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Lupus and Menopause

 

We are fortunate to live in a day and age when many of us can speak openly about sexual health and well-being, and it’s no longer considered taboo to discuss menopause.  Once whispered under the breath – and never around men – “the change of life” was something you only discussed with your bestie or uncomfortably with your OBGYN.  Generations of young women were more prepared to cook a proper Thanksgiving turkey than they were to deal with their changing bodies.  Instead, many of us came-of-age reading Judy Blume’s “Are you there God? It’s me, Margaret” to give us some remote idea of what to expect when the hormones started surging, but we had no idea what to expect when they slowed to a trickle. Blume should have considered a sequel that followed Margaret through menopause.

Introduction

Menopause is the natural stage in life when a woman’s ability to reproduce comes to a close and her/their ovaries stop releasing eggs.  It can be both a challenging and yet freeing time of life, and each woman will approach it differently.  I think it’s easy to over-generalize or stereotype what we see on TV or hear from other women around us as being symptoms of menopause.  The experience will be unique for each and every one of us, and this is compounded for those of us with lupus.

While Blume’s Margaret enthusiastically embraced the onset of womanhood, she had no reason to consider what would happen to her body forty years later. Margaret probably never faced a lupus diagnosis, either. In this article, I will fill in the blanks and unravel some of the mysteries of menopause, especially when you experience menopause as an individual with lupus. We’ll also take a look at treatment options such as hormone replacement therapy (HRT), what that looks like when you have lupus and some alternative practices that may bring symptom-relief. It may not be as exciting as Margaret’s first brush with adolescence, but you’ll be a little more in the know about what to expect as you grow older.

How Does Menopause Present When You Have Lupus?

Menopause occurs in stages: perimenopause, menopause and postmenopause – with premenopause sometimes added to the sequence. The whole process starts between the mid-forties and mid-fifties and can last from seven to fourteen years. Perimenopause, is the transitional time just before menopause when estrogen levels begin to decrease and may occur several years before menopause when a woman begins experiencing changes in her monthly cycle.  During this time and into menopause, hormone levels – in particular estrogen and progesterone – may fluctuate greatly, bones may become less dense, and many women find themselves putting on weight very easily. A 2010 study by Jorge Sanchez-Guerrero showed that women with lupus started showing symptoms of the onset of menopause at the same age as women without lupus and the symptoms were similar to both groups.

Symptoms of perimenopause may also include:

  • Spotting
  • Periods that last for more than a week
  • Periods that come close together
  • Heavy bleeding
  • Period resumes after no bleeding for a year
  • Hot flashes and flushing that occur because of changing estrogen levels – It is important to note, however, that the use of corticosteroids can also cause hot flashes and night sweats.
  • Vaginal dryness
  • Painful intercourse or a loss of interest in sex
  • Incontinence
  • Changes in sleep that may include night sweats
  • Changes in mood
  • Changes in body, such as weight gain, muscle aches and thinner hair

A woman enters the next stage, “officially” menopause, twelve months after her last period. During menopause even though a woman’s period has stopped, she may still experience many of the symptoms listed above.  After menopause, women enter the last stage, post-menopause, when they can become particularly vulnerable to heart disease and osteoporosis, making it very important to develop healthy habits and talking with a trusted healthcare practitioner regularly.

When you have lupus, the symptoms of menopause are surprisingly similar to those of women who do not have lupus. As a women who has lupus and who is going through menopause, blogger Sabrina Nixon writes that she also experiences similar symptoms from both which can be confusing and make it unclear as to what to treat. Nixon writes, “Lupus is called ‘The Great Mimicker’ because of its ability to mask a disorder or mimic another.”

The Role of Estrogen in Lupus and Menopause

Evidence suggests that estrogen plays a significant role in the onset of lupus in women. Incidents of lupus increase for women of child-bearing years because of the presence of elevated levels of estrogen – there is actually a decrease in the incidence of lupus in girls prior to puberty and post-menopausal women. Women who take oral contraceptives and even fertility treatments also have an increased chance of developing lupus because of fluctuating estrogen levels.

Sanchez-Guerrero notes that during menopause, women with lupus who experience ovarian failure “developed less severe flares…and total flares.” Entering the perimenopausal and postmenopausal stages of menopause does not change the frequency of more severe flares. However, the incidence could possibly decrease throughout the duration of post-menopause as estrogen levels are low.

Hormone Replacement Therapy (HRT) Benefits and Risks

In our blog article, “Lupus and Hormones,” we learned that because a “disproportionate number of women have [lupus]”… scientists believe that “estrogen somehow either regulates the severity of the disease or is a possible catalyst for developing the disease itself.” While maintaining those higher levels of estrogen post-menopause may benefit women who have osteoporosis, the increase in estrogen for the general population of post-menopausal women with lupus could potentially be detrimental.  A 2012 study found that while hormone replacement therapy (HRT) did not “significantly increase the risk of severe flares”, it did account for a small increase in the risk of mild to moderate disease flares. In “How Hormones Affect Lupus Treatment,” Dey and Isenberg note that “the use of exogenous hormones has been associated with lupus onset and flares, suggesting a role for hormonal factors in the pathogenesis of the disease.” It is important to note that HRT can also increase the risk for blood clots, heart disease, breast cancer and stroke. It’s always best to speak with your healthcare practitioner about the risks of HRT and what is right for you.

Natural Ways to Manage the Symptoms of Menopause

There are many things you can do to naturally help manage the symptoms of menopause. You may already be practicing these good habits as part of your lupus symptom management plan!

  • Drink plenty of water – water keeps you hydrated and helps you maintain a healthy weight.
  • Achieve and maintain a healthy weight – A healthy weight will decrease the severity of menopausal symptoms you could experience as well as help you avoid cardiovascular disease and diabetes.
  • Diet – Protein helps prevent muscle loss. Fruits and vegetables help you maintain a healthy weight and can ward off heart disease. Calcium and Vitamin D are good for bone and muscle health. Fish oils are rich in Vitamin D and can keep your heart healthy. Avoid dietary triggers such as spicy foods, caffeine, and alcohol which can further exacerbate symptoms like hot flashes and sweats. Avoid processed foods and refined sugars, which can cause inflammation, changes in mood, and spikes in blood-sugar levels.
  • Exercise – Taking physical limitations and abilities into consideration, find a variety of exercises you can do comfortably, safely, and without discomfort that will help you keep moving. Yoga, gentle stretches, Pilates or Tai Chi may be great low impact options.
  • Acupuncture – This may help with hot flashes.
  • Mindful breathing ­– Being aware of your breath may help limit the duration of hot flashes as well as reduce anxiety.

There may be supplements you can take that help take the edge off the potentially unpleasant symptoms of menopause. As always, we caution you to speak with your healthcare practitioner first in order to make well-informed, healthy choices and to avoid any drug interactions. 

In Conclusion

Menopause can be a positive and meaningful time of life and does not have to be something to fear. While, yes, night sweats and hot flashes are the reality of many women experiencing this hormonal transition, not everyone is affected in the same way. If you do experience any of these symptoms, there are treatment options to discuss with your healthcare practitioner.  As an individual with lupus, you may already be able to keep your lupus symptoms and flares to a minimum, which in turn could help reduce the symptoms of menopause as well. Staying healthy and effectively communicating with a trusted healthcare practitioner is key as you navigate your “new normal” gracefully.

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References

Brown, M. (2016). 11 natural ways to reduce the symptoms of menopause. Retrieved from: https://www.healthline.com/nutrition/11-natural-menopause-tips#section1
Cappelloni, L. (2018). Alternatives for treating menopause. Retrieved from: https://www.healthline.com/health/menopause/alternative-treatment#black-cohosh
Farage, M., Malbach, H., & Miller, K. (2012). Effects of menopause on autoimmune diseases.  Expert Review of Obstetrics & Gynecology, 7(6), 557-571.
Gibb, J. (2012). Lupus and early menopause. Retrieved from: https://www.disabled-world.com/health/autoimmunediseases/lupus/early-menopause.php
Menopause: Diagnosis and management. (2018). Retrieved from: https://www.nice.org.uk/guidance/ng23/ifp/chapter/benefits-and-risks-of-hrt
Nixon, S. (2016). Lupus and menopause is a horrible combination. Retrieved from: http://www.chicagonow.com/lupus-purple-reigns/2016/04/lupus-and-menopause-is-a-horrible-combination/
Sanchez-Guerrero, J. (2010). Round 29: Menopause in women with systemic lupus erythematosus: A clinical perspective. Retrieved from: https://www.hopkinsarthritis.org/physician-corner/rheumatology-rounds/round-29-menopause-in-women-with-systemic-lupus-erythematosus-a-clinical-perspective/
Thomas, D. E. (2014). The lupus encyclopedia: A comprehensive guide for patients and families. Baltimore, MD: Johns Hopkins University Press.
What are the signs and symptoms of menopause? (n.d.). Retrieved from: https://www.nia.nih.gov/health/what-are-signs-and-symptoms-menopause
What is menopause? (n.d.). Retrieved from: https://www.nia.nih.gov/health/what-menopause

 

Article written by: Liz Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at info@kflupus.org for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

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Elizabeth Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.