The Effect of Menstrual Cycles on RA
Last updated: August 2021
If being a woman wasn’t difficult enough sometimes, add rheumatoid arthritis (RA) to the mix during your monthly cycle and there’s bound to be some unique challenges.
Many women with RA claim that their joint pain or stiffness is different depending on where they are in relation to their period.
Research shows the monthly fluctuations of hormones can be to blame for the changes in disease symptoms and severity over the month.1
Let’s find what typical disease patterns a woman can expect during the month and what you can do to help alleviate some of the pain.
Menstrual cycle basics
In a normal menstrual cycle, there are two phases: follicular and luteal phases marked by menstruation and ovulation, respectively.2
Estrogen and progesterone
During the different phases, two hormones - estrogen and progesterone - rise and fall at various points to signal to the body to build and shed the uterine lining.
The same hormones also play a role in developing a follicle on the ovary containing an egg to be released during ovulation halfway through the cycle.2,3
Typically, the cycle repeats on average every 28 days or between a range of 25-30 days, unless a pregnancy is conceived.2
When do women report monthly RA flare-ups?
The follicular phase is marked from the start of menstruation until ovulation when the follicle containing an egg is growing.
At this time, the hormones estrogen and progesterone are low but gradually begin to rise over the next two weeks.
Since estrogen is believed to be protective against joint pain and inflammation, many women report their RA symptoms to be at their best shortly after their periods are done until some time after ovulation when hormones are rising.4
When hormones are at their lowest
In addition, flare-ups are most commonly reported a few days prior to and during menstruation when estrogen and progesterone are at their lowest.4
In one report, about half of women (49 percent) surveyed said they noticed changes in disease activity during their menstrual cycles.1
Ninety-six percent of those women reported the most disease severity right before and during menstruation.1
My personal experience
In my own experience, I would have to agree with the women in this study.
I also have flare-ups with more pain and achiness, specifically in my hands and wrists, right before I am expected to get my period. It’s not a fun time!
Can oral contraceptive pills help control RA?
Due to the disruption of the natural cycle of the hormones estrogen and progesterone, it is hypothesized that oral contraceptives pills (OCPs) may have a beneficial effect on the risk of RA severity and symptoms.
Some studies show a decrease in joint swelling score, joint tenderness score, and overall general health score for women who take oral contraceptive pills in comparison to the control group.1,5,6
More research is needed
Other studies show there isn't a significant difference in RA disease severity between the two groups that can be explained by OCPs.
Although the research is mixed, OCPs could be a potential treatment option for women who have monthly flare-ups of RA pain and symptoms.5
Do other women experience monthly RA flares? How do you deal with it? Share with us below!
Did you know rheumatologist Dr. Donica Baker is answering community questions?
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