Jump To

Extra weight carried around the waistline is medically known as truncal, central, or abdominal obesity and colloquially nicknamed things like spare tire or beer gut. But there’s a greater concern than just what to call it: When you have more fat stored around your midsection, it may also bring with it greater health risks.

“This is the type of fat that increases the risks of cardiovascular disease and certain cancers,” says Tzvi Doron, D.O., a board-certified family medicine, obesity medicine, and clinical lipidologist at Health Meets Wellness in New York City.

And the number of people with abdominal obesity is on the rise: One large study looking at obesity trends in the U.S. found 67% of women and nearly 50% of men were considered to have abdominal obesity, numbers that had an increase of 9% and 11%, respectively, over a 15-year period.

What makes truncal obesity particularly harmful? We’ve got the latest info on how it may differ from other types of body fat, what it means for your well-being, and the best ways to reduce your health risks.

Truncal Obesity What Is Truncal Obesity?

“Truncal obesity refers to excess adipose—or fat—tissue in the abdomen that can surround internal organs, including the liver, pancreas, and intestines,” says Kathleen Dungan, M.D., M.P.H., an endocrinologist at The Ohio State University Wexner Medical Center in Columbus.

There are two types of fat tissue in the body: subcutaneous and visceral. In most people, about 90% of their total body fat is subcutaneous, which sits just beneath the skin. Visceral fat, on the other hand, is centered deep in the abdomen, wrapping around critical organs. People with truncal obesity often has a higher concentration of visceral fat, explains Dr. Dungan. Visceral fat is primarily found around the waistline and in other parts of the abdomen, whereas subcutaneous fat can appear all over your body. Those who have truncal obesity often have both types of fat around their trunk.

Visceral fat can also be reactive in your body. “It’s more hormonally active than subcutaneous fat,” says Dr. Dugan, meaning it produces and releases hormones that can affect your health. Research suggests visceral fat is especially reactive to the stress hormone cortisol—as stress levels go up, visceral fat can, too.

Our New Obesity Newsletter Has Launched! Get the latest obesity treatment options and expert advice—delivered directly to you. Your Email… required Please Enter a Valid Email Address Your privacy is important to us.

Having obesity isn’t the same thing as having truncal obesity. Some people may have a body mass index (BMI) score that falls within the “normal” range but carry excessive weight around their stomach, adds Dr. Dungan. And research has shown that people with high levels of visceral fat are at increased risk for cardiovascular disease and other health concerns—even if their BMI falls within that healthy range. Truncal obesity is also specifically measured, but in ways that are different from traditional BMI.

Measurements Measuring Truncal Obesity

Truncal obesity is typically measured in two ways. The first method involves assessing your height-to-weight ratio (divide your height in inches by your weight in pounds). If it’s more than 0.5, that could be a sign of truncal obesity. Another approach is to measure your waist circumference. If it’s more than 35 inches for females or 40 inches for males, that may indicate you’re carrying excess weight around your belly. (Note that this measurement can also account for subcutaneous fat.)

A third, and more precise, way you can evaluate the type of fat you’re carrying around your abdomen is to get a DEXA scan: This low-radiation X-ray measures your body composition and distinguishes visceral adipose tissue from subcutaneous.

Causes Causes and Risk Factors for Truncal Obesity

Truncal obesity doesn’t develop suddenly, and your diet isn’t the only thing to blame. There are several possible causes.

Sex hormones and age: “Men are more likely to have more visceral fat than women—at least until menopause,” says Dr. Dungan. Age may also increase visceral fat. As men age, their testosterone levels can decrease, which can cause weight gain and in some instances, truncal obesity, says Suneye Koohsari, M.D., a board-certified obesity medicine and family medicine physician at Manhattan Medical Weight Loss in New York City. And during menopause, plummeting estrogen levels—and other hormonal shifts—can promote fat accumulation in the abdomen for women.

Genetics: Your genetics can influence where your body stores fat, notes Dr. Dungan. “Some ethnic groups, such as those of South Asian descent, may have higher risk of visceral fat accumulation, increasing the risk of cardiovascular disease at lower overall weights,” says Dr. Koohsari.

Medications: In general, “ certain medications can be weight-promoting,” says Samantha P. Flanagan, D.O., an assistant professor of clinical family and community medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia. These include certain mood stabilizers, antipsychotics, steroids, as well as certain diabetes and anti-seizure medications. (Steroids, in particular, have been shown to specifically increase visceral fat.) “Some cardiovascular medications, like beta-blockers, and hormonal contraceptive medications like the Depo-Provera shot, among others, can contribute to weight gain and visceral fat accumulation,” Dr. Doron says. Protease inhibitors, used to treat HIV, can also cause increase visceral fat, Dr. Koohsari adds.

Lifestyle habits: “The same factors that contribute to obesity in general also increase the risk of truncal obesity,” Dr. Flanagan says. Eating a diet high in refined carbohydrates and processed foods loaded with saturated fats can cause abdominal fat gain. Other factors include excess alcohol consumption and low levels of physical activity, adds Dr. Koohsari says.

Insulin-resistant conditions: Insulin resistance occurs when the body’s cells no longer respond effectively to insulin, which can lead to increased blood sugar levels. “In turn, this can increase your hunger and cravings,” Dr. Flanagan says. “It also can signal the body to store fat in the abdomen.” Insulin resistance can be seen in those with prediabetes and diabetes, and in some people with polycystic ovarian syndrome (PCOS).

Endocrine disorders: “ Cushing’s disease and hypothyroidism can cause weight gain, as well as some rare genetic diseases,” Dr. Doron says. (Cushing’s disease especially is linked to visceral fat accumulation around the trunk, due to prolonged use of steroids.)

Psychosocial factors: “ These include stress, low social support, and mental health disorders such as depression,” says Dr. Dungan.

Socioeconomic challenges: Socioeconomic status can contribute to obesity, including truncal obesity, Dr. Dungan says. Some potential challenges include living in a food desert where there’s minimal access to fresh, nutrient dense foods; having a lack of access to preventive health care; and earning low income.

Health Risks Health Risks Associated With Truncal Obesity

There’s a lot of overlap between truncal obesity and obesity complications. A large meta-analysis of 72 studies published in the British Medical Journal concluded that the more abdominal fat a person has, the higher their risk of dying from any cause.

More specifically, truncal obesity increases the risk of:

Asthma

Cardiovascular disease

Certain types of cancer, including breast cancer and colorectal cancer

Dementia

Fatty liver disease

High blood pressure

Obstructive sleep apnea

Type II diabetes and insulin resistance

Solutions Managing Truncal Obesity

Obesity is often reversible. “Weight loss, in general, leads to loss of fat everywhere, including visceral fat,” says Dr. Doron. Lifestyle modifications, such as prioritizing plant-based foods in your diet and incorporating a mix of strength and cardio-based workouts into your routine, are a good place to start. “Exercise has a specific impact on visceral fat, with aerobic and resistance training both leading to reduced visceral fat even when there isn’t much total weight loss,” Dr. Doron says.

Prioritizing sleep can also help, adds Dr. Koohsari, who notes that not getting enough sleep is linked to obesity. You may also want to look into getting tested for sleep apnea, which can disturb sleep quality and has its own health risks.

If lifestyle changes don’t appear to make a difference, the latest generation of obesity medications (AOMs), such as injectable GLP-1s like Wegovy and oral pills like Contrave, may make a significant difference.

Finally, you may also want to consider surgery if none of the above are helping in your fight against truncal obesity. “For those with a very high body weight, or multiple weight-related medical conditions who aren’t able to successfully lose weight or sustain their weight loss, weight-loss surgery like bariatric or metabolic surgery could be very effective,” notes Dr. Dungan.

Bottom Line Bottom Line

Truncal obesity isn’t always linked with general obesity. You may be at a normal weight and/or BMI, but if you carry a majority of weight around your belly, it could be a sign that you’re also carrying extra visceral fat. This can have negative consequences on your health, including raising your risk of cardiovascular disease and certain cancers. Multiple conditions, such as low testosterone, and other factors like medication or other health concerns can contribute to truncal obesity. Addressing the root causes may help you reduce your visceral fat stores and improve your overall wellbeing.

© 2025 HealthCentral LLC. All rights reserved.

There are many treatment options for uterine fibroids, such as medications, diet or lifestyle changes, and, in severe cases, surgery. The best treatment for uterine fibroids will depend on your symptoms and factors, such as whether or not you have reached menopause or may want to get pregnant in the future.

What Are Uterine Fibroids?

Fibroids are abnormal growths that form on or in the uterus. About 20-80% of women will develop fibroids by age 50. These overgrowths of the muscle cells in the uterus are noncancerous, so there is no need to panic, said Janice Newsome, MD, associate division director of interventional radiology and image-guided medicine at Emory University Hospital.

Most uterine fibroids are non-symptomatic and do not need treatment. Fibroids can sometimes cause symptoms like:

Bleeding

Lower back pain

Painful periods

Symptoms may depend on factors like how big the fibroids are, how many there are, and where they are located. Fibroids may also increase the risk of infertility and adverse pregnancy outcomes.

Watchful Waiting

If you have uterine fibroids but do not have any symptoms or only minor symptoms, doing nothing—while staying alert for any changes—is an option.

“If the fibroids are not causing any problems, and they are not dramatically enlarged, they can be watched,” Mitchell Kramer, MD, chairman of obstetrics and gynecology at Northwell Health’s Huntington Hospital, told Health. “You do not necessarily need to intervene.”

This is often the strategy when you are nearing menopause or post-menopause. Increased estrogen can result in fibroid growth. As estrogen naturally diminishes, so do fibroids.

Watchful waiting is also an option if you want to get pregnant and the fibroid does not look like it will interfere with pregnancy. A healthcare provider can help you decide if this option is a safe and effective one for you. “From a pregnancy point of view, some fibroids are very problematic, some aren’t,” said Dr. Kramer.

Diet and Lifestyle Changes

“Because we actually don’t understand what causes fibroids to form, it’s difficult to say what you should do to prevent them,” Dr. Newsome told Health. There may be some possible lifestyle changes to consider. Some evidence suggests that lifestyle factors like having a healthy diet and exercising regularly may help prevent fibroids.

Estrogen affects fibroids, and fat cells produce estrogen. Having less excess body fat could therefore improve fibroid symptoms, said Dr. Newsome.

Exercise may also help ease some uterine fibroid symptoms, but there are no known ways to get rid of fibroids naturally, added Dr. Newsome.

While there are no large studies on diet or foods that can shrink fibroids, there is some anecdotal evidence. Research has shown that eating more fruits and green vegetables is associated with a lower risk of fibroids forming.

GnRH Modulators

If watchful waiting and lifestyle changes are not options for you, healthcare providers may move on to hormonal medications to control symptoms and even shrink the fibroids. Several of these medications, like Lupron (leuprolide), are gonadotropin-releasing hormone (GnRH) agonists.

GnRH agonists work by blocking hormone production. This causes the fibroids to shrink, which relieves uterine fibroid symptoms like heavy bleeding, which lowers your risk of anemia and pelvic pain.

Added Hormones

Halting hormone production means you may also end up with menopausal symptoms like hot flashes. Some healthcare providers prescribe “add back” medications, which are low doses of hormones, to counter that effect without decreasing how well the GnRH agonist works.

GnRH agonists, available in pill, nasal spray, and injection forms, are typically used for a short period. They can be helpful in reducing the size of a fibroid before surgery. Fibroids will grow back after these medications are stopped.

Hormonal Medications

Hormonal contraceptives are another option to treat uterine fibroid symptoms. They will not necessarily reduce the size of uterine fibroids, but they may regulate periods or reduce heavy bleeding.

Some evidence suggests that danazol, a synthetic drug that mimics testosterone, can shrink fibroids and reduce symptoms. This treatment might also result in weight gain, acne, and unwanted hair.

Non-Hormonal Medications

Non-hormonal options include Lysteda (tranexamic acid), which can lighten bleeding if it is taken on days when your period is heavy.

While they will not do anything to reduce fibroid size, non-steroidal anti-inflammatories (NSAIDs) like ibuprofen can help relieve fibroid pain. “For the most part, medical therapy tends to be more of a temporizing measure,” said Dr. Kramer.

MRI-Guided Focused Ultrasound

In this non-surgical procedure, healthcare providers use a magnetic resonance imaging (MRI) system to locate your uterine fibroids and then zap them with high-frequency ultrasound. “It’s considered to be a permanent procedure to eliminate or decrease the size of the fibroids,” said Dr. Kramer.

The actual procedure is painless and non-invasive. It is performed inside an MRI machine, and you can usually go home the same day.

Using MRI-guided focused ultrasound to treat uterine fibroids appears safe, even if you still want to get pregnant. It is unclear if there are side effects or possible complications.

Uterine Artery Embolization

Also called uterine fibroid embolization, this procedure deprives fibroids of their lifeblood. “Embolization can block off blood supply to the fibroids,” said Dr. Newsome. “The fibroids shrink and die.”

A healthcare provider will inject tiny particles into the arteries that supply blood to the fibroids. The particles set up a roadblock for any blood trying to reach the uterine fibroid. Uterine artery embolization can be done as either an inpatient (in a hospital) or an outpatient procedure (without hospitalization).

Embolization is generally an option if uterine fibroids are causing heavy bleeding. It is not recommended if you plan to get pregnant.

“There are studies being done now to assess whether or not it’s safe to have this procedure and get pregnant,” said Dr. Kramer. It is thought to weaken the walls of the uterus, which puts you at risk for complications during pregnancy.

Ablation

Endometrial and radiofrequency ablations are procedures. They may be helpful for the treatment of uterine fibroids.

Endometrial Ablation

Endometrial ablation is a type of minor surgery that destroys the endometrium (the lining of the uterus). This usually takes care of heavy bleeding, but the procedure tends to only work for some cases of uterine fibroids.

“Endometrial ablation doesn’t treat all fibroids, just ones that are towards the inside portion of the uterus,” said Dr. Newsome.

Endometrial ablation is usually done on an outpatient basis, even right in a healthcare provider’s office. An instrument is inserted through the vagina and into the uterus, where it uses heat, electric currents, or microwave energy to destroy the fibroids and uterine tissue.

It is unlikely for you to be able to get pregnant after endometrial ablation. If pregnancy does occur after ablation, there is a higher risk of miscarriage or other problems.

Ultrasound-Guided Radiofrequency Ablation

Another type of ablation for the treatment of fibroids is ultrasound-guided radiofrequency ablation (RFA). An RFA procedure uses heat to cause tissue destruction, through the use of direct thermal conduction, ultrasound, or electromagnetic energy.

RFAs for fibroids are minimally invasive outpatient procedures. They have also been found to be safe and effective.

There are two kinds of ultrasound-guided RFAs: laparoscopic (Acessa) and transcervical (Sonata). For either type, a healthcare provider will use the ultrasound to insert the ablation device into the fibroids, resulting in the tissue being destroyed.

Following the procedure, the size of the fibroids will get smaller weeks to months later. It is also possible for pregnancy to occur after an ultrasound-guided RFA, but it is typically not recommended.

Myomectomy

Unlike endometrial ablation, a myomectomy is an option if you still want to get pregnant and can be used to take care of intracavitary fibroids or those that go into the uterine cavity. “Myomectomy is surgery to remove the fibroids from the uterus, and it keeps the uterus intact,” said Dr. Kramer.

There are several different ways to perform a myomectomy:

Abdominal: Is an open surgery with an incision in the abdomen

Is an open surgery with an incision in the abdomen Hysteroscopic: Uses an instrument called a hysteroscopic resectoscope inserted through the cervix

Uses an instrument called a hysteroscopic resectoscope inserted through the cervix Laparoscopic: Uses thin scopes with a camera attached (laparoscope), and small instruments are inserted through tiny incisions

Uses thin scopes with a camera attached (laparoscope), and small instruments are inserted through tiny incisions Robotic: Is laparoscopic but uses robotic surgical instruments

Some involve inserting an instrument through the vagina and cervix into the uterus to destroy or remove the fibroids. Others involve making small incisions in the uterine and abdominal walls to do the job. The procedures are considered permanent.

“The fibroids do not grow back,” said Dr. Kramer. In some cases, it’s not the end of fibroids entirely. “Theoretically, there could be very small ones that will grow over time that weren’t detected at the time of the surgery.”

Morcellation

Sometimes myomectomy is accompanied by morcellation. This procedure breaks fibroids into smaller pieces before removing them.

The Food and Drug Administration (FDA) recommends against this practice, especially if you are near or in menopause, in case there is an undiagnosed cancerous tumor present. If a cancerous tumor is broken into little pieces, it could spread.

Hysterectomy

Fibroids are a common reason for a hysterectomy, a surgical procedure to remove the uterus. This procedure is permanent and typically cures heavy menstrual bleeding and other fibroid-related symptoms.

The procedure is usually reserved for those with very large uterine fibroids and heavy bleeding who are nearing or post-menopause. It may be the preferred treatment method for others. “If a woman has a family history of ovarian cancer or endometrial cancer, maybe they’re not the best person to have a uterine-sparing procedure,” said Dr. Newsome.

Healthcare providers may opt to remove just the uterus, part of the uterus, or also the ovaries and fallopian tubes. It is not uncommon for the ovaries and cervix to be left in place if the procedure is for fibroids. Removing the uterus means you will not be able to have children. Taking out the ovaries means you will go into menopause.

Notable ways of performing a hysterectomy involve making incisions in the abdomen or vagina, or laparoscopy. This is a procedure in which a thin telescope (laparoscope) is inserted through small incisions made in the abdomen.

Hysterectomy is considered a major procedure. As with any major procedure, there can be risks that include bleeding, blood clots, and infection.

A Quick Review

If fibroids are small and there are no symptoms or only minor symptoms, treatment may not be needed and you will be monitored for any changes. If you have symptoms, there are many treatment options you can explore with your healthcare provider, including medications and surgical procedures.

Jump To

Many factors can influence disease progression with multiple sclerosis (MS), including viral infections, the presence of other medical conditions, smoking, physical activity levels, and even pollution. One more thing that might go on the list? Exposure to sunlight, especially at an early age, per a new study suggesting that the earlier babies receive at least some sun exposure, the better it might be for later MS activity.

The study, which was published in Neurology, Neuroimmunology & Neuroinflammation, examined a cohort of children with MS and found that those who had spent more than 30 minutes per day in the sun during their first summer of life had a reduced risk of MS relapse when they were later diagnosed. A similar protective effect was also noticed for those whose mothers had sun exposure in their second trimester of pregnancy.

“Our main finding about early sun exposure, including prenatal exposure, was unexpected, so it definitely took us by surprise,” says the study’s lead author, Gina Chang, M.D., a researcher in child neurology at Children’s Hospital of Philadelphia. “These findings prompt more questions that will need additional research to answer, but this does feel like a step toward interesting and valuable insight into the link between sun exposure and MS, especially earlier in life.”

Study Findings Early Sun Exposure Appears to Lower Relapse Risk

In the study, researchers recruited pediatric-onset MS patients—ranging in age from 4 to 21—from 18 pediatric MS clinics across the U.S. and assessed the amount of sun exposure for various periods of life, using a detailed questionnaire as well as data on UV exposure in specific geographic locations. They investigated whether there was an association between time spent in the sun in early childhood and a risk of relapse in a three-year timeframe.

In the cohort of 334 children with MS, 62% experienced at least one relapse from disease onset to the end of the follow-up period. Dr. Chang says those who spent 30 minutes or more daily in sunlight during their first summer had a 45% risk of relapse while those who got less than 30 minutes of sun exposure had a 65% risk of relapse. After adjusting for type of MS medication taken, season of birth, and sun protection used, researchers found that childhood sun exposure before age 1 was associated with a 33% lower relapse risk.

That first year of life appeared to be key: There was no significant association between more recent sun exposure and lower risk of relapse in this study. That said, the researchers did note that previous research has linked higher summer UV exposure during childhood and adolescence and a reduced risk of developing MS.

In addition, researchers found that children whose mothers spent 30 minutes or more in the sun a day during their second trimester of pregnancy were 32% less likely to relapse compared to those whose mothers received less than 30 minutes daily sun exposure, says Dr. Chang. This protective effect did not seem to hold during the first and third trimesters.

“Early life or in utero sun exposure seems to have a protective effect on patients with pediatric-onset MS, in terms of relapse risk,” says Dr. Chang. “This builds on a previous study by our group that found that greater sun exposure, including in early life, was associated with a reduced risk of pediatric-onset MS, which means lower incidence of MS.”

While the researchers didn’t explore whether sun exposure early in life protects against incidence or relapses later as an adult, given these findings, Dr. Chang notes that may be an important premise to investigate next.

Role of Sunlight Exploring the Sunlight/MS Connection

Admittedly, a large number of variables factored in the researchers’ data set, and an association between less sunlight in infancy and greater MS risk in adulthood by no means equals causation. Still, although the findings about infants gaining potential protection thanks to sunlight might have been surprising—even to the research team—previous studies have already linked low sun exposure and vitamin D deficiency to MS progression in general.

For example, a research review in the Journal of Neurological Sciences found that sunlight is a key environmental variable when it comes to MS, and that reduced exposure may trigger symptoms. In that review, most lifestyle and environmental factors seem to have the greatest effect during adolescence, which means sunlight may help teens with preventing MS exacerbation and progression.

MS is also more common at latitudes farther from the equator and less common in areas closer to the equator, per the National Multiple Sclerosis Society, which suggests that sunlight may have a significant influence in the development of MS.

Most likely, these protective effects are related to the way that sunlight triggers your skin to produce vitamin D3, which is then converted to a usable form of vitamin D by the liver and kidneys. The vitamin plays a major role in immune system function, so having an adequate amount could help those with MS—and everyone else—have stronger immunity, says Dr. Chang

That may also apply to babies in utero, says Dr. Chang. As a mother processes sunlight into vitamin D, that benefit is passed along during pregnancy and may help with the developing fetal nervous or immune system.

Balancing Risks Striking a Balance

While the research may point to the need for more sun time for infants when it comes to MS risks, it’s important to have a strategy that also considers skin health and cancer risk.

“The potential protective effect of early-life sun exposure on MS relapse risk is an intriguing finding,” says Gage Alvernaz, D.O., a pediatrician at Children’s Minnesota in Woodbury, MN, who was not part of the research team. “We know that vitamin D plays a role in immune system regulation, and sunlight exposure is a primary source of vitamin D synthesis. However, it’s important to balance these potential benefits with well-established risks, particularly in infants under six months.”

Ultraviolet exposure at this age is associated with an increased risk of skin damage and later skin cancers, he notes. That’s why the American Academy of Pediatrics recommends keeping infants out of direct sunlight and using protective clothing.

“For all ages, sun safety remains a priority at this time,” Dr. Alvernaz adds. “Sunscreen use, seeking shade, and obtaining vitamin D through diet or supplementation when appropriate are safer strategies for young infants as the benefit regarding MS relapse risk has yet to be established to outweigh the risks.”

Without any official guidelines on sun exposure for infants and children, despite what the recent study finds, erring on the side of sun safety is prudent, Dr. Alvernaz says. Talk to your pediatrician or dermatologist to create a plan that can blend a safe amount of sun exposure with recommended protection against cancer, particularly for babies and children.

© 2025 HealthCentral LLC. All rights reserved.

Jump To

While about 85% of people with multiple sclerosis (MS) are diagnosed with the relapsing-remitting (RRMS) type, which involves periods of worsening symptoms followed by remission, for a small subset of people, living with MS involves minimal disability and more or less a normal existence, despite having the disease for many years.

What might they be doing differently? Recent research has shown that certain lifestyle factors, like eating fish regularly, quitting smoking, and avoiding obesity, are associated with slower disease progression. Now, a related new study is showing that lifestyle factors like these may help improve long-term outcomes of MS.

Study Findings Trying to Crack the Progression Code

The same research team who authored this new study about lifestyle, published in Neurology, Neurosurgery & Psychiatry, also recently explored the role of fish in the diet and MS progression and the combined effect of obesity and smoking on MS disability. Based on their initial findings, they decided to investigate the role that lifestyle and environmental factors might play in MS severity.

The study authors, who were based in China and Sweden, reviewed the medical history for 2,040 people who “exhibited minimal disability after many years of living with the disease.” They then compared this data with that of 4,283 people with symptomatic forms of MS. (The researchers used the term benign MS to signify people without significant symptoms—this term is being phased out by the medical community due to its misleading nature.) To be considered “benign,” participants had to score 3 or lower on the Expanded Disability Status Scale (EDSS, which ranges from 0 to 10)—the most commonly used disability scoring tool for MS—after at least 15 years with MS.

The researchers also looked at such factors as a history of smoking, body weight in early adulthood, fish consumption, having had infectious mononucleosis (IM), and sun exposure (sun helps the body produce vitamin D). They found that people with MS who consumed fish weekly had less severe progression of MS compared to those who never or seldom ate it. On the other end of the spectrum, people who had contracted IM at some point—which is caused by the Epstein Barr virus (EBV)—were more likely to have disease progression than those who’d never had IM. Subjects who had been overweight or obese at age 20 were more likely to have more severe forms of MS than those who reported a normal weight (body mass index, or BMI, less than 25).

In addition, obesity and IM were linked with increased odds of moving from mild to more severe MS after 15 years. (The researchers did not find a strong association between smoking or low sun exposure at time of MS onset and the severity of a person’s disease.)

Role of Inflammation Inflammation: A Common Denominator

Although the question of what makes MS progress more quickly in some people than others is a complicated one, the three factors raised in the study—fish, obesity, and a history of IM—all relate to inflammation in the body. Excess body fat is highly inflammatory and it increases the risk of having other health conditions, including high blood pressure, diabetes, and cardiovascular disease, says Ingrid Loma-Miller, M.D., the assistant chief of the neuroimmunology/multiple sclerosis division at the University of Pittsburgh School of Medicine in Pittsburgh, who was not associated with the current study. Fish—both fatty types like salmon, trout, and tuna, and lean types like cod, sole, and halibut—contain anti-inflammatory nutrients, such as omega-3 fatty acids, taurine (an amino acid), and vitamin D.

Finally, having a history of IM may have caused inflammation that lingers in the body, says Claire Riley, M.D., the director of the Columbia University Multiple Sclerosis Center in New York City, who was also not involved with this study. “We don’t know if the EBV variant someone got that caused the IM was worse or the immune system responded in a bigger way to it,” she says. “It’s not clear, but it seems to be important in setting up the immune dysregulation. It tells us more about the person’s initial propensity to have more severe MS, potentially due to how their immune system reacted.”

Lifestyle Changes Small Lifestyle Changes Could Yield Big Symptom Improvement

You can’t go back and change the viruses you were exposed to, but knowing you had IM could still help your doctor manage your MS. “Patients with a history of IM might benefit from closer monitoring for signs of MS progression,” noted the researchers. “Early identification of individuals at higher risk for non-benign MS could lead to more proactive management strategies.”

And while you can’t change your past weight, you can take steps now to lose pounds if you’re overweight or obese. Even if you already have a more severe form of MS, losing weight may affect how your MS progresses, says Dr. Loma-Miller. If you have obesity, ask your doctor about weight-loss strategies that might work for you, and for referral to a dietitian who can design a personalized weight-loss plan.

You can also easily increase your fish consumption. For optimal heart health, the American Heart Association recommends eating two servings of fish (especially the fatty kind) a week, while the Dietary Guidelines for Americans advises eating at least 8 ounces of fish a week.

Finally, if you smoke, do what you can to quit. It may not only help slow down disease progression, but it’s vital for your overall health. Smoking harms nearly ever organ in the body, per the Centers for Disease Control and Prevention—while quitting smoking lowers the risk of early death and the development of numerous smoking-related diseases.

© 2025 HealthCentral LLC. All rights reserved.

Jump To

Menopause marks a period of change for all women, affecting both physical and mental health. But for those with multiple sclerosis (MS), this transition may have an even deeper and more wide-ranging impact, according to recent research published in Neurology. That’s because the natural shifts that come with menopause can exacerbate MS symptoms, the researchers noted.

“We know that early menopause, especially surgical menopause, is associated with elevated risk of various brain conditions such as dementia later on,” says study co-author Riley Bove, M.D., an associate professor of neurology at the University of California San Francisco Weill Institute for Neurosciences. “With that in mind, we wanted to see whether there is any worsening in MS severity after menopause due to changes in the brain.” The answer? “We found a small but statistically significant acceleration in the pace of worsening for women with MS,” Dr. Bove reports.

Study Findings A Subtle Progression of Disability

To conduct the study, Dr. Bove and her team followed 184 postmenopausal women with MS for a period of 13 years; 85% had natural menopause at the average age of 50, and 15% had surgical menopause following removal of both ovaries.

Researchers focused on two measures to determine potential changes in disease progression over the course of the study, says Dr. Bove. The first measurement, the Multiple Sclerosis Functional Composite (MSFC), is a three-part assessment that’s used in clinical studies of MS and measures walking speed, dexterity, and cognition. The second measurement involved blood tests to track the severity of nerve injury progression. The researchers combined the results from these tests to determine where each participant fell on the Expanded Disability Status Scale (EDSS), often used for measuring MS disability.

“We expected to see a very subtle worsening in the functional MS scores, and a subtle increase in the levels of nerve damage, and that was exactly what we found,” Dr. Bove says. “The changes weren’t dramatic but did include worsening on all three measures of the MSFC after menopause, particularly with walking speed.”

Menopause and MS The Menopause/MS Connection

Women with MS often report there’s an overlap between menopause (which is defined as going a full year without having a period or spotting) and worsening of MS, says Dr. Bove, with shifting hormones creating a ripple effect on MS symptoms. Frequent or intense hot flashes can exacerbate MS challenges like insomnia, sleep disruption, fatigue, and low mood. (That doesn’t mean MS will always get worse during menopause: In one research review published in the International Journal of Women’s Health, a study looking at MS patients’ perceptions of symptom severity after menopause found 40% of cases got worse, 56% had no change, and 5% had decreased symptoms.)

Previous research done by Dr. Bove and her colleagues found that the most increased symptoms after menopause among women with MS included more anxiety and depression, as well as bladder irritability and incontinence, fatigue, and low libido. In this study, says Dr. Bove, the researchers structured the analysis to focus on whether there was a worsening of change after menopause, accounting for age. “We did our best to evaluate the contribution of reproductive aging in addition to biological aging on a number of statistical models,” she adds.

The correlation between menopause and MS has to do with the way menopause affects the brain, researchers believe, particularly when it comes to hormonal changes. According to research in Scientific Reports, the years leading up to menopause (a time called perimenopause) involves the development of more estrogen receptors on brain cells. Those researchers found that the closer a woman gets to menopause, the higher the density will be for those receptors. Most likely, this happens because estrogen levels are declining, and the brain is attempting to compensate by absorbing as much of that hormone as possible.

These shifts in how the brain processes estrogen are especially relevant for women with MS, explains Tirisham Gyang, M.D., a neurologist and MS specialist at The Ohio State University Wexner Medical Center in Columbus, OH.

“Hormones like estrogen and testosterone play an essential role in the condition,” she says. “Although MS is a chronic inflammatory disease of the central nervous system, these hormonal factors can potentially influence symptom severity and frequency, as well as how quickly MS might progress.”

Hormone Therapy The Role of Hormone Therapy

While hormone therapy (HT) can help improve quality of life for women with MS who are going through menopause, that didn’t seem to be the case in the recent study, says Dr. Bove. However, it was difficult to determine since only a small percentage (17%) of study participants used estrogen-containing systemic hormone therapy for at least one year.

But previous research suggests this type of therapy should at least be considered for women with MS as a way to mitigate menopausal and MS symptoms. For example, commentary in Multiple Sclerosis notes that hormone therapy may help slow disease progression and improve brain function.

In addition to talking with your health provider before, during, and after menopause about changes in treatment and lifestyle behaviors that can improve symptoms, simply being aware of how menopause may worsen MS can be important, says Dr. Bove.

“Both clinicians and patients can benefit from understanding how the menopausal transition may affect symptoms in women with MS,” she suggests. “That can lead to emphasizing healthy aging, including maintaining function when you have this condition.”

© 2025 HealthCentral LLC. All rights reserved.