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-up. 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 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-up. 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.
What Research Shows
According to one study, the symptoms associated with menopause in SLE lupus are identical to the symptoms associated with menopause in the general population. In other words, lupus does not seem to impact menopause, though there are some cases of early onset of menopause (mostly associated with certain lupus medications).
For some good news — menopause, in most, but not all cases, does not have a negative impact on lupus. The frequent need to take corticosteroids for lupus inflammation does not seem to change menopause symptoms either. Essentially, studies have found that premenopausal patients taking corticosteroids had the presence of hot flashes and night sweats, but the ingestion of corticosteroids is not associated with these symptoms in postmenopausal patients.
Will the Drop in Hormones Trigger a Lupus 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 has 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 can 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 is very low.
- There is no difference between these two periods in the incidence of severe flares.
- There is, however, a trend towards lower numbers during the postmenopausal period as compared to the premenopausal period, although this is not statistically significant.
In fact, several studies indicated that lupus may actually calm down in intensity once a woman makes it through menopause. Maximum disease activity may become significantly lower during the postmenopausal period.
Interestingly, another study indicates that perhaps a decrease in lupus activity after age 50 has more to do with the number of years the women has battled lupus versus the onset of menopause. The conclusion is 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 for Lupus Patients?
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 conclude that HRT is generally safe and does not increase the incidence rate of lupus flares.
The Takeaway
Disease activity is mild during the peri- and postmenopausal period, and 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. However, 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 new medication I must take and how it will affect the other medication and diseases. I worry about catching the flu, in case it triggers 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.