Lupus and Perimenopause: Managing the Transition

Women navigating perimenopause while living with lupus face a complex intersection of hormonal shifts and autoimmune activity. Perimenopause is the transitional period leading up to menopause, characterized by fluctuating hormone levels, primarily estrogen, which can significantly impact lupus symptoms. Understanding this dynamic relationship is crucial for managing symptoms and improving quality of life.

The Connection Between Hormones and Lupus

Courtesy of Menopausenow.com

Lupus, or systemic lupus erythematosus (SLE), is an autoimmune disease where the body’s immune system mistakenly attacks its own tissues and organs. Though it is not a "women's disease," it is far more prevalent in women than in men, with the highest incidence occurring during the reproductive years. This strong female predominance suggests a link between sex hormones, particularly estrogen, and the disease's development and progression. Since women experience more hormonal changes than men, this may be another theory as to why autoimmune diseases are more prevalent in women. Women typically mount a more vigorous immune response than men to infections and vaccinations (which leads to men having more infectious diseases than women…at least we have that going for us), producing higher levels of antibodies. In the case of autoimmune disorders, this trait seems to backfire.

Additionally, estrogen has been shown to influence immune system activity. For instance, it can promote inflammation and increase the production of autoantibodies, the proteins that target and damage healthy tissue.

Perimenopause and Lupus Symptoms

As a woman enters perimenopause (average age is 35-45), her hormone levels begin to swing unpredictably. These hormonal fluctuations can have a direct impact on lupus disease activity. For some women, the changing hormones may trigger an increase in the frequency and severity of lupus flares, while others may find that their symptoms stabilize or even improve as estrogen levels decline. This is why many women with lupus notice their symptoms, such as joint pain and fatigue, worsen during their menstrual cycles or pregnancy when estrogen levels are high.

 For some women, the changing hormones may trigger an increase in the frequency and severity of lupus flares. In contrast, others may find that their symptoms stabilize or even improve as estrogen levels decline.

A major challenge during this time is that many perimenopause symptoms overlap with those of a lupus flare. This can make it difficult to determine the cause of a new or worsening symptom.

• Fatigue: Both perimenopause and lupus are associated with significant fatigue that isn't relieved by rest.

• Joint Pain: Aches and pains are common in both conditions.

• Cognitive Issues: "Brain fog," including memory problems and difficulty concentrating, can be a symptom of both.

• Mood Changes: Anxiety, depression, and mood swings can be heightened by hormonal shifts and the stress of managing a chronic illness.

This overlap highlights the importance of close communication with your healthcare team to accurately diagnose and treat new symptoms.

Key Considerations for Women with Lupus in Perimenopause

Navigating this transition requires a personalized and proactive approach. Here are a few things to keep in mind:

• Early Menopause Risk: Women with lupus may be at a higher risk for premature ovarian insufficiency (early menopause), particularly if they have been treated with certain immunosuppressive medications like cyclophosphamide. This can increase the risk of osteoporosis and cardiovascular disease.

• Bone Health: Lupus and some of its common treatments, such as corticosteroids, can increase the risk of osteoporosis. The natural bone density loss that occurs with menopause further compounds this risk. It's vital to discuss bone density screenings and calcium and vitamin D supplementation with your doctor.

• Hormone Replacement Therapy (HRT): HRT can be an effective way to manage severe perimenopausal symptoms like hot flashes and vaginal dryness. Many women find it helpful to improve their quality of life. It is given in two ways:

  • Oral Estrogen: Taken as a pill or capsule, this form is absorbed through the digestive system.

  • Transdermal Estrogen: The hormone is applied to the skin in the form of a patch, gel, or cream and absorbed through the dermis. It directly enters the bloodstream.

  For women with lupus, HRT is a more complex consideration. Since estrogen can trigger lupus flares in some, some doctors are hesitant to prescribe it. Though topical HRT is far less of a risk, it is important to understand that any medication can have its drawbacks. It is also more complicated if someone is positive for aPL antibodies and has been diagnosed with APS. The decision to use HRT should be made in close consultation with a rheumatologist and a gynecologist, weighing the potential benefits against the risks. (Note: For the last 25 years, there have been thousands of studies analyzing the safety of HRT. Most studies have established HRT as safe for the heart, bones, breast, and brain. In 2002, the WHI published its discoveries of higher breast cancer rates among women taking HRT when using combined HRT of estrogen and progestogen. These findings were confirmed in the 2019 analysis of worldwide data on HRT, which also discovered long-term effects of HRT on breast cancer risk. The risk is low, and more research has shown that when estrogen is used alone, it is NOT associated with breast cancer.

For women with lupus, HRT is a more complex consideration.

Managing Symptoms and Staying Healthy

While the combination of perimenopause and lupus can be challenging, there are many strategies to help you manage your health.

• Lifestyle Management: Prioritize self-care. This includes getting adequate sleep (7-9 hours), managing stress through mindfulness or meditation, and engaging in low-impact exercise like walking, swimming, or yoga. A healthy, anti-inflammatory diet can also help reduce symptoms.

• Open Communication: Keep a symptom journal to track your flare-ups and perimenopausal symptoms. This information is invaluable for your healthcare provider to distinguish between the two and adjust your treatment plan accordingly. Be open with your rheumatologist, primary care physician, and gynecologist about all of your symptoms. You have the right to ask for your hormone levels to be checked to see if you need to start a conversation about possibly incorporating supplements or HRP into your treatment plan.

• Support System: Connect with other women who are also living with lupus and navigating this stage of life. Finding a support group, like the one we offer here at MTL online, can provide a sense of community and shared understanding.

• Reducing addictions to mood stimulants, like caffeine, and depressants, like alcohol, can help women balance their emotions and mood more effectively.

Here is an excellent educational webinar from Dr. Megan Lockwood on the female reproductive system:

https://youtu.be/iKkBo3l0vNY?si=87ylI48SnsvrxpEX

 Sources & Resources:

Here are some organizations that would be good sources for information:

• Lupus Foundation of America: The Expert Series: Lupus and Menopause | Lupus Foundation of America

• American College of Rheumatology: bltd7028987847788b9

• Lupus Corner: Estrogen, Sex Hormones and Lupus (SLE) - LupusCorner

• Lupus Encyclopedia: Lupus and The Endocrine System - The Lupus Encyclopedia

• Menopause Now: Mood Swings during Menopause | Menopause Now

Compiled By:

Kelli (Casas) Roseta

*All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. MTL encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site is owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2025.

September 2025