If you notice your rheumatoid arthritis symptoms worsen during menopause, you’re not alone. Learn more about how menopause and hormone replacement therapy impact this condition.
Jul 25, 2023
By Lara DeSanto
Going through menopause is a major transition for your mind and body, as your hormones shift and your period ends. Managing menopause symptoms like hot flashes and mood swings when you’re already managing a chronic condition like rheumatoid arthritis (RA), which causes joint pain, swelling, fatigue, and more, can feel especially daunting.
Are there ways to prepare for entering menopause with RA? How might your RA symptoms be affected, and can rheumatoid arthritis make menopause worse? We asked our experts to break down the ways these conditions can impact each other, treatment considerations when you’re going through menopause and have RA, and lifestyle tips to manage the transition.
How Does Menopause Affect RA?
Menopause occurs when a woman’s ovaries stop making estrogen and progesterone, hormones that are needed for ovulation to occur, according to the National Institutes of Health (NIH). With this change in hormones, your whole body can feel the impact. In addition to changes in your period, menopause symptoms might include:
- Difficulty focusing
- Hair thinning
- Hot flashes and night sweats
- Mood swings
- Problems with sleep
- Vaginal dryness
When you have RA, you may also notice changes in your condition when you reach menopause, says Jill Liss, M.D., an OB-GYN at UCHealth in Denver, CO, who specializes in menopause, but it’s not necessarily a straightforward cause-and-effect relationship. “There tends to be a general worsening of RA post-menopause—though this is not true for everyone, and research has not clearly shown that this is due only to hormonal changes,” Dr. Liss explains. “Keep in mind this is also a period of aging. It is overly simplistic to equate decline in estrogen to worsening RA, and more research is needed.”
Indeed, research on the topic of whether menopause and the hormonal changes involved worsen RA symptoms tends to contradict itself, according to the Arthritis Foundation. Some studies report that lower hormone levels can increase the inflammatory proteins that contribute to the disease, while others find no link between RA and menopause at all.
But if you do notice your RA symptoms changing or worsening during menopause, you’re not imagining it—and you’re certainly not alone. A study published in the journal Rheumatology of women with RA who had gone through menopause found they were more likely to have declining function compared with premenopausal women with RA, although the study did not identify the reasons behind this link.
Regardless of the exact reasons why, it’s undeniable that managing RA symptoms along with menopause can be especially challenging. Some factors contributing to these challenges include:
Osteoporosis Risk
“Women with RA who are entering menopause face a ‘double hit’ in terms of their osteoporosis risk, as RA and menopause are both independent risk factors for the development of osteoporosis,” explains Caroline H. Siegel, M.D., a rheumatology fellow at the Hospital for Special Surgery in New York City. “Treatment with systemic steroids, like prednisone or methylprednisolone, is another risk factor for osteoporosis that may be a third hit for some women with RA.”
This loss of bone mass can lead to back pain, stooped posture, and increased risk of broken bones, according to the Mayo Clinic. “Women with RA should be followed closely by their doctor with early osteoporosis screening,” Dr. Liss adds. “Advocate for your bones—remind your doctors you need early screening for osteoporosis if this isn’t being offered.”
Fatigue
Fatigue is one of the most common symptoms of RA, according to the Arthritis Foundation. “Fatigue is a hallmark feature of RA that is also multifactorial, driven in part by systemic inflammation and chronic pain,” explains Dr. Siegel. Add menopause to the mix—with symptoms like hot flashes at night, anxiety, or good old insomnia—and you may feel even more exhausted than usual, she says.
Sex Life
Having a chronic illness can complicate your sex life, thanks to symptoms of pain, fatigue, and joint swelling that can limit your mobility, says Dr. Siegel. Changes during menopause can make things worse in this department, too. “Among common symptoms of menopause, vaginal atrophy and dryness caused by decreased estrogen may also interfere with a patient’s sex life,” Dr. Siegel says. “For women diagnosed with RA in the postmenopausal period, and those whose existing RA worsens or is active after menopause, the combination of RA and menopause may be especially disruptive.”
Heart Health
Women with RA have a higher risk of heart disease after going through menopause than women without RA, according to the nonprofit CreakyJoints. Both the hormonal changes of menopause and the inflammation of RA may lead to heart problems, making this a dangerous combination. According to research published in Current Cardiology Reviews, the hormonal changes of menopause, specifically a decline in estrogen levels, can impact cardiovascular health. Estrogen has been shown to have protective effects on the cardiovascular system, including promoting healthier blood vessel function and reducing inflammation. You should be monitored closely for heart disease during this time, per CreakyJoints.
How to Manage Menopause and RA Symptoms
The main goal of RA treatment during menopause is the same as it was pre-menopause: Reduce disease activity and inflammation, which in turn decreases symptoms and the risks of joint damage, says Dr. Siegel. Common RA treatments include steroids, conventional disease-modifying antirheumatic drugs (DMARDs) like methotrexate, biologic drugs like Humira (adalimumab), and other effective medical therapies, per the Mayo Clinic.
If you’re finding that you’re experiencing new RA symptoms during menopause, talking to your doctor early is key, Dr. Siegel adds. Your doctor will work with you to find the best treatment option for you, considering factors like how severe your joint disease is, whether inflammation is impacting other parts of your body, other medical conditions you have, and drug side effects, Dr. Siegel says.
For menopause and RA symptoms, lifestyle changes can also be a key part of your routine to get relief. Plus, menopause-specific symptoms may benefit from treatments like hormone therapy. These are some of the treatment avenues you and your doctors may explore.
Lifestyle Tips for Menopause and RA Symptoms
Whether your symptoms are RA-related, menopause-related, or a combination, taking these steps in your daily life may help ease the burden.
- Stay active. When you’re dealing with RA during menopause, exercise is a great way to combat your symptoms, Dr. Liss says. Among the many benefits of exercise during midlife are improved bone, joint, and heart health; reduced fatigue; better mood and sleep.
- Decrease stress. Going through menopause while managing RA is no picnic, and it makes total sense if you’re feeling extra stressed out during this transition. Things like prioritizing sleep, nurturing your social relationships, and practicing mindfulness can help, suggest Dr. Liss.
- Talk to your doc about intimacy problems. Your doctor may be able to prescribe treatment to help with menopause symptoms like vaginal dryness, like prescription lubricants, or even refer you to a sex therapist for support, says the Arthritis Foundation.
- Eat a healthy diet. Eating well can benefit your overall health and help manage symptoms of RA as well as menopause. For example, a Mediterranean diet focused on plant-based foods and healthy fats can help fight inflammation in people with RA, per the Arthritis Foundation.
Hormone Therapy for Menopause When You Have RA
Sometimes lifestyle changes alone simply don’t cut it when it comes to getting the relief you deserve from symptoms during menopause. Many women going through menopause take hormone replacement therapy (HRT) to help ease their symptoms, and you may consider this option if you have RA and are struggling with symptoms during menopause. “Menopausal hormone therapy can be considered for women with RA as it would for any other woman,” agrees Dr. Liss.
Interestingly, a 2023 study of women with RA found that those taking birth control pills or HRT had a greater likelihood of reaching remission. But the study authors say more research is need before declaring a clear protective effect of HRT or birth control pills against RA.
“Menopausal hormone therapy should be initiated to treat persistent symptoms associated with menopause, and not directly to treat RA,” says Dr. Liss. “It is possible a person may feel better generally, including RA symptoms, on menopausal hormone therapy, but this would not be an indication alone to treat.”
So, if you’re finding your menopause-related symptoms—like those nasty hot flashes—are impairing your daily life, it’s more than worth a conversation with your doctor to discuss treatment options, including HRT, to help you feel better. That said, it’s important to keep in mind that HRT may not be an option for everyone.
“HRT is contraindicated for women with specific comorbidities, including a history of breast cancer, coronary heart disease, blood clot or stroke, and active liver disease,” Dr. Siegel says. “It is important to discuss with your doctors to understand the potential benefits and any individual risk factors to consider when deciding whether HRT is an appropriate treatment option for you.”
How to Talk to Your Doctor About Treating RA in Menopause
While more research is needed to fully understand the complex connection between RA and menopause, it’s clear that experiencing both at once can be extremely difficult, thanks to the compounding of symptoms, increased risk of health conditions like osteoporosis, and added mental stress.
To best manage your symptoms during midlife, experts recommend talking to your health care team sooner than later about your concerns—and that often means working closely with a range of specialists, including your rheumatologist and gynecologist. “It is important to be open with your doctors about what you are experiencing, both in terms of RA and menopause, so that your treatment plan can be appropriately tailored to your symptoms,” Dr. Siegel says.
Together, your health care team can help you by adjusting RA treatments if needed, recommending lifestyle changes, or prescribing hormonal therapy or other solutions. “Speak up to your doctor about how you think your menopause transition may be impacting your RA,” recommends Dr. Liss. “Advocate for the treatment you need to make this transition a comfortable one.”
https://www.healthcentral.com/article/hair-loss-in-rheumatoid-arthritis-causes-and-how-to-cope
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