Lupus and Menopause — What Will Happen Next?
As a woman with lupus, I have come to expect that just about everything and anything my body goes through has the potential to trigger a flare. As I enter my 49th year I have to wonder how menopause will impact my lupus.
How does lupus activity behave during menopause? Does menopause onset influence the course of SLE activity or not?
These are all questions any female warrior over the age of 40 begins to think about. I worry about hot flashes and how taking prednisone may impact my menopause symptoms. I worry that as my body goes through a drop in hormones, it will trigger major lupus symptoms.
A change in hormones in my teen years accompanied what my doctor believes was my first lupus flare. So in my mind, hormonal changes play a role in the onset of lupus.
As of today, I have yet to have a hot flash. But I know, at 49, it is probably coming soon.
The clock is ticking. So, I did some research on lupus and menopause and found some studies that put my mind at ease — at least a little.
The Studies and What They Mean
According to a study, the symptoms associated with menopause in SLE lupus were identical to the symptoms associated with menopause in the general population.
In other words, lupus does not seem to impact menopause, though there were some cases of early onset of menopause (mostly associated with certain lupus medications).
For some good news — menopause, in most, but not all cases, doesn’t have a negative impact on lupus. The frequent need to take corticosteroids for lupus inflammation did not seem to change menopause symptoms either.
Essentially, studies found that premenopausal patients taking corticosteroids had the presence of hot flashes and night sweats, but the ingestion of corticosteroids was not associated with these symptoms in postmenopausal patients.
Will the Drop in Hormones Trigger a Flare?
The short answer to this is question is that the onset of perimenopause and menopause itself does not seem to be a trigger for lupus flares in most patients. But, if you look at many of the lupus support group websites, some warriors who share their personal experiences say that menopause brought on their lupus. In their stories, there is definitely a hormonal link to some flares and even the onset of lupus.
So, even though the studies indicate there is hope that lupus will not be exacerbated by menopause, I can well believe that for some people the drop in hormones experienced at menopause could cause an onset of lupus symptoms.
Looking only at the studies published, these key points are found to be true in most lupus warriors.
- The level of lupus activity in the perimenopausal period and the postmenopausal period was very low.
- There was no difference between these two periods in the incidence of severe flares.
- There was, however, a trend towards lower numbers during the postmenopausal period as compared to the premenopausal period although this was not statistically significant.
In fact, several studies indicated that lupus may actual calm down in intensity once a woman makes it through menopause. Maximum disease activity was significantly lower during the postmenopausal period.
Interestingly, another study indicated that perhaps a decrease in lupus activity after age 50 had more to do with the number of years the women had battled with lupus versus the onset of menopause. The conclusion was not that menopause onset decreases the level of disease activity, but it is the length of the disease that influences the course of activity.
Although premenopausal women with SLE have more disease activity than postmenopausal, there is a constant rate of improvement overtime independently of where they fall in the menopausal status.
Is Hormone Replacement Therapy Possible With Lupus?
You may have heard that women can ease the symptoms of menopause by taking prescribed hormone preplacement. I was prescribed progesterone to help with heavy periods and mid-cycle bleeding due to fibroids in my uterus. Progesterone is a hormone, so I worried if it would have an impact on my lupus.
Studies vary as to whether women should take hormone replacement therapy — whether the benefits outweigh the risks of increased cardiovascular issues and deep venous thrombosis that can sometimes be triggered. But, these same studies concluded that HRT is generally safe and does not increase the incidence rate of lupus flares.
- Disease activity is mild during the peri- and postmenopausal periods
- The real threat of menopause hormonal therapy in women with SLE is the risk of developing thrombosis, not the effect on disease activity
- In selected patients, menopause hormonal therapy may be of great benefit in women with SLE
- Use of menopause hormonal therapy should be consistent with treatment goals, benefits, and risks for the individual woman
I have battled lupus and fibromyalgia for many years. I most recently have been diagnosed with Sjögren’s disease and Hashimoto’s thyroiditis.
I worry about very new medication I must take and how it will affect the other medications and diseases. I worry about catching the flu and it will trigger a lupus flare that lasts for months.
But, it appears I can worry a little less about the onset of menopause. I actually hold a little hope that maybe it will ease some of my flares and let me enjoy life more.