Hormone Shifts, Rheumatoid Arthritis Symptoms Create a Perfect Storm
“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. “My joints got progressively worse to the point that I had to take medical leave from work. The Enbrel stopped being effective, and I just couldn’t control my symptoms.”
Midlife Biochemical Changes Can Worsen RA Symptoms
Byrnes discovered on her own something that research has also found: Women with RA have a greater decline in function when they experience menopause, a study published in May 2018 in Rheumatology suggests. Here’s what you need to know.
1. Hormone fluctuation around menopause can affect RA symptoms and disease progression.
Researchers have been looking at the link between RA and hormones for a long time. “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. In our study 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,” says study coauthor Elizabeth Mollard, PhD, assistant professor at the University of Nebraska Medical Center College of Nursing – Lincoln Division.
2. Decisions to use hormone therapy should be made on an individual basis.
The use of hormone therapy (HT) or hormone replacement therapy (HRT) for menopausal symptoms is an option that needs to be discussed between the clinician and patient. While there are some benefits to using HT, there are also well-known risk factors that may outweigh the benefits, such as increased probability of cardiovascular events and some cancers.
3. Early menopause may increase risk of developing rheumatoid arthritis.
“The average age of menopause is about 51; early menopause or premature menopause is considered 40 or under, and this occurs in about 1 percent of women,” says Mollard. There is data, however, that shows even experiencing menopause at 45 or younger can be associated with the development of RA.
4. RA and menopause together also double the risk for osteoporosis.
The chances of developing postmenopausal osteoporosis are doubled for women who have RA compared with women in the general population. “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.
Be Sure to Have Your Bone Density Measured
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, Florida, and a medical advisor to 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.” 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 very controversial recently, with some studies pointing toward increase 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 (IU) of vitamin D. The correct dose is still not clear but clearly should not exceed 2,000 mg of calcium.” Also, with regards to protecting bone health, stop smoking. Maintaining physical mobility and muscle strength is also key to reducing the decline in muscle mass through menopause.
5. Sex and RA and menopause = a complicated 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 discuss openly sexual needs and limitations,” says Domingues.
6. Stay on top of your rheumatoid arthritis symptoms.
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.
7. Be your own health advocate.
“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.
8. You can be part of the solution.
Byrnes has joined Forward, a national data bank of rheumatic diseases that helps researchers such as Mollard conduct research and make advancements in treatment and understanding of the diseases. Byrnes says, “I am so glad there is research being done about it, as this validates my feelings and what I am going through. I think it’s important to help so maybe in the future other women won’t have to endure this.”
