Most women are only too well acquainted with the physical and psychological havoc female hormones can unleash before and during menstrual periods and at the time of menopause: bloating, weight gain, brain fog, crabbiness, depression, feelings of creeping insanity, hot flashes, bizarre food cravings, insomnia, acne — and rheumatoid arthritis.
Rheumatoid arthritis?
Possibly. If you’re a woman, you’re two to three times more likely to have RA than a man. In fact, if you were born with two X chromosomes, you are more likely to experience most autoimmune disorders — like RA, multiple sclerosis, lupus, some thyroid diseases and scleroderma — compared with your XY chromosome counterparts.
The National Institute of Arthritis and Musculoskeletal Skin Diseases defines autoimmunity as a largely inflammatory condition that occurs when the acquired immune system — the part of the immune system that evolves over time by developing antibodies to fight foreign invaders like viruses and harmful bacteria — mistakenly produces antibodies that target the body’s own healthy tissues, signaling the body to attack them.
And although researchers are not sure why there is such a pronounced gender difference in the prevalence of RA, a growing body of evidence indicates that sex hormones may play a significant role.
[See: 11 Changes Women Go Through in Menopause.]
For example, the risk of developing RA is lower during pregnancy, and in women who have breast-fed for a total of more than 12 months. This risk rises after delivery, and is higher in women who begin menstruating at an early age, have irregular periods, have never given birth or suffer from polycystic ovarian syndrome. And the likelihood of getting RA is highest following menopause, when the body’s levels of sex hormones are lowest.
“There does appear to be a hormonal component to developing RA,” says Dr. Kristen Demoruelle, a rheumatologist in Denver with a special interest in how gender differences influence the development of RA-related autoimmunity.
Sex hormones may not only play a role in acquiring RA, but they may also determine how sick you feel and how well you respond to treatment throughout your life once you develop the disease. For example, studies show that women with RA often go into remission or experience milder symptoms and better disease control when they are pregnant.
Similarly, women who are diagnosed with RA early — at age 65 or younger — are more likely to have gone through menopause at or before age 45, and they also report worse pain than women who experience menopause later in life.
But although current and past research shows a link between female hormones and RA, the process is not well understood.
Studies of hormone levels in individuals with RA may not be conclusive because treatment for the disease or the disease itself can often affect hormone levels. And it’s possible that hormones may not represent the whole story.
“There may be different pathways that lead to RA,” Demoruelle notes.
For example, in addition to declines in estrogen levels, menopause increases the production of interleukin 1, interleukin 6 and tumor necrosis factor alpha, the same pro-inflammatory cytokines that are elevated in people with RA and are responsible for the disease’s damaging effects on joints and organ systems throughout the body.
[See: 7 Surprising Things That Age You.]
This may be one reason why the use of hormone replacement therapy in postmenopausal women with RA has not been shown to have any effect on disease activity.
It may ultimately be more beneficial to evaluate the interplay between sex hormones and RA-related autoantibodies in the early, preclinical phase of the disease, when certain markers for RA are present in the blood but symptoms have not yet developed.
“This preclinical period may be influenced by hormone-specific factors, and hormone levels during this time may help us understand why some people develop RA and others do not, but more studies are needed,” says Demoruelle, who is an assistant professor of medicine in the Division of Rheumatology at the University of Colorado School of Medicine.
What is known is that both RA and menopause increase the incidence of cardiovascular disease and other complications, such as osteoporosis, and “women who have both RA and early menopause have a still greater risk of these problems,” according to Demoruelle.
“There are concerns when a woman with RA enters menopause, especially if it is early,” echoes Kimberly Steinbarger, a physical therapist in Bangor, Maine, who also suffers from RA herself. “Rheumatoid arthritis increases a woman’s risk of cardiac disease and osteoporosis all by itself. Menopause carries the same risks, so if you add the two together, the overall risk of a cardiac event or fracture rises dramatically,” says Steinbarger, the academic coordinator of clinical education in the School of Physical Therapy at Husson University. “Add any kind of hormonal supplement, and cardiac risk rises even more.”
To minimize these risk factors, menopausal women with RA “need to be monitored closely by their physicians,” Steinbarger says.
[See: The 12 Best Heart-Healthy Diets.]
They should also take other steps, like stopping smoking, losing weight and adopting a healthy, balanced diet. Steinbarger also advises women with RA who are nearing or have gone through menopause to consult a physical therapist for an individualized exercise program to help further lower their risk of developing cardiovascular disease.
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Do Female Sex Hormones Contribute to Rheumatoid Arthritis? originally appeared on usnews.com
