Women with myasthenia gravis: the menstrual cycle, pregnancy and menopause can also play a role in the development of symptoms

Myasthenia gravis most often affects young women and older men. What are the specifics of the disease in women, how is it related to their reproductive role and what vicissitudes does it entail in the individual phases of their lives?

In women, symptoms can be intensified by hormonal changes

Both women and men with myasthenia gravis tend to have similar symptoms. In women, however, the menstrual cycle, pregnancy and menopause can also play a role in their development. In about a third of women, symptoms worsen during menstruation.

Another period in which myasthenic problems can be more intense is menopause . In this case, the use of hormone replacement therapy, which is a treatment based on supplying insufficient hormones and thus suppressing the manifestations of their deficiency, can be effective. Postmenopausal women are also more prone to developing osteoporosis (thinning of the bones). In women with myasthenia gravis taking corticoids, the risk of osteoporosis increases, as bone thinning is one of the side effects of these drugs. However, there are drugs that are designed to prevent and treat osteoporosis.

It pays to plan pregnancy for women with myasthenia gravis

Women with myasthenia gravis should plan their pregnancy in advance. Before deciding to become pregnant, it is ideal that they discuss their health status and the medications they are taking with their treating neurologist. Pregnancy is suitable during the period when the disease is under good control. In addition, some drugs are quite aggressive and can be dangerous during pregnancy (e.g. methotrexate or mycophenolate mofetil are among the substances that can harm the fetus). When using these drugs, it is advisable to prevent conception with suitable contraception, for women with myasthenia, there should be no problem with tablet or implanted contraception.

It may be advisable to have your thymus removed before becoming pregnant

In some cases, before a plan pregnancy, it is still advisable to perform a thymectomy – a special operation in which the thymus gland is remove from the body. This procedure is often performed thoracoscopically (i.e. with the help of special probes and a micro-camera), sometimes doctors use the option of robotic surgery.

Approximately half of people after thymectomy experience long-term improvement. This operation is especially effective in younger patients. Another reason for performing it can also be a tumor of the thymus (thymoma), which can be see quite often in myasthenics after the age of 40.

Myasthenia gravis should be under the supervision of a gynecologist and a neurologist during pregnancy

During pregnancy, a woman with myasthenia gravis should have regular check-ups with her neurologist and gynecologist. In women with a stabilized disease, the symptoms of the disease usually do not worsen during pregnancy.

Myasthenia should also not affect the timing or method of delivery in any way. The mother-to-be should avoid taking certain medicines during pregnancy, it is advisable to discuss specific preparations with the attending physician in advance. There should be regular gynecological check-ups – if necessary, additional examinations can be carry out, for example to rule out excessive amniotic fluid production or to assess fetal movements. In general, it can be say that most women with myasthenia gravis have a problem-free pregnancy.

Neonatal myasthenia gravis is nothing to worry about

For a myasthenic woman with a stabilized disease, a classic vaginal delivery should not be a problem. In some cases (as in women without myasthenia), it is necessary to proceed with a caesarean section. This type of birth is also possible for women with myasthenia gravis. It should also be safe to administer epidural analgesia to relieve labor pains. It is generally recommend to avoid using magnesium products. 

Immediately after birth , so-called neonatal myasthenia may appear in newborns – a condition where, as a result of the transfer of maternal antibodies into the body of the newborn, transient symptoms of myasthenia may also occur in her child. Neonatal myasthenia occurs in about 10% of births and it is report that the risk of its occurrence can be reduce by the aforementioned thymectomy. There is also no reason to prohibit breastfeeding for myasthenia gravis, but it is recommend to breastfeed for a maximum of 6 to 9 months.