for women with autoimmune disease offers mixed results and is not always an appropriate option . Small trials have demonstrated a reduction in inflammatory cytokine production and neurological lesions with MHT in MS . However , MHT in women with SLE should be cautioned . Improvements in SLE after menopause have been noted with less severe flares , reduced renal damage and lowered auto-antibody markers . Even though progesterone seems to counteract some of the immunological effects of oestrogen , women with SLE have lower levels of progesterone . Little is known about the safety of exogenous progesterone and SLE . 15
There is solid evidence of the role that vitamin D plays in both autoimmunity and supporting women ’ s health in the post-menopause years . While the primary physiological function of vitamin D is in bone metabolism , the vitamin D receptor ( VDR ) and 1α-hydroxylase ( CYP27B1 ) are widely expressed in immune cells . Vitamin D and VDR signalling have an inhibitory role in autoimmune reactions with anti-inflammatory effects . 16 Vitamin D promotes dendritic and Treg cell differentiation , and reduces inflammatory cytokine secretion . In post-menopausal women with RA and metabolic syndrome , vitamin D levels are lower , and disease activity is higher . If outdoor exposure to sunlight during times of lower UV index (< 3 ) is not frequent or possible , vitamin D supplementation should be considered , particularly as cutaneous synthesis of the nutrient diminishes in the post-menopausal years . 16 One study demonstrated that a combination of supplemental Vitamin D and omega-3 Fatty Acids can lead to a decrease in autoimmune disease via their synergistic anti-inflammatory action . This is not the case for omega 3 on its own , however ; over time it has been noted that omega 3 fatty acids reduce inflammatory cytokines that may help reduce overall disease morbidity . 16 Studies have also demonstrated the role of omega 3s in supporting sleep quality , improving low mood and to a lesser extent in minimising vasomotor symptoms . 17
Sufficient evidence exists for the antiinflammatory Mediterranean diet ( MD ) that also supports body composition , cognition and mood . Key components include :
• Daily consumption of 5 or more vegetables varieties , raw or cooked
• Twice weekly fish consumption such as wild salmon , mackerel , trout and sardines
• Daily consumption 30g of walnuts and / or seeds ( ground flaxseeds , chia seeds , sesame seeds )
• Daily serve of pre and probiotic foods such as yoghurt , tempeh , sauerkraut
• Daily consumption of antioxidant fruits such as berries and pomegranate
• Daily addition of spices such as ginger , saffron , cinnamon , and garlic 18
Dietary lignans and their metabolites derived from gut bacteria can control inflammatory responses via suppression of pro-inflammatory cytokines . For example , undigested flax or sesame seeds contain a lignan class called secoisolariciresionol ( Seco ) diglucoside ( SDG ) conjugate . When deconjugated , Seco is liberated and then demethylated to produce lignan metabolites that are readily absorbed . 15 It is important to note that women whose menopause is compounded by autoimmune disease can experience gastrointestinal complaints often associated with dysbiosis aggravated by the chronic physiological stress of inflammation . Typically , oestrogen and gut bacteria ( the estrabolome ) work synergistically to liberate endogenous oestrogen metabolites and phytoestrogens for recirculation . The function of the estrabolome is significantly reduced with dysbiosis and this can also reduce the proper digestion and absorption of lignans . This is also the case for lectins . While many plant foods contain lectins , particularly legumes which form part of a complete MD , until gut health and the microbiome are restored , they should be avoided . 19
Conclusion
The menopausal transition ( MT ) represents a critical period of physiological change that uniquely affects women with autoimmune conditions , aggravating symptoms and increasing vulnerability to other inflammationrelated health challenges . The interplay between declining reproductive hormones , immune dysregulation , and systemic inflammation underscores the importance of early , targeted interventions to mitigate these effects . Evidence supports the role of solid nutritional foundations , in managing both MT and autoimmune symptoms . Providers of holistic healthcare are in a unique position to empower individuals to navigate the MT with a sense of purpose toward improved quality of life and healthy aging .
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