Why Does Rheumatoid Arthritis Worsen During Menopause?

Transitioning into menopause brings about various health changes for every woman, including hormonal changes that can lead to bone fragility and cardiovascular disease. Yet, for women who also have rheumatoid arthritis (RA), the health changes that are brought about with menopause may be even more complex.

According to a new research study, RA is likely to worsen in women during menopause. The study was based on previous findings of a link between hormonal changes in women coping with RA and their physical function. It was observed that hormonal life events, such as pregnancy and childbirth, had a positive effect on the physical condition of women with RA, whereas women in post-partum phase experienced an increased occurrence of the disease and flare-ups. Doctors also observed that women who had gone through early or premature menopause were more likely to develop RA in comparison to those who had experienced normal or late menopause.

The new study looked further into the link between RA and menopause by enrolling 8,189 middle-aged women with RA and observing their degree of functional decline associated with RA. The women were divided into three categories:

• 611 women who had transitioned into menopause
• 2,005 pre-menopausal women
• 5,573 post-menopausal women

The women were asked to answer questions such as how difficult they found their daily tasks to be, including getting dressed, tying their shoes, walking, and more. Based on the gathered findings, the researchers noted that pre-menopausal women showed a lower decline in physical function in comparison to post-menopausal women. What’s more, they found that symptoms were less severe in women who had previously had children or who had undergone hormone replacement therapy. “When people talk about menopausal symptoms, many just think about hot flushes and night sweats. We know that women often notice joint pains which they do not necessarily connect with the menopause,” said Dr. Heather Currie, former chairman of the British Menopause Society. “We are not at the point of advising women who have rheumatoid arthritis to have HRT purely to reduce effects of the arthritis. But for those who are considering hormone therapy for menopause symptoms, this is something else to consider,” she added.

Why oestrogen plays an important role

The findings led the researchers to conclude that menopause greatly impacts both the level and degree of functional decline caused by RA and it worsens its progression. The trigger is thought to be a lack of oestrogen, which is the primary female sex hormone that is no longer needed once childbearing years have ended. Oestrogen is believed to play a vital role in managing the health of the joints, which in RA become stiff, painful and swollen. “Further study is needed as to why women with rheumatoid arthritis are suffering a greater decline in function after menopause. Not only is this decline causing suffering for women, it is costly to both individuals and the healthcare system as a whole. Research is specifically needed on the mechanism connecting these variables with the eventual goal of identifying interventions that can maintain or improve function in postmenopausal women with rheumatoid arthritis” said Elizabeth Mollard, lead author of the study.

Read on to learn more about what this discovery means for women with RA.