RA and Menopause
Menopause occurs at an average age of 51 years and marks a period of significant hormonal change for women, impacting a range of organs and body systems, including the cardiovascular and musculoskeletal systems.
Interactions between levels of sex hormones (estrogen, progesterone) and the immune system are complex, but decreases in hormone production, as occurs during menopause, can be associated with an increase in disease activity in RA. Indeed, early menopause may be a factor that increases risk for developing RA and the post-menopausal period is associated with the most significant levels of joint damage and disability in women with RA.1
Early menopause and risk of RA
Results from a large study conducted in Sweden that examined associations between reproductive factors and RA found that women who went through menopause early (at or below the age of 45 years) were significantly more likely to develop RA.2
Menopause and increased risk of disability
Menopause appears to influence the course of RA, leading to an increase in the activity of the disease and an increase in disability associated with RA.
One study found that post-menopausal women with RA had significantly higher levels of joint damage visible on radiography and significantly greater levels of physical disability than their pre-menopausal counterparts.3
Menopause and bone loss
The period shortly before menopause (1.5 years before) and the period following menopause are associated with loss of bone, with bone density decreasing on average at a rate of 2.5% yearly during peri-menopause and at a slower rate (about 1%) after menopause. This rapid loss of bone can result in osteoporosis, which affects approximately 35% of post-menopausal Caucasian women, significantly increasing the risk for fractures, including spinal compression fracture and hip fracture.1
Women with RA, who already face a risk of bone loss associated with chronic inflammation, face additional increased risk of osteoporosis from menopause. This means that they are at extremely high risk for fractures and other complications associated with continued bone loss.1
Menopause and cardiovascular risk
Following menopause, women in the general population face significantly increased risk for cardiovascular disease. In fact, while rates of cardiovascular disease in women are approximately one-third of those in men before menopause, after menopause rates of cardiovascular disease in women increase to roughly the same level as those in men. Loss of the hormone estrogen with menopause causes a rise in low-density lipid levels and total cholesterol, as well as changes that affect blood vessels.1
In women with RA, changes that occur with menopause can lead to a pronounced increase in the risk for cardiovascular disease, a risk that is already increased due to chronic inflammation associated with RA.1
Counteracting the increased risk that comes with menopause
There are a number of things that you can do to counteract the increased health risks that come with menopause. The first is to make sure that you are treating and controlling your RA optimally. Working closely with your doctor to find the right treatments at all stages of RA can help you prevent joint damage and other related health problems. There are more treatment options for RA now than ever before and many available treatments can minimize and, in some cases, prevent damage and help you to maintain optimal functioning.
In addition to getting the right treatment for RA, you should also pay close attention to your risk for other health conditions that commonly affect postmenopausal women, principally cardiovascular disease and osteoporosis. Make sure that you and your doctor monitor for the signs of cardiovascular disease (high blood pressure, high cholesterol) and bone loss and treat these conditions as they arise. You can also reduce your risk for cardiovascular disease if you smoke by kicking the habit. Additionally, make sure that you engage in regular exercise. A low-fat, heart-healthy diet, with plenty of vegetables will also help when it comes to lowering your risk for cardiovascular disease. Regular exercise, including some resistance or strength training, as well as adequate intake of calcium and vitamin D (check with your doctor to determine whether you are getting adequate amounts of these), will help you lower your risk for bone loss and osteoporosis
- Sammaritano LR. Menopause in patients with autoimmune diseases. Autoimmun Rev 2012;11:18.
- Pikwer M, Bergstrom U, Nilsson JA, Jacobsson L, Turesson C. Early menopause is an independent predictor of rheumatoid arthritis. Ann Rheum Dis 2012;71:378-81.
- Kuiper S, van Gestel AM, Swinkels HL, de Boo TM, da Silva JA, van Riel PL. Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis. J Rheumatol 2001;28:1809-16.