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#Grand Rounds

Euro-MOTOR Study Results: Is There an Association Between Exogenous Hormones and ALS Risk in Women?

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BACKGROUND AND PURPOSE: 

  • Despite research efforts, amyotrophic lateral sclerosis (ALS) remains a fatal disease with no known etiology  
  • There is some research implicating genetics but limited data on environmental factors 
  • Men are more commonly affected and when women are diagnosed with ALS, they tend to be older  
    • Additional studies suggest that sex hormones may modulate ALS risk  
  • Rooney et al. (Neurology, 2017) sought to determine if exogenous hormone exposure may be associated with risk for ALS in women 

METHODS: 

  • Case-Control study  
  • Euro-MOTOR Consortium   
    • Generation of data on potential environmental etiologic factors from ALS cases and controls across 3 different countries (Ireland, Italy, and the Netherlands) 
    • Incident cases and controls matched by age, sex, and location 
  • A validated questionnaire was used to assess hormonal exposures, including reproductive history, breastfeeding, contraceptive use, hormonal replacement therapy, and gynecologic surgical history 
  • Multivariate logistic regression models adjusted for biasing factors and applied to determine association between female hormones and ALS risk 

RESULTS: 

  • Study included 653 patients and 1,217 controls  
  • History of ever having used oral contraceptives (OCP) was significantly associated with reduced ALS risk 
    • Odds ratio (OR) 0.65, 95% CI 0.51-0.84 
    • Dose-response effect was observed between duration of OCP use and reduced ALS risk  
      • OR 0.98, 95% CI 0.96–0.99 per year of use 
  • Hormone treatment (HT) was associated with a reduced risk of ALS, but only in the Netherlands  
    • OR 0.57, 95% CI 0.37-0.85 
    • Isolated finding to Netherland only may be related to lower prevalence of HT users or different formulations elsewhere 
  • History of hysterectomy or oophorectomy was not associated with ALS 

CONCLUSION: 

  • There appears to be an association between exogenous estrogens and progestogens and reduced ALS risk in women 
  • Hormonal factors may be important etiological factors in ALS 
  • While this study is currently the largest on this topic, some of the findings contradict previous studies and authors recommend further research to replicate their findings 

Learn More – Primary Sources:  

A case-control study of hormonal exposures as etiologic factors for ALS in women: Euro-MOTOR

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Related ObG Topics:

North American Menopause Society: Hormone Therapy Statement
What Are Bioidentical Hormones?
Does Hormone Therapy Protect Against Alzheimer’s?

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