295. MS & Menopause: Are Your Symptoms Changing…or Are Your Hormones? | Dr. Rhonda Voskuhl

If you're a woman with multiple sclerosis (MS) and you've noticed your fatigue, brain fog, or word-finding trouble getting worse in your 40s or 50s… you're not imagining it. And you're not alone in this.

In this episode, I sit down with Dr. Rhonda Voskuhl, a leading MS neurologist and menopause researcher from UCLA, to talk about something the MS community rarely hears explained clearly: what menopause is actually doing to your brain, and why it can look and feel so much like an MS flare.

Here's the part that surprised me most. Your MRI can come back completely clean… no new lesions… and you can still feel like your cognition is slipping. That doesn't mean nothing is happening. It means we need to look at what's happening at the cellular level, not just the lesion level.

Here's what we cover 🔑:

Why estrogen matters for your brain, not just your reproductive system. Estrogen receptors sit on neurons and on the cells that support them. When estrogen drops during perimenopause and menopause, those cells lose a signal they've been relying on for decades. That's one reason cognition and energy can shift so noticeably during this window.

What is the difference between smoldering MS vs. menopause-related change? These two can produce similar symptoms (fatigue, brain fog, slower processing) through very different mechanisms. Dr. Voskuhl explains how to tell them apart and why your neurologist may not have brought this up.

Why "your MRI looks fine" isn't the whole story? MRI shows lesions. It doesn't show gray matter atrophy well, and it doesn't show what's happening inside cells that are still alive but struggling. Your symptoms are real data.

What is estriol, the pregnancy estrogen, and why it's different? Many women with MS notice their symptoms quiet down during the third trimester. Estriol is a big part of why. Dr. Voskuhl walks through the research on estriol as a potential MS treatment and how it differs from traditional hormone replacement therapy.

Why this conversation matters

So many women with MS are told their symptoms are "just MS" or "just menopause" and sent on their way with no plan. Both answers leave you stuck. What you deserve is a clear explanation of what's happening in your body and options you can actually act on.

If you've been quietly wondering whether hormones are part of your picture, this one's for you. And if you're the type of person who wants to understand the why behind your symptoms before you change anything… you're going to get a lot out of Dr. Voskuhl's explanations.

About Dr. Rhonda Voskuhl