Another thing to keep in mind is that in general, everyone experiences MS differently, at any stage of the disease, according to the Mayo Clinic. So when we talk about early symptoms of MS, keep in mind that it’s not a checklist (and that many other things can cause these symptoms), but a collection of possible flags.
With all of that said, here are some of the most common early signs of MS women should look out for. Though everyone should be aware of the disease, its prevalence in women and onset age suggest it’s even more important for women in their 20s and 30s to pay attention to potential early signs of MS.
Fatigue (overwhelming physical or mental exhaustion that’s not relieved by sleep) is the most common symptom of MS, occurring in 75 to 95 percent of patients, according to the Cleveland Clinic. Given that it’s not related to the severity of the disease and can occur at any stage, it’s frequently one of the earliest recognizable signs of MS. The exact cause of fatigue with MS is still unknown—another mystery—but there are a few theories that could explain it. One has to do with the activation of the immune system; people with MS have a higher level of chemical messengers called cytokines, so you may feel like your body is fighting a virus all the time, which of course could present as fatigue. Another theory is that people with MS have to work harder to function in general, because you have to use more parts of your brain to do the same task as someone without MS.
Dr. Vollmer recommends that any young woman who has serious, unexplained fatigue that interferes with her ability to function on a daily basis should get an MRI. It’s one of the various diagnostic tools used when it comes to MS.
Alongside fatigue, depression can be an early sign of MS. Depression can happen in people with MS for multiple reasons, Abbey Hughes, Ph.D., clinical psychologist and assistant professor in the Johns Hopkins Medicine Department of Rehabilitation Psychology and Neuropsychology, tells SELF. First, it can be a direct result of how MS affects the brain. “When you have a chronic inflammatory condition like MS, it causes inflammation that disrupts neurotransmitter systems that we know are implicated in depression,” says Hughes. On the other hand, depression is often a natural reaction to other aspects of the disease, like dealing with mysterious symptoms with seemingly no answer. (It’s also a symptom on this list that can exacerbate fatigue, Hughes points out.)
All that said, depression can be a hard symptom to pinpoint, given how common it is, both as a symptom of other disorders and as its own illness. “Particularly for women in their 20s and 30s, this is usually a time of growth and development and life changes that in and of themselves could lead to challenges with mental health,” says Hughes. For that reason, it’s often most helpful to look at depression as a flag for MS particularly when it’s in combination with other symptoms on this list.
3. Sleep disturbances
In a 2014 Journal of Clinical Sleep Medicine study that surveyed more than 2,300 people with MS, researchers found that around 70 percent of people screened positive for at least one sleep disorder, such as insomnia, sleep apnea (when you stop breathing multiple times as you sleep), and restless leg syndrome.
While sleep disturbances in MS like sleep apnea can be direct results of MS’s damage to nerves in the brain and spinal cord, Hughes notes that there are likely behavioral factors at play, too. “For example, if someone is fatigued from MS, they may take a nap during the day or use caffeine excessively, which can significantly impact their ability to sleep at night,” says Hughes.
4. Numbness or tingling
These sensations are symptoms of the demyelination in the brain, which is a central part of MS that we talked about earlier. They’re most common in the legs, but you might also experience them in your arms, trunk, or face. And on top of numbness or tingling, you also want to be on the lookout for pain, burning, or itching, according to the Merck Manual.
5. Weakness and motor control problems
Impairments of muscle function are a central feature of MS because of nerve damage, but this can manifest in a few different ways, such as weakness, stiffness, or involuntary muscle actions like spasms. According to materials from the Institute of Medicine’s Committee on Multiple Sclerosis, early in MS, weakness is usually more noticeable after exertion, but it can increase gradually as the disease progresses. The key with weakness (and with all of these early MS signs) is to look for something that feels new and unusual for your baseline. “If you find you can’t lift something you normally wouldn’t be able to lift or can’t sustain physical activity for as long as you once could, that’s a sign you should seek medical attention,” Hughes says.
6. Vision problems
When talking about MS, problems with vision typically fall into two buckets: afferent visual pathway symptoms, which affect how you see the world, and efferent visual pathway disorders, which impact how your eyes move together. According to the Mayo Clinic, one of the earliest indications of MS is something called optic neuritis, an afferent visual pathway symptom that occurs when inflammation damages the optic nerve. It usually only affects one eye and leads to pain with eye movement and temporary vision loss. On the other hand, efferent visual pathway disorders might cause symptoms like ocular misalignment, which can make you see double, or repetitive, uncontrolled eye movements.