow a schedule or worsen in the evenings.
   
   
4. Could it be something else? UTIs can mimic MS flare-ups and are more common during menopause due to bladder changes.
   
   
5. Have you started new medications? Some meds can cause side effects that mimic menopausal symptoms or impact your MS.

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TIP FROM DR. GRETCHEN: Start tracking your cycle and symptoms today! You might be surprised by the patterns you discover. Apps like Natural Cycles, Flo, or even free options like Clue make this super simple. One of my clients realized her fatigue always spiked during the same week of her cycle—knowledge that helped her plan rest days when she needed them most.

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Here’s what I tell my clients all the time—there’s no one-size-fits-all answer. But figuring out what’s behind your toughest symptoms is the best first step. Whether it’s MS or menopause, knowing the root cause of your fatigue, brain fog, or pain can help you decide where to focus your energy.

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And just like we talk about inside The MSing Link, relief usually doesn’t come from one single solution. It’s often a mix of things working together. So keep experimenting, stay curious, and give yourself permission to keep going until something helps. The right combination is out there, and you deserve to find it.

How to Manage MS and Menopause Symptoms

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Managing MS and menopause at the same time requires a multi-layered approach. Some symptoms may come and go. Others might hit harder as hormones shift. But the good news is that there are practical steps you can take to experience symptom relief sooner rather than later.

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Question – would it help to hear from other women who are also navigating MS and menopause at the same time? You’re not alone. Inside The MSing Link, our online program and private community, this is a common topic of discussion. 

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The support in our Facebook group is incredible—sometimes, just hearing "me too" is exactly what you didn’t know you needed. In fact, this is one of the most talked-about topics in the community. Members regularly share what’s worked for them, ask questions, and find comfort in knowing they’re not the only ones dealing with this.

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7 Tips for Managing MS and Menopause Symptoms:

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1. Hormone Replacement Therapy (HRT): For some women, HRT can reduce symptoms like fatigue, brain fog, and spasticity. But it’s not one-size-fits-all. If you’re considering it, be sure to talk with your gynecologist to weigh the risks and benefits for your specific situation.
   
   
2. Every Day Habits Matter: Small changes in your daily routine can make a big difference. Focus on staying hydrated, moving your body regularly, getting quality sleep, and cutting back on refined sugars that can trigger inflammation and worsen symptoms.
   
   
3. Cool Down Hot Flashes: Keep a fan nearby, try cooling towels, or invest in a cooling vest—especially if heat worsens your MS symptoms.
   
   
4. Stay Active In Ways That Work For You: I know staying active isn’t always easy when you’re living with MS. But movement—when it’s consistent and tailored to your ability—can really help with fatigue, hormone balance, and mental clarity. If you’re looking for a gentle way to get started, my free 5-Day MS Strength Challenge is a great place to begin. It’s designed specifically for people with MS and can be done from home, at your own pace!
   
   
5. Track Your Symptoms: Use apps like Natural Cycles, Flo, or Clue to log what you’re experiencing and identify patterns. You may be surprised how often hormones are at the root of worsening MS symptoms.
   
   
6. Eat With Intention: Cutting back on inflammatory foods, especially refined sugar, can help with both menopause symptoms and MS-related inflammation.
   
   
7. Hydrate: It sounds simple, but dehydration can make both fatigue and heat sensitivity worse.

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If you're feeling overwhelmed, know that you’re not alone—and you don’t have to figure this out on your own either. The MSing Link was created to help you take control of your MS symptoms with proven strategies and a supportive community cheering you on every step of the way.

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You’re Not Alone—Get The Right Support

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Whether it’s fatigue, hot flashes, or something you can’t quite put your finger on, you deserve answers and support. 

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Ready to stop guessing and start feeling better? Here are some ways I can help you right now:

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1. Join The MSing Link Community: Get immediate access to our private Facebook group where women openly discuss menopause and MS challenges—and share what's actually working. Click here to learn more about our most transformational program →
   
   
2. Watch My Interview with MS Nurse Cherie Binns: Dive deeper into the MS-menopause connection in this detailed YouTube discussion, where we answered the most common questions about managing both conditions. Watch the video → 

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If you're in your 40s or 50s and noticing new or worsening MS symptoms, menopause might be playing a bigger role than you think. The sooner you understand what’s going on, the sooner you can take steps toward relief. Whether it’s through lifestyle changes, medical support, or MS-specific exercises, you have options and you deserve to feel empowered.

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Still have questions? You can always message me on Instagram @doctor.gretchen. I’m here to help you feel empowered, informed, and supported every step of the way!