Many people with rheumatoid arthritis report increased severity of symptoms during the menopausal transition. In one survey, 80 percent of respondents said their arthritis was worse during menopause.
“Menopause just kicked me over the edge,” says Christine Byrnes, 63, of Myrtle Beach, South Carolina. She was diagnosed with rheumatoid arthritis (RA) about 17 years ago. For nine years, the medication etanercept (Enbrel) kept her symptoms at bay. But as menopause revved into high gear, her body went “haywire,” she says.
“I had a lot more flare-ups and was generally feeling really unwell. I had fatigue, sleepless nights, dizziness, and difficulty with stress and focusing,” Byrnes says. “My joints got progressively worse to the point that I had to take medical leave from work and then eventually retire altogether.”
Byrnes discovered on her own something that research appears to back up: A study published in Rheumatology suggests that women with RA have a greater decline in function when they experience menopause.
Another study found that “in women with RA, functional disability progression differed between pre- and postmenopausal women,” with the latter having a “less favorable evolution.” The better outcomes in pre-menopausal women were not explained by disease duration, age, or radiographic damage. Here’s what you need to know.
1. Loss of Estrogen Around Menopause May Affect RA Symptoms and Disease Progression
Researchers have been looking at the link between RA and hormones for a long time. A meta-analysis of research notes that estrogen plays a complex role in immune response and that the “partial loss of the immunomodulatory effects exerted by estrogen” is an important factor in disease progression and severity of symptoms in people with RA during menopause.
Research has also found that declining estrogen levels in menopause (and postpartum) are consistently associated with an increased risk and severity of RA.
“It does appear that estrogen has a protective effect for RA, but it is unclear if this is the main factor as to why women with RA have worsening physical function after menopause,” says Elizabeth Mollard, PhD, an associate professor at the University of Nebraska Medical Center College of Nursing in Lincoln.
Dr. Mollard is a coauthor of the Rheumatology study mentioned above. She adds that “women who were ever pregnant or ever used hormone replacement therapy had less functional decline after menopause, indicating that lifetime estrogen exposure is a protective factor. However, it is likely there are multiple factors and more research is needed.”
2. Menopause and RA Symptoms Can Overlap
Depression, for instance, is common in people with RA. It’s not clear whether it’s a result of having a chronic health condition or the underlying inflammation that causes RA is also causing depression.
You may need to consult your doctor to determine what’s causing your symptoms — RA, menopause, or both — in order to treat them properly.
3. Decisions to Use Hormone Therapy Should Be Made on an Individual Basis
One study found that the use of oral contraceptives appears to protect against RA, while menopausal hormone therapy may increase the risk of late-onset RA.
In the survey of people with RA going through menopause mentioned earlier, almost half of the respondents had taken HRT, and 30 percent of them reported a “moderate or large improvement in their arthritis symptoms.” But the responses also indicated a lack of discussion about the topic with their doctors — that it was often up to the patient to bring it up to their rheumatology team and that they were met with conflicting advice about HT.
4. RA and Menopause Together May Double the Risk for Osteoporosis
“RA and many of the drugs prescribed for RA, as well as menopause, are associated with osteoporosis independently. When combining these risk factors, osteoporosis risk increases. Some of the hormonal changes of menopause also cause complex changes to the immune system, which may hasten bone loss,” says Mollard.
Because of that, it is important to get bone density tests prior, during, and after menopause, says Vinicius Domingues, MD, a rheumatologist in private practice in Daytona Beach, Florida, and a medical advisor to patient advocacy organization CreakyJoints. “Depending on overall lifetime exposure with steroids, I start checking bone density tests around 10 years earlier than recommended by the U.S. Preventive Services Task Force. It is known that patients with RA are more prone to bone fragility and fractures, so we need to be proactive about the screening,” he says.
It is also important to eat a diet rich in calcium and vitamin D. Dr. Domingues says, “The whole debate over calcium supplementation has been controversial, with some studies pointing toward increased risk of coronary disease. In my office, we encourage a diet rich in calcium with dairy products to reach around 1,000 milligrams (mg) of calcium and 600 international units of vitamin D. The correct dose is still not clear but clearly should not exceed 2,000 mg of calcium.”
5. Menopause Can Further Complicate Your Sex Life
RA can affect sexual function in women of any age because of RA-related pain, fatigue, self-image, depression, and changes in desire and sexual function. “It can be especially challenging for women with RA, who go through the same difficulties all women may experience regarding sexual function at menopause compounded with a possible increase in disease activity,” Mollard points out. This often goes unaddressed by healthcare providers, so it is important that you address your needs with your clinician.
“RA is a chronic disease, and the couple as a whole suffers together. In my view, it is pivotal to have an honest and supportive relationship to thrive. I strongly encourage the couple to openly discuss sexual needs and limitations,” says Domingues.
6. RA Treatment Needs May Change With Menopause
Work very closely with your rheumatologist to keep your disease under control before, during, and after menopause.
“Treatment needs may change with the changes that occur at menopause. Medication adherence is extremely important. Self-monitoring the daily symptoms of RA, even using pen and paper, can help a woman notice flares, changes in her RA, and changes to her responses to medication and treatments. It is also important that women engage with other specialty providers such as gynecologists and cardiologists to help manage system-specific related symptoms and changes even when it is known to be related to her RA,” says Mollard.
“Keep on telling your doctors that you don’t feel well, even if you feel like a complainer. You have to be honest with them,” says Byrnes, who did a lot of personal research on the subject. She found Mollard’s study and discussed the ramifications with her rheumatologist.
“I am so glad there is research being done about it, as this validates my feelings and what I am going through,” says Byrnes. “I think it’s important to help so maybe in the future other women won’t have to endure this.”
7. Lifestyle Measures Can Help Both RA and Menopause Symptoms
Making the following lifestyle changes can help you manage symptoms, whether they’re related to menopause, rheumatoid arthritis, or both.
Don’t smoke. Smoking can worsen RA symptoms. It’s been found to increase the risk of hot flashes, too.
The Takeaway
- Hormonal fluctuations during menopause can exacerbate rheumatoid arthritis (RA) symptoms, and menopause symptoms can overlap with those of RA.
- Discuss any increasing symptoms or flare-ups with your healthcare provider, as adjustments to your treatment regimen might be necessary during and after menopause.
- Consider lifestyle changes, such as prioritizing a balanced diet and getting regular exercise, which can help alleviate both menopause and RA symptoms.
- Menopause combined with RA significantly raises the risk of osteoporosis, so it’s crucial to undergo regular bone density testing and maintain adequate calcium and vitamin D levels.
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