The hormonal changes experienced during the MT potentiate the prevalence and flares of autoimmune disorders in women during midlife . Given the chronic nature of autoimmune diseases , long-term management is essential , and their higher prevalence in women highlights the need for gender-specific treatment strategies , especially for middle-aged and older populations .
Although all women will experience the MT , it is essential to recognise that individuals of diverse gender identities may also undergo this transitional period in their lives . Acknowledging that not all individuals who experience menopause identify as women , this article will use the term " women " to refer to those assigned female at birth . 8
The role of oestrogen in immunity and inflammation
Many women enter the MT already managing chronic conditions , including autoimmune diseases which in some conditions reach peak onset during this midlife period . The MT and ultimate decline in reproductive hormones lead to shifts in immune function that make the MT a particularly vulnerable time for individuals with autoimmune conditions . In fact , hormonal changes associated with the MT and their impact on inflammation may heighten the risk for more severe autoimmune disease symptoms , as well as adding increased susceptibility to additional chronic conditions like cardiovascular disease , insulin resistance , and metabolic syndrome . 5
With the influence of fluctuating oestrogen and declining progesterone , the inflammatory environment sees increased production of proinflammatory cytokines and a suppression of anti-inflammatory factors . Autoimmune conditions such as rheumatoid arthritis ( RA ), systemic lupus erythematosus ( SLE ), and Hashimoto ’ s Thyroiditis occur more frequently in women , and symptoms are known to worsen during major hormonal changes . 7 While a precise understanding of the interplay between the sex hormones and immune responses is still being identified , studies acknowledge that women in midlife face a heightened risk of autoimmune diseases , with some , like SLE , more prone to flare-ups around menopause . 7 This demonstrates the complex influence of oestrogen and progesterone on immune function .
The early stage of MT is associated with a rise in chronic low-grade inflammation as the immunomodulatory action of oestrogen waxes and wanes . Oestrogen modulates humoral immunity , whereas androgens and progesterone act as natural immunosuppressants . Thus , it is noted that post-menopausal women tend to exhibit higher chronic levels of pro-inflammatory cytokines such as monocyte chemotactic protein 1 ( MCP- 1 ), interleukin-1 ( IL-1 ), interleukin-6 ( IL-6 ), and tumour necrosis factor-alpha ( TNFα ) along with reduced cytotoxic activity of natural killer ( NK ) cells , which decreases the ability to respond to pathogens or other immune stimuli . Additionally , decreased CD4 T and B lymphocyte counts support the shift to a more pro-inflammatory profile . 9
In the physiologically stressed state of the MT , increased activation of inflammasomes has been noted . The inflammasome is a key element of
The hormonal changes experienced during the MT potentiate the prevalence and flares of autoimmune disorders in women during midlife . Given the chronic nature of autoimmune diseases , long-term management is essential ...
JATMS | Summer 2024 | 201