A TSEC for Symptom Management in Menopausal Women With Multiple Sclerosis

Inclusion Criteria: * Women aged 40-62 years. * Perimenopausal: 6 months of amenorrhea; women who had a bi-lateral oophorectomy; women without a uterus and who still have one or both ovaries, with FSH level \> 20 mIU/mL and estradiol ≤ 50 pg/mL; women with a uterus who have skipped 2 or more menstrual cycles with an amenorrhea interval; women who are using the Mirena IUD or who have had an endometrial ablation and who still have one or both ovaries, with FSH level \> 20 mIU/mL and estradiol ≤ 50 pg/mL * Bothersome MS symptoms: Mean of two or more hot flashes/night sweats per 24 hrs; Hot flashes/night sweats rated as bothersome ('moderately' to 'a lot') and/or severe ('moderate' to 'severe') on 4 or more 12 hour (day/night) blocks of times * In general good health (determined by medical history, blood pressure, and heart rate) * No history of endometrial, ovarian, or breast cancer; No abnormal mammogram in the last 2 years; Absence of any current severe or unstable medical illness MS considerations: * If using psychotropic medications: no change in the past 3 months * If on DMT, no change in past 6 months Normal vitamin D levels (20-50 ng/mL) Exclusion Criteria: * BMI \>35 kg/m2 as higher BMI may affect PK/PD * Use of hormone therapy or hormonal contraceptives 2 months prior to enrollment * Use of any prescribed therapy that is taken specifically for hot flashes in the past 1 month. * Use of any over-the-counter or herbal therapies that are taken specifically for hot flas…