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Perimenopause, Menopause and Autoimmune Disease

Perimenopause and menopause are significant transitional phases in a woman's life marked by hormonal fluctuations, particularly a decline in oestrogen levels. These hormonal changes can have far-reaching effects on various systems within the body, including the immune system. Understanding the connection between perimenopause/menopause and autoimmune disease requires a closer look at the physiological mechanisms at play and the complex interplay between hormones and the immune system.


Hormonal Fluctuations and Immune Dysregulation: Oestrogen, one of the primary female sex hormones, exerts profound effects on immune function. It regulates the activity of immune cells, modulates the production of cytokines (chemical messengers involved in immune responses), and influences the balance between inflammatory and anti-inflammatory processes. During perimenopause and menopause, estrogen levels decline, leading to alterations in immune function. This dysregulation can disrupt the delicate balance of the immune system, potentially triggering autoimmune responses.


Genetic Predisposition and Hormonal Triggers: Genetic factors play a significant role in the development of autoimmune disease. However, hormonal changes during perimenopause and menopause can serve as a trigger, prompting the onset or exacerbation of autoimmune disease in genetically susceptible individuals. The interplay between genetic susceptibility and hormonal fluctuations underscores the complexity of autoimmune disease development during menopausal transition.


Impact on Immune Cells: Oestrogen influences the function and distribution of various immune cells, including T cells, B cells, and macrophages. These cells play critical roles in immune surveillance, defence against pathogens, and maintenance of self-tolerance. Changes in oestrogen levels during perimenopause and menopause can alter the behaviour and responsiveness of immune cells, potentially leading to the breakdown of self-tolerance and the development of autoimmune responses.


Inflammation and Tissue Damage: Oestrogen exerts anti-inflammatory effects, helping to dampen excessive immune responses and mitigate tissue damage. The decline in estrogen levels during perimenopause and menopause may tip the balance towards a pro-inflammatory state, characterised by elevated levels of inflammatory mediators. Chronic inflammation can promote tissue damage and perpetuate autoimmune processes, contributing to the onset or progression of autoimmune diseases in susceptible individuals.


Overlap of Symptoms and Diagnostic Challenges: The symptoms of perimenopause and menopause, such as fatigue, joint pain, mood disturbances, and cognitive changes, can overlap with those of autoimmune disease. This overlap can pose diagnostic challenges, as symptoms attributed solely to hormonal changes may mask an underlying autoimmune condition. Consequently, autoimmune disease may be under-diagnosed or misdiagnosed during menopausal transition, delaying appropriate management and treatment.


In our clinic, we often see women presenting with either new manifestations of autoimmune disease or exacerbations of pre-existing condition. Women also carry the weight of the world on their shoulders. They may be raising teenagers, navigating demanding work environments, and caring for ageing parents. This chronic burden of stress can further exacerbate inflammation and contribute to autoimmune processes.


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