Preclinical and clinical studies showed that gender influences the risk of developing multiple sclerosis, its clinical course as well as patients’ disability progression. Globally, females are affected twice as often as males. Furthermore, women are significantly more likely to have a younger age of multiple sclerosis onset and the initial relapsing-remitting disease course. In turn, men are characterised by an older age of multiple sclerosis onset with the predominance of the primary progressive disease type. In relapsing-remitting multiple sclerosis course, women experience more bouts than men. Nevertheless, men experience an earlier conversion to secondary progressive disease variant and more advanced disability progression. Among all sex-related aspects influencing therapeutic decisions, the most important issue is motherhood, which should be taken into account at the stage of establishing multiple sclerosis diagnosis and qualifying for treatment. Compared to healthy individuals, women with multiple sclerosis have fewer offspring and are more often childless, which indicates a significant impact of diagnosis on further maternal plans. Less than 50% of multiple sclerosis patients have a feeling of insufficient knowledge about family planning while undergoing disease modifying therapy. Therefore, it is extremely important to take into account the potential impact of the proposed treatment on foetal development to choose an appropriate treatment strategy, as well as to identify the optimal time for conception. The paper presents differences between the epidemiological, clinical and therapeutic aspects of multiple sclerosis, with particular emphasis on clinical trials and current recommendations concerning motherhood.