Menopause with a Rheumatic Disease

By Linda Rath | Sept. 23, 2022

Menopause is the natural end of menstruation, defined as 12 months in a row without a period or spotting. The average age, depending on whom you ask, is 50 or 51, but it may come earlier or later. Newer research suggests that inflammatory forms of arthritis, like rheumatoid arthritis (RA) or psoriatic arthritis, has little effect on when or how you go through menopause. But despite reams of data, the science about the relationship between the two isn’t entirely clear.

Shaky Science

Scientists long assumed that plunging hormone levels at menopause increased the risk of arthritis or made arthritis symptoms worse. That’s partly because the hormonal ups and downs of perimenopause — the long transition to menopause — and menopause itself are similar to hormonal shifts during and after pregnancy.

In early pregnancy when estrogen levels are high, joint pain and swelling may improve or even disappear, only to flare after delivery when hormone levels drop. Another significant factor is that many inflammatory autoimmune conditions, including RA and lupus, affect many more women than men (2 to 1 and 9 to 1, respectively). Hormones are thought to play a large part in this disparity.

But studies about menopause and arthritis are contradictory, and findings vary from one disease to another. For example, a few small studies reported that disease activity and flares actually lessened after menopause in people with lupus — a surprising finding — although these studies weren’t able to prove a definite link between lower hormones and fewer flares. Other research has shown that treatment with hormone replacement therapy (HRT) may increase the risk of mild-to-moderate flares in lupus patients.

On the other hand, some studies have found that lower hormone levels during menopause increase inflammatory proteins known to contribute to RA. Others report that function is worse in postmenopausal RA patients than in premenopausal RA patients. Yet a 2020 study of more than 1.3 million women found no association between and RA and reproductive factors like menopause, although it did find a small increase in RA with HRT. A 2021 study also found no relationship between RA and menopause, age of first period or pregnancy.

Common Symptoms and Solutions

One thing that’s certain about arthritis and menopause is that they can cause similar symptoms, including fatigue, gastrointestinal (GI) issues, bone loss and sleep problems.  It can be challenging to figure out whether arthritis or menopause is causing certain symptoms, but both can be helped by the following:

• Daily exercise. Aerobic exercise and resistance training are crucial to relieve arthritis pain, improve mobility, manage weight and ease depression and anxiety (thanks in part to an anti-anxiety brain chemical called neuropeptide Y, which is released during exercise and may also aid sleep). Exercise has the same benefits during and after menopause, when it also helps prevent menopause-related bone loss and improves quality of life. Experts say to choose exercise that is challenging but doable. Too hard and you’ll get discouraged; too easy and you won’t get the benefits.
• Healthy food. Decades of research has shown that the plant-based Mediterranean eating pattern — with its emphasis on vegetables, some fruit, a small amount of fish and healthy fats, especially olive oil — offers powerful benefits for both arthritis and menopausal complications, including cardiovascular disease, hot flashes and night sweats.  Cutting caffeine alone can help prevent hot flashes and RA flares.
• Not smoking. Not only is smoking a leading risk factor for RA, it also amps up vasomotor symptoms like hot flashes and night sweats. If you smoke, learn the best ways to quit. If you don’t smoke, don’t start.
• Mindfulness meditation. A number of studies have shown that mindfulness meditation, which focuses on paying attention in the present moment nonjudgmentally, relieves many common symptoms of menopause and arthritis, including insomnia and depression.
• HRT. Twenty years ago, the National Institutes of Health (NIH) abruptly ended its large-scale research on hormone replacement therapy (HRT) for postmenopausal women, citing a link between HRT and breast cancer and some types of heart disease. That link has since been disproven, or at least shown to be much more nuanced. Today, the American College of Rheumatology (ACR) guidelines recommend HRT for most postmenopausal people with rheumatic conditions. The exceptions are those with lupus or anti-phospholipid antibodies, both of which increase the risk of blood clots. The ACR conditionally recommends HRT for those with lupus who don’t have anti-phospholipid antibodies, citing a small risk of increased flares. A conditional recommendation means there’s not enough evidence to make a strong judgment one way or the other. You should not take HRT you have antiphospholipid syndrome or are being treated with anti-clotting medication, like warfarin or heparin.

For some people, HRT can help relieve many menopausal symptoms, including skin and vaginal dryness and a sinking libido. If you meet the requirements and think you’d like to try it, talk to your doctor. But don’t neglect lifestyle changes, which are side effect-free and can benefit arthritis, menopausal symptoms and your overall health.