What to know about psoriatic arthritis (PSA) and menopause (2023)

Menopause can affect other health conditions, includingpsoriasic arthritis(PSA). PSA is a type ofautoimmune diseasein which the immune system malfunctions and attacks healthy tissue. It affects around 30% of people with the skin condition.soriasis, although psoriasis can develop after the onset of PsA.

Menstruating people eventually stop menstruating, usually between the ages of 40 and 50. This natural part of life is calledmenopause, defined as a point in time 12 months after your last menstrual period.The time before this is known asperimenopause. The transition to perimenopause begins between the ages of 45 and 55 and lasts between seven and 14 years.

PsA is characterized byinflammationof the joints andunderstood(the places where the tendons and ligaments meet the bone). Autoimmune diseases that affect the joints are sometimes calledinflammatory arthritisoautoimmune arthritis.

The connection between PSA and menopause is hormones, mainly the fallestrogenmenopausal levels. These reduced levels can lead to an increasepublic service announcement banners(periods of high inflammation and pain),menopause symptoms, changes in bone density andosteoporosis(thinning of the bones).

This article will cover the connection between PsA and menopause, the effect of chronic inflammation, and how to manage hormonal changes and inflammation.

Hormones and joint pain

The list of symptoms of menopause is extensive. Symptoms range from mood swings to hot flashes and even joint pain. And while swollen and painful joints are a sign of aging or even autoimmune arthritis, studies have also found it to be a symptom of menopause.

For people with PsA and other types of autoimmune arthritis, joint pain from both PsA and menopause can be an additional challenge. Studies suggest that hormonal changes throughout a person's life—the menstrual cycle, during pregnancy, and during menopause—can lead to periods of increased inflammation, which can lead to joint damage and disability.

These hormonal changes and differences may also explain why these diseases are more common in women and why women are more affected by autoimmune arthritis than men.

estrogen effect

The effect of reducing estrogen is extensive. Loss of estrogen can lead to weight gain, weak and painful bones, painful intercourse, increasedurinary tract infections, depression,cardiovascular disease, is much more.

estrogen andprogesterone, both alone and together, play an important role in sexual and reproductive health. For example, both help regulate menstrual cycles and make pregnancy easier.

Estrogen has other functions as well, including:

• control cholesterol
• Protect bone health
• Manage different aspects of human health and development, including the brain, bones, heart, skin, and other tissues.
• Help in the development of the reproductive organs during puberty.
• Building the uterine lining
• Regulation of thyroid hormones
• Promote blood clotting
  

Additional functions of progesterone include:

• Protects against breast cancer and high blood pressure.
• Induction of libido (sexual desire)
• Mood regulation and protection against depression.
• preparing theendometrium(the inner lining of the uterus) for pregnancy afterovulationactivate the lining to thicken and accept a fertilized egg
• Stimulates the body to supply blood vessels to the endometrium during pregnancy

estrogen changes

Inflammation studies show that it increases during menopause due to the decrease in estrogen. This theory makes sense because estrogen has anti-inflammatory benefits.

A study reported in 2020 concluded that postmenopausal people had higher white blood cell counts, indicating greater systemic (body-wide) inflammation.Here, the researchers suggest that both visceral body fat (fat hidden inside the belly and coiled around stomach organs) and decreased hormone levels could be to blame for increased inflammation.

There has been very little research on an estrogen-PsA connection. However, researchers have looked at the effect of estrogen on psoriasis, which is related to PsA, and the role of hormones in other types of autoimmune arthritis, includingrheumatoid arthritis(REAL ACADEMY OF BELLAS ARTS).

Research shows that hormonal fluctuations can make psoriasis worse during puberty, after childbirth, and during menopause.Also, psoriasis symptoms may improve during pregnancy when hormone levels are higher.

For RA, researchers have found that keeping estrogen and progesterone regulated may protect against the disease.Additionally, effects on hormones such as pregnancy, postpartum, lactation, menopause, or the use of oral contraceptives and hormone replacement therapy can produce hormonal changes that play a role in the development of RA and trigger RA flares. .

During the Menstrual Period

The connection between inflammatory arthritis and menstrual cycles is not well understood by researchers. Some research suggests that changes in hormones during menstrual cycles influence the activity of autoimmune arthritis and increase symptoms.

A study published in 2022 suggests that people with RA may experience fluctuations in their joint symptoms related to their menstrual cycles.The study analyzed the case of a 49-year-old perimenopausal woman who had recurrent outbreaks that began 10 days before menstruation and resolved spontaneously after menstruation ended.

In this study, the researchers treated the person with aGonadotropin-releasing hormone agonistin aestradiol gelto prevent low estrogen levels andlevonorgestrel-releasing intrauterine system(a device to release levonorgestrel, a hormone).

The treatment plan has been found to reduce RA symptoms that the person has experienced before and during menstruation. The researchers concluded that hormone therapy may be a beneficial option for people who experience increased inflammatory arthritis symptoms during their monthly cycles.

Research also shows that psoriasis can increase around the time of a person's period. A 2015 review of immune changes and hormonal fluctuations found that increased estrogen levels, especially during pregnancy, may be linked to less inflammation in the body.But the opposite can happen at the time of a monthly period.

During pregnancy

Research on PSA and pregnancy is mixed. Some studies show an improvement, while others show a worsening of disease activity, especially in the postpartum (after delivery) period.

A study reported in 2017 found improvement or stabilization in 58% of pregnancies, and skin symptoms improved in 88% of cases.This study also found that PsA can also worsen, as shown in 32% of study participants.

Pregnancy can also trigger PsA in people with psoriasis. A 2015 report found that up to 40% of study participants with psoriasis developed PsA symptoms in the weeks after delivery.

PsA can worsen after giving birth in someone with a previously diagnosed PsA. A study published in 2019 onArthritis care and research.found that the PSA can worsen at any time during the first six months after delivery.

Interestingly, this study also reported that about 75% of study participants experienced remission (little or no disease activity) during pregnancy and shortly after delivery. Here, disease activity did not increase until weeks or months later.

during menopause

Hormonal changes duringperimenopauseand menopause can increase flare-ups of psoriatic arthritis. Research on psoriasis symptoms (skin and joints) shows that hormonal fluctuations can trigger PsA and psoriasis flare-ups.Reduced estrogen can also contribute to breakouts.

PsA and menopause have overlapping symptoms, making it more difficult to distinguish which of the two conditions is causing the symptoms. For example, you may experience fatigue, sleep problems, and mood swings as a result of PsA and menopause or perimenopause. Additionally, menopausal symptoms, such as sleep disturbances, can trigger PsA flares.

PsA can intensify menopause

Most menstruating people stop menstruating between the ages of 45 and 55.This transition from perimenopause to postmenopause lasts between seven and 14 years. However, people with PsA and other types of inflammatory arthritis can experience menopause even sooner.

According to a 2015 report in the magazineRheumatic Disease Clinics of North America, inflammatory rheumatic diseases can lead to an underlying decrease in ovarian reserve (total number of healthy immature eggs in the ovaries).In addition, some of the therapies used to treat these conditions can also induceearly menopause.

PSA can change bone density

Osteoporosis causes the bones to become weak and brittle. Bones become so soft that mild stressors can lead to fractures, such as bending over or coughing.

In the United States, osteoporosis affects about 10 million people, the majority of whom are women.Additionally, more than 43 million Americans have low bone mass, which increases the risk of osteoporosis.

Estrogen is vital for protecting bone health, and reduced estrogen levels during menopause can increase the risk of osteoporosis. Chronic inflammation can also increase the risk of osteoporosis.

Research shows that having PsA or psoriasis puts you at higher risk forosteopenia(low bone density) and osteoporosis. A 2020 study suggests that both inflammation and the drugs used to treat both conditions could be to blame.

The study authors conclude the value of evaluating osteoporosis in people with PsA and psoriasis, especially those treated withmethotrexateocyclosporine. Chronic use of steroids, such as those given for inflammatory arthritis like PAs, can also lead to osteoporosis.

Control hormonal changes and inflammation.

There are many things you can do to control hormonal changes and inflammation. This includes lifestyle tips and medications that can help.

lifestyle tips

Lifestyle changes may be beneficial in managing PsA and menopause.

Diet: Eat a healthy diet that includesanti-inflammatory foods– fruits, vegetables, lean proteins, healthy fats and whole grains.you may want to avoidfoods that increase inflammation, such as refined carbohydrates (white bread and pasta), fried foods, sugary drinks, red meat and saturated fats (margarine and other fats).

Increase calcium and vitamin D:Soccermivitamin Dthey are critical to bone health, and your diet is the first place you can start to improve your intake.Great sources of vitamin D include spinach, kale, okra, navy beans, some fish (for example, sardines, salmon, and perch), and calcium-fortified foods (such as orange juice and breakfast cereals).

Foods that provide vitamin D are fatty fish (tuna, mackerel, and salmon), egg yolks, cheese, beef liver, and dairy products and vegetable milks fortified with vitamin D. Consult your doctor before starting take vitamin D or calcium supplements.

Exercise: Decreased estrogen may facilitate weight gain. Weight gain on the joints can trigger PsA symptoms and joint damage.You'll want to stay as active as possible to control your PSA and combat the effects of menopausal stress.

Different exercises that includeweight bearing(walking, climbing stairs, dancing, etc.), can promote bone health and reduce the risk of osteoporosis.

manage stress: Stress can trigger PsA flare-ups and systemic inflammation.Attemptstress reduction techniquessuch as yoga, meditation, and deep breathing, to manage stressors in your life, especially in the years leading up to menopause.

Try to have a restful sleep:Symptoms of menopause, including night sweats and mood swings, can disrupt sleep. Poor sleep can contribute to PsA flare-ups.

To improve sleep quality, try to stick to a sleep schedule, avoid caffeine too close to bedtime, keep your bedroom and bed comfortable, and keep electronic devices out of your bedroom. Talk to your doctor if you feel better.sleep habitsand still have trouble getting a good night's sleep.

Hormone replacement therapy

Hormone replacement therapy(HRT) may be an option to control inflammation and the effects of menopause. The increase in estrogen can also prevent bone loss.

But research on HRT in psoriatic arthritis is limited and mixed. For example, research on HRT inpsoriatic diseaseshowed no improvement in symptoms.Other studies mention a potential benefit but do not detail information about the participants, the dose and the adverse effects.

When deciding if HRT is right for you, you should consider all the benefits and risks.

The main benefit of HRT is to reduce the symptoms of menopause, includingHot flushes, night sweats, mood swings, reduced sex drive, and vaginal dryness. HRT can also help prevent bone thinning and osteoporosis.

HRT side effects can include:

• abnormal swelling
  
• Breast pain, tenderness, and swelling
• Leg cramp headaches
• Digestive problems
• vaginal bleeding
• Weight gain
• hair loss

The risks of HRT may include:

• endometrial cancer
• blood clots
• AVC
• breast cancer
  

Your doctor is in the best position to advise you on the potential benefits of HRT, whether it is for managing menopausal symptoms, reducing inflammation, or another health condition. They will take into account specific factors such as:

• If HRT will benefit you
• If it can worsen the symptoms of PsA or psoriasis or causePsA disease progression
• Whether HRT may pose additional health risks
• What other options may be available
• How much follow-up is needed, especially in the first few months of HRT treatment

After you and your doctor have discussed these issues, you can decide if HRT is a viable option to control inflammation and hormonal changes.

you have options

Your doctor is in the best position to help you manage the effects of PSA during menopause. If you find that your PSA has gotten worse since the age of 40, your doctor can help you find solutions or treatments to make you more comfortable and reduce inflammation.

You need to make sure your PsA is in as much control as possible, which can minimize the risks associated with PsA and menopause. You might also consider talking to your doctor when you start.bone density teststo check your bones for signs of osteopenia or osteoporosis.

If you find that you have frequent flare-ups, especially around the time of your period, contact your doctor to find ways to better monitor your PSA during these periods.

If your doctor doesn't raise issues related to menopause, it's okay to talk. You and your doctor are partners in your health care and will want to know about health issues that are important to you.

Summary

Estrogen reduces inflammation in the body, offering a proactive effect for people with psoriatic arthritis and other types of autoimmune arthritis. But during the years leading up to menopause, reduced estrogen can mean more inflammation and increased PsA flare-ups. People with PsA may also be at increased risk of osteoporosis and low bone density during menopause.

Fortunately, there are many things you can do to control hormonal changes and inflammation. Steps to take include eating a healthy diet that promotes bone health, staying active, managing stress, and getting a good night's sleep.

Hormone replacement therapy may also be an option to control menopausal symptoms, but it may not improve PsA symptoms. Talk to your doctor if you think HRT might be beneficial for you. You'll also want to make sure your PsA is well managed.

A word from Verywell

The emotional effects of PsA and menopause can be just as complex as the physical, and both can cause stress, mood swings, and mood disorders such as anxiety and depression. You need to find the best ways to deal with and manage stress. Activities such as yoga, meditation, and rhythmic breathing can be helpful.

It is also helpful to build a social support network to help you deal with the effects of PsA and menopause on your daily life. That way, when you feel overwhelmed, you can reach out to a family member or friend.

You might also consider joining a PsA support group. Chances are, you will find people who are dealing with the effects of both conditions. And if you're having trouble coping or often feel anxious and depressed, ask your doctor for a referral to a mental health counselor.