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Weaknesses, your name is woman! (William Shakespeare, Hamlet, act I)
Is MS a woman? What a perverse sexist question that is! However, it is worth remembering that women suffer from multiple sclerosis twice as often.
Recent statistics show that in more industrialized regions this ratio rises to four. Scientists speculate that there is a link between lifestyle (smoking, stress, environmental pollution) and the increase in disease among women. However, there is no such correlation in the case of men. Apparently, female hormones are one of the culprits behind getting MS. Scientists are now paying special attention to the role of estrogen in the development of this disease. Studies with orally administered estradiol in mice with experimental autoimmune encephalopathy (EAE, an animal model of MS) showed a reduction in the symptoms of the disease (see the box for studies on the mechanism linking hormone levels, especially estrogen, and immune system function in the box).
Hormones, hormones …
Woman, woman,
you are abyss, hell, mystery, Aurore Dudevant (George Sand)
Let’s take a closer look at the relationship between the level of female hormones and the course of multiple sclerosis. Hormone levels are not constant throughout a woman’s life. Childhood is a hormonal silence, then there is a storm of adolescence, stabilization and slight waves related to pregnancy, the monthly cycle, then gradually calming down …
These fluctuations are well seen in the epidemiology of MS. Among sick children, girls are outnumbered. You can even notice the slight domination of the boys. Only in adolescence, as the levels of female hormones increase, do relationships change. There is one boy for two sick girls. This proportion persists throughout adulthood. Since a diagnosis is rare after the menopause, it is difficult to assess how the decline in hormones reduces the likelihood of developing the disease.
It is known, however, that the well-being of women with MS is influenced by hormonal changes, both those caused by pregnancy and those related to the menstrual cycle. The beginning of pregnancy, the first trimester, apart from typical ailments at that time, is usually silence in the disease. The best mood occurs in the last trimester, when the woman’s immune system weakens to prevent rejection of the fetus. In the early XNUMXs, when little was known about multiple sclerosis, medics recommended pregnancy as a way to reduce the symptoms of the disease. The method is not the best, because childbirth and subsequent care of the newborn often provoke a relapse as a great effort. It is also favored by the hormonal storm following the birth of a child. Hence, many women suffering from multiple sclerosis experienced their first symptoms just after giving birth. For this reason, in the XNUMXs, for a change, pregnancy was discouraged as being too dangerous for the patient’s health. Today, some women still give up motherhood because they are at risk of relapsing MS after childbirth, although doctors, according to research, are trying to convince them that there is no significant link between getting sick and pregnancy.
The level of hormones also fluctuates in the monthly cycle of women and affects the well-being. In a study of 149 women, it was found that 70 percent of them reported a regular change in symptoms during the cycle, before menstruation. Some researchers refer to these states as “pseudo-accidents.” They occur up to seven days before and up to three days after menstrual bleeding begins. Usually, the symptoms intensified: weakness, acute imbalance, fatigue, and depression appeared. From the point of view of their etiology, it is important that just before menstruation, in the second half of the cycle, the body temperature rises by about 1 ° C. This can worsen symptoms such as heat and fever. However, research shows that the increase in temperature alone does not explain the deterioration of well-being. The relationship between hormone levels and the functioning of the immune system also plays a large, though yet unknown, role. It has been proven that relief in this case can be obtained by taking aspirin (Wingerchuk & Rodriguez 2006).
The menopause (climacteric period) is a period of turbulent hormonal changes. It is difficult for many women, not only those suffering from MS. During the menopause, your body’s production of estrogen drops significantly. However, there are no data indicating any effect of this process on the frequency of relapses or the progression of MS. However, some symptoms of the disease, such as fatigue or ailments related to the urinary system, may worsen.
Mother, wife, lover …
… you are not a woman:
you are the challenge Karl Kraus
– Which of us did not dream of a white dress and a small white house outside the city. This fairy tale can only come true when a prince on a white horse appears on our way. And will love me the way I am? Not very self-sufficient, with a million problems per minute, not quite emotionally balanced. Such a combination will result in a black comedy rather than a romantic movie with a happy ending. May it not be a drama. However, if he falls in love, do I have the right to condemn him to a life of constant stress and uncertainty? That’s what this disease is. One big unknown. Let him approach or let him go? Which way will make him suffer more? Milena asks.
Such a dilemma is not experienced by women who were already in a relationship at the time of diagnosis. Time has chosen. This does not mean that they have no trouble fulfilling the role of a wife. – MS does not allow me to be the wife and mother I would like to be. I don’t like telling my daughter that we won’t go out for a walk or play at the moment because I need to rest! This is awful. Just like the fact that I have planned to bake my husband’s favorite pie, and again I do not have the strength! I never thought you could be so tired with so few activities. And the state of vitality depends on the day …, perhaps hormones … – writes Katarzyna.
Unfortunately, it is not just a partnership in taking care of the home. – What about sex? How to feel attractive, unable to move your legs, having hypersensitivity and seeing only the blurry face of your loved one? Milena asks directly. Statistics are brutal, with at least half of all women with MS experiencing all sorts of sexual problems. As many as 80 percent of sick women have experienced this kind of trouble at least once in their life. Usually these are problems with reaching orgasm, decreased libido, fatigue, problems with the bladder, feeling of being physically unattractive. In both women and men, experiencing orgasm depends on the correct flow of signals from the brain (emotional center) through the upper, lower and middle parts of the spinal cord, which controls stimuli from the erogenous zones. If this flow is disrupted by demyelinating changes, sexual responses are impaired or absent. In addition, the sensation of orgasm can be disturbed by secondary symptoms such as changes in sensation, spasticity, urinary problems, or tertiary symptoms such as depression and low self-esteem. In men, the main symptom of these disorders is difficulty getting and keeping an erection. In women – decreased libido, vaginal dryness, no orgasm.
While men in such situations can reach for drugs, for example the famous “blue tablets”, science has not yet found an appropriate remedy for women. (Foley 2008) Studies on the administration of this drug (it was expected that the preparation would increase vaginal lubrication) did not produce satisfactory results. Not surprisingly, the onset of orgasm for women is much more complex than for men. Medicine only learns its mechanisms, the Nobel Prize to those who deal with this problem. Therefore, in the case of insufficient vaginal lubrication, it remains to reach for lubricants such as KY, available not only in pharmacies. It is worth knowing that doctors do not recommend gels based on petroleum jelly, as they may increase the risk of bacterial infection.
High heels, lipsticks, frills,
I will not say that women have no character,
rather, they have a different one every day. Heinrich Heine
Femininity is not only about hormones. This is something that makes men ‘s knees soften, their voices tremble, they forget about the whole world, they are capable of waging wars. This is something that art owes its most beautiful works. A secret keeping the world alive. The essence of being. How women can nurture her! Entire industries for millennia have focused solely on this: smoothing out wrinkles, producing shoes that provide a promising sensual walk, designing dresses that emphasize the curves of the body, lengthening the eyelashes properly to make the look seductive enough. A woman is a promise, not necessarily a fulfillment, but always an invitation to play …
Beautiful. Unfortunately, MS can also take advantage of these elusive attributes of femininity. Almost every sick person remembers the moment when she had to put in the wardrobe forever, if not high heels, then high heels, a dress, beautiful, but maybe not the most comfortable. It hurt, it hurt a lot. So is giving up dancing, good makeup. Hand trembling or double vision does not allow for precise mascara. Can you still be a woman in velcro-fastened shoes, sweatpants that are easy to put on and, in an emergency, quickly take off, but not easy to maintain a sense of femininity in them?
– MS has not robbed me of my femininity. On the other hand, it limited the possibilities very much. It is like taking the fishing rod from the angler. One will try to fish with his hands, the other will hastily assemble a bamboo substitute, and the other will give up, losing hope of a successful catch. The effectiveness of actions often depends on the degree of determination and contribution of one’s own forces, but the opportunities will never be equal, writes Milena.
Preserving these attributes of femininity is difficult. It requires a lot of effort, self-denial, sometimes the involvement of loved ones, but it pays off to maintain my self-esteem as a woman … – I go to the hairdresser once every six months. It is a whole trip. My husband carries me from the first floor to the car, then we go to my hairdresser, there they put me on an armchair and I am brushed, dyed and I come out beautiful. My husband cannot understand (or pretends) what these “hardships” are for, but I feel good – writes Wanda. – When I have a bad day, she feels ugly, awkward and ashamed to go out into the street, I paint my lips with pink lipstick. Maybe it’s shallow, maybe it’s an attempt to distort reality. For me, however, this is the only way to return to the world of women. No affectionate words, no compliments will make me feel good in my body. But the awareness that nothing can take my femininity, yes. And you can kiss with your eyes closed, it’s even more romantic.
Grandma, meaning a woman
We usually don’t think about the fact that Grandma is a woman. And yet it is, for grandchildren it can be a model of female warmth and a sense of security. Most remember from their childhood cakes baked by their grandmother, dressing bruised knees, a time of carefree and forgiving the worst offenses. What is the grandmother with MS like?
– I no longer dream of high heels or dancing, you can get used to living without it. My femininity is suffering in grandma’s skin now. My 3,5-year-old granddaughter says to me, holding out her hand: “Come, grandma to the playground,” and I have to explain my disability. And pleasant moments of communing with a small child fly away like butterflies. I suffered as a woman-wife, and now I am suffering as a woman-grandmother – says Maria
Fortunately, most children love grandmothers and moms just like they are. In a wheelchair, on a crutch with broken hands, poor eyesight. They only love because they are …
The editors would like to thank the Readers for their letters. They allowed for a deeper understanding of the essence of femininity in MS, and fragments were used in reports.
Is MS a woman?
Definitely yes, in addition capricious, moody, moody and indecisive, a woman in many forms and varieties. Once she is full of energy, creating and acting woman who can command, raise her voice, and even bang, and everywhere is full of her, only to run out of strength in a moment and look with a pleading, sad gaze at what is happening to her. She wants to be elegant and tempting today, but the mascara ends up in the eye, not on the eyelashes, and the pin flap is left on the street because the leg went crooked, not in the direction the lady wanted to turn.
Another woman, although still the same, wakes up in the morning and already knows that today she will lie in bed only in her pajamas and will pretend to the world that she is lazy, and in fact the world is so spinning in her head, after all she did not drink alcohol. it was not a party, it did not make it on the dance floor, but “blood alcohol concentration” is completely free. Finally, she got out of bed and sees how much has gone without her, the husband another day in the same shirt, the children are eating up the leftovers of the last night’s pizza, the cat has not cleaned the litter box again, nothing is the same as when she went to bed. But this changing woman has one thing that still doesn’t change – OPTIMISM. dreams
A word about contraceptives
When a woman with MS decides not to have children, temporarily, for example while taking immunomodulatory medications, or forever, she should take appropriate contraceptive measures. There are many products on the market today, they usually contain small amounts of hormones, so they do not affect the course of MS. When selecting them, the gynecologist should therefore be guided by both the health of the woman and the convenience of use. For example, a woman with arm ataxia and precise movements are difficult for her should not reach for vaginal pessaries. In cases of severe ataxia, there may also be problems with maintaining hygiene during menstruation. You should then talk to your doctor about the possibility of blocking the cycle.