Women Physicians Day 2026: Supporting Women With MS Through Reproductive and Life Stage Transitions

Women with multiple sclerosis often navigate reproductive health, pregnancy, and menopause alongside ongoing disease management. Hormonal changes, family planning decisions, and life stage transitions can influence symptoms, treatment timing, and overall wellbeing. A care approach that integrates neurologic and women’s health considerations helps ensure management strategies align with both disease control and personal health goals.¹

In honor of National Women Physicians Day, held February 3, 2026, NeurologyLive^® spoke with Rocky Mountain MS Center experts Katrina Bawden, MSN, MSCN, FNP-C, an MS nurse, and April Erwin, MD, a neurologist, along with Parisa Khosravi, DO, an MS specialist at Central Texas Neurology Consultants, to further discuss key considerations in the care of women with MS. Throughout the interview, the trio highlighted the complexity of managing MS across the lifespan in women, emphasizing the need for individualized treatment strategies that align with patients’ personal goals, reproductive plans, and evolving health priorities.

As the conversation continues, the MS experts underscore the importance of shared decision-making when selecting disease modifying therapies (DMTs), particularly during the reproductive years, pregnancy, postpartum, and menopause. They also noted how advances in women-focused research have improved clinical counseling and expanded therapeutic options. However, they emphasized that important gaps remain, particularly in understanding menopause-related disease changes, long-term treatment safety, and the social and psychosocial challenges experienced by women with MS.

NeurologyLive: What are the most important considerations when caring for women with MS across different life stages?

Katrina Bawden, MSN, MSCN, FNP-C: From my clinical experience, lifestyle and family planning are two of the most important considerations when caring for women with MS across different life stages. The goal is to choose treatment options that not only effectively manage disease activity, but also fit seamlessly into a woman’s life. Because we have so many disease-modifying therapy options available today, it is critical to select one that minimizes disruption, aligns with safety and adverse effect preferences, and supports a patient’s personal goals.

For example, does she need a medication that is flexible for frequent travel? Does she have young children and want to prioritize a lower infection risk? Is she considering pregnancy in the future? Or is she later in life and hoping to safely reduce or discontinue medication?

At Rocky Mountain MS Clinic, these are the individualized factors we consider every day, and they are essential to helping women choose the right MS treatment and feel supported through every stage of life. We make it a priority to meet with each woman and address their individualized needs at every stage of life they are in.

April Erwin, MD: One of the most rewarding aspects of being an MS neurologist is embarking on a long-term journey with each patient through the seasons of her life. Caring for women with MS requires attention to shifting priorities and the evolving balance of risks and benefits of treatment over time.

A new MS diagnosis in a young woman can be profoundly jarring, so early and frequent check-ins around mood, adjustment, and coping are essential—particularly during the first year after diagnosis. Young patients often are in the busiest phases of life, so treatment decisions must account not only for efficacy, safety, and reproductive considerations, but also for what therapies a patient realistically can adhere to over time. From the outset, we must remain vigilant about long-term outcomes, working proactively to protect both physical and cognitive function through early physical therapy, diet and lifestyle modifications, and other pharmacologic and nonpharmacologic interventions.

During the reproductive years, discussions often center on contraception, pregnancy intent, lactation, and postpartum relapse risk. As women move into the perimenopausal period, care focus shifts to address vasomotor symptoms, sleep and cognitive changes, and fatigue, while normalizing conversations around urinary, bowel, and sexual health. Ensuring that age-appropriate health screenings remain on track is critical to avoid tunnel vision around MS.

Later in life, MS intersects with the natural aging process, requiring renewed alertness to mental health concerns, social support, and coping. This is also a time to reassess the appropriateness of immunomodulatory therapy and also maintain heightened awareness around possible polypharmacy in order to improve safety and quality of life.Across these seasons, the most important tools for an MS neurologist are listening closely and remaining engaged with what matters most to each woman at each stage.

Parisa Khosravi, DO: As we know women are two to three times more likely to develop MS than men. Based on current research and clinical experience, women tend to have higher relapse rates during their reproductive years. During this phase, neurologist’s main goal is to control the disease optimally with high efficacy DMT. Beyond disease control, symptom management is a major focus.

During the reproductive years, much of the clinic discussion centers on pregnancy planning, medication safety, and timing of treatment. Based on available data relapse risk generally decreases during pregnancy but increases in the postpartum period. Most DMTs are paused during pregnancy to minimize fetal exposure. However, given the higher risk of relapse after delivery, we tend to be proactive about restarting treatment in the postpartum period.

Mid age women with MS deal with menopause related hormonal shifts which often affect their overall symptom burden. Therefore, discussion about hormone replacement therapy if no contraindication noted may be initiated. During this stage, immunosenescence and medical comorbidities become more relevant, and the balance between risks and benefits of continuing high efficacy DMT begins to shift. Treatment decisions focus more on long term safety and preserving function and independence, rather than relapse prevention alone.

“One of the most rewarding aspects of being an MS neurologist is embarking on a long-term journey with each patient through the seasons of her life. Caring for women with MS requires attention to shifting priorities and the evolving balance of risks and benefits of treatment over time.”

How has research led by or focused on women improved our understanding of MS and its impact on patients?

Katrina Bawden, MSN, MSCN, FNP-C: Research led by and focused on women has completely changed how we treat MS during pregnancy. In the past few years, we have received updated guidance and recommendations for treating MS before, during, and after pregnancy. These advances have significantly increased patients' choice and quality of life. Remaining neurologically stable during and after pregnancy has a long-term impact on overall MS status across the entire lifespan.

April Erwin, MD: One of the most meaningful advances in research led by and focused on women has been the growing body of pregnancy and lactation data, including prospective studies and real-world registries. Having firm longitudinal data in these areas has allowed MS neurologists to counsel women more confidently about the risks and benefits of specific disease-modifying therapies, moving care away from overly restrictive or fear-based guidance and opening a broader range of treatment options aligned with both disease activity and life goals.

Women-focused research has also clarified relapse patterns during pregnancy and the postpartum period, while emerging work on hormonal transitions has improved our understanding of symptom burden and disease experience during the perimenopausal timeframe. Beyond reproductive health, studies led by women have elevated outcomes that matter deeply to patients but may have been underrecognized, including fatigue, mood, cognition, sexual health, and bladder dysfunction—helping shift MS care toward a more holistic, patient-centered model.

When women researchers and women neurologists engage together in the care of women with MS, a powerful level of trust develops in the data and its implications for shared decision-making. This sense of professional sisterhood and shared purpose strengthens the therapeutic alliance and improves translation of evidence into real-world care planning.

Parisa Khosravi, DO: Existing research on sex-based immunology demonstrates a higher incidence of MS in women, as well as higher relapse rates during their childbearing years. This type of data has allowed clinicians to adopt a more individualized approach when selecting DMTs. In addition, research identifying the most disabling MS symptoms at different stages of life in women with MS has guided clinicians to focus on targeted symptom management specific to each phase of the disease.

On the other hand, data from pregnancy registries and related studies many of which have been led by women investigators (e.g., Riley Bove, MD) have provided valuable insight into the risks and safety of disease-modifying therapies during pregnancy planning and breastfeeding. This growing body of evidence has improved counseling and clinical decision making for women with MS who are considering pregnancy. However, despite these advances, safety data are not yet available for all MS therapies, and further studies are needed to better inform treatment decisions during pregnancy and the postpartum period.

“Research led by and focused on women has completely changed how we treat MS during pregnancy. In the past few years, we have received updated guidance and recommendations for treating MS before, during, and after pregnancy. These advances have significantly increased patients' choice and quality of life.”

What gaps still exist in women’s health and MS, and how can women physicians help drive progress in this area?

Katrina Bawden, MSN, MSCN, FNP-C: There is a definite gap in understanding how menopause affects MS. Women physicians can help drive the progress in this area by researching MS during menopause further.

April Erwin, MD: The most significant gaps in the care of women with MS sit at the intersection of women’s clinical and social contexts. We will always need more longitudinal data, particularly in more diverse populations, around pregnancy and lactation, perimenopause, and how MS symptoms and treatment plans interact with comorbidities that may develop over a woman’s lifetime. But beyond biologic considerations, an important and often underrecognized gap is social vulnerability.

MS can increase a woman’s risk for employment disruption, financial strain, caregiver burden, and relationship stress. Data on partnership dissolution suggests higher rates of social isolation and loss of support among women with MS, factors that can meaningfully affect treatment adherence, mental health, and long-term outcomes. Despite this, access to social work, mental health services, and caregiver resources remains limited in many MS care settings.

Women physicians are uniquely positioned to drive progress by advocating for more inclusive research, integrating reproductive- and menopause-informed counseling into routine MS care, and elevating patient-reported outcomes that matter most to women’s daily lives. Equally important is building multidisciplinary models that proactively address psychosocial needs rather than treating them as ancillary.

The opportunity is huge: when women physicians lead—clinically and academically—we broaden what counts as “successful” MS care and generate evidence that truly reflects the realities of women’s lives.

Parisa Khosravi, DO: To answer this question, I would point to a comprehensive priority-setting study that involved 5,266 individuals and aimed to identify the most critical research needs in women’s health and multiple sclerosis.² Based on this large and inclusive study, several high-priority questions remain unanswered.

These unanswered questions include:

• A better understanding of how perimenopause and menopause affect MS disease activity and treatment response
• Developing effective strategies to manage sexual dysfunction in women with MS
• Understanding the long-term effects of disease-modifying therapies on children born to women with MS
• Generating data on hormone-related treatments for symptom stabilization in women with MS
• Another important area that deserves greater attention from women physicians is understanding how MS-related fatigue affects parenting and caregiving responsibilities

As a woman neurologist whose primary focus is caring for patients with MS, I believe these topics should be treated as priority research areas that require greater attention and investment.

Transcript edited for clarity. Click here for more of our multiple sclerosis coverage.

REFERENCES
1. Ross L, Ng HS, O'Mahony J, et al. Women's Health in Multiple Sclerosis: A Scoping Review. Front Neurol. 2022;12:812147. Published 2022 Jan 31. doi:10.3389/fneur.2021.812147
2. Ross L, Finlayson M, Amato MP, et al. Priority setting: women's health topics in multiple sclerosis. Front Neurol. 2024;15:1355817. Published 2024 Feb 19. doi:10.3389/fneur.2024.1355817