What to Know About Psoriatic Arthritis (PsA) and Menopause

Menopause can affect other health conditions, including psoriatic arthritis (PsA). PsA is a type of autoimmune disease in which the immune system malfunctions and attacks healthy tissues. It affects about 30% of the people with the skin condition psoriasis, although psoriasis may develop after the onset of PsA.

People who menstruate eventually stop experiencing periods, usually in their 40s and 50s. This natural part of life is called menopause, defined as a point in time 12 months after your last period. The time before that is known as perimenopause. The perimenopause transition begins between ages 45 and 55 and lasts around seven to 14 years.

PsA is characterized by inflammation of the joints and entheses (the places where tendons and ligaments meet bone). Autoimmune diseases that affect the joints are sometimes called inflammatory arthritis or autoimmune arthritis.

The connection between PsA and menopause is hormones—mainly dropping estrogen levels from menopause. These decreased levels might lead to increased PsA flares (periods of high inflammation and pain), menopausal symptoms, bone density changes, and osteoporosis (bone thinning).

This article will cover the connection between PsA and menopause, the effect of chronic inflammation, and how to manage hormonal changes and inflammation.

Hormones and Joint Pain

The list of menopausal symptoms is extensive. Symptoms range from mood swings to hot flashes and even joint pain. And while swollen, achy joints are a sign of aging or even autoimmune arthritis, studies have also found it to be a symptom of menopause.

For people with PsA and other types of autoimmune arthritis, joint pain from both PsA and menopause can be extra challenging. Studies suggest that hormonal changes throughout a person's life—the menstrual cycle, during pregnancy, and during menopause—can lead to periods of increased inflammation, which could eventually result in joint damage and disability.

These hormonal changes and differences might also explain why these diseases are more common in females and why females are more severely affected by autoimmune arthritis than males.

Effect of Estrogen

The effect of decreased estrogen is wide-ranging. Estrogen loss can lead to weight gain, weak and achy bones, painful intercourse, increased urinary tract infections, depression, cardiovascular disease, and so much more.

Estrogen and progesterone, both alone and together, play a significant role in sexual and reproductive health. For example, both help to regulate menstrual cycles and help the pregnancy to get started.

Estrogen also has other functions, including:

• Managing cholesterol
• Protecting bone health
• Managing different aspects of human health and development, including the brain, bones, heart, skin, and other tissues
• Aiding in the development of reproductive organs during puberty
• Building up the uterine lining
• Regulating thyroid hormones
• Promoting blood clotting
  

Additional functions of progesterone include:

• Protecting against breast cancer and high blood pressure
• Inducing libido (sex drive)
• Regulating moods and protecting against depression
• Preparing the endometrium (the inner lining of the uterus) for pregnancy after ovulation by triggering the lining to thicken to accept a fertilized egg
• Stimulating the body to provide blood vessels to the endometrium during pregnancy

Estrogen Changes 

Studies on inflammation show that it increases during menopause because of declining estrogen. This theory makes sense because estrogen has anti-inflammatory benefits.

One study reported in 2020 concluded that postmenopausal people had higher white blood cell counts, indicating increased systemic (whole-body) inflammation. Here, researchers suggest that both visceral body fat (hidden fat inside the belly and wrapped around the stomach organs) and declining hormone levels might be to blame for increased inflammation.

There has been very little research on an estrogen-PsA connection. However, researchers have looked at the effect of estrogen on psoriasis, which is linked to PsA, and the role of hormones in other types of autoimmune arthritis, including rheumatoid arthritis (RA).

Research shows hormone fluctuations can cause psoriasis to flare up during puberty, after giving birth, and during menopause. Also, symptoms of psoriasis can improve during pregnancy when hormone levels are higher.

For RA, researchers have found keeping estrogen and progesterone regulated can protect against the disease. In addition, effects on hormones, such as pregnancy, postpartum, breastfeeding, menopause, or the use of oral contraceptives and hormone replacement therapy can produce hormonal changes that play a part in the development of RA and trigger RA flares.

During Menstrual Period

The connection between inflammatory arthritis and menstrual cycles isn't one that researchers understand well. Some research studies suggest variations in hormones during menstrual cycles influence autoimmune arthritis activity and increase symptoms.

A study reported in 2022 suggests people with RA may experience fluctuations in their joint symptoms linked to their menstrual cycles. The study looked at the case of a 49-year-old perimenopausal woman who experienced recurrent flares that started 10 days before her period and spontaneously resolved after her period ended.

In this study, researchers treated the person with a gonadotropin-releasing hormone agonist in an estradiol gel to prevent low estrogen and a levonorgestrel-releasing intrauterine system (a device to release levonorgestrel, a hormone).

The treatment plan was found to reduce RA symptoms the person experienced before and during her period. The researchers concluded hormonal therapy might be a beneficial option for people who have increased symptoms of inflammatory arthritis during their monthly cycles.

Research also shows that psoriasis can flare around the time of a person's period. One 2015 review of immunological changes and hormone fluctuations found that increased estrogen levels, especially during pregnancy, could be linked to lower inflammation in the body. But the opposite could occur around the time of a monthly period.

During Pregnancy

Research on PsA and pregnancy is mixed. Some studies demonstrate improvement, while others show worsening disease activity, particularly in the postpartum period (after childbirth).

One study reported in 2017 found improvement or stabilization occurred in 58% of pregnancies, and skin symptoms improved in 88% of cases. This study also found that PsA could also worsen, as demonstrated in 32% of the study participants.

Pregnancy might also trigger PsA in people who have psoriasis. A 2015 report found up to 40% of study participants with psoriasis went on to develop symptoms of PsA in the weeks following childbirth.

PsA might worsen after childbirth in someone with previously diagnosed PsA. A study reported in 2019 in Arthritis Care and Research found PsA could get worse at any time during the first six months after childbirth.

Interestingly, this study also reported that about 75% of the study participants had experienced remission (little or no disease activity) during pregnancy and shortly after giving birth. Here, disease activity did not increase until weeks or months later.

During Menopause 

Hormonal changes during perimenopause and menopause might increase psoriatic arthritis flares. Research on psoriatic symptoms (skin and joint) shows that hormone fluctuations can trigger PsA and psoriasis flare-ups. Reduced estrogen can also contribute to flares.

PsA and menopause have overlapping symptoms, which makes it harder to distinguish which of the two conditions is causing the symptoms. For example, you might experience fatigue, sleep problems, and mood swings resulting from PsA and menopause or perimenopause. In addition, symptoms of menopause, such as sleep disturbances, might trigger PsA flares.

PsA Can Intensify Menopause 

Most people who menstruate stop getting periods around ages 45 to 55. That transition from perimenopause to post-menopause takes between seven and 14 years. However, people with PsA and other types of inflammatory arthritis might experience menopause even earlier.

According to a 2015 report in the journal Rheumatic Disease Clinics of North America, rheumatic inflammatory diseases can lead to an underlying decreased ovarian reserve (total number of healthy, immature eggs in the ovaries). In addition, some of the therapies used to treat these conditions can also induce early menopause.

PsA Can Change Bone Density 

Osteoporosis causes bones to become weak and brittle. Bones become so soft that mild stressors can lead to fractures, such as bending over or coughing.

In the United States, osteoporosis affects around 10 million people—the majority of whom are female. Also, over 43 million Americans have low bone mass, which increases their risk for osteoporosis.

Estrogen is vital for protecting your bone health, and reduced estrogen levels during menopause could increase your risk for osteoporosis. Chronic inflammation can also increase the risk for osteoporosis.

Research shows having PsA or psoriasis puts you at a greater risk for osteopenia (low bone density) and osteoporosis. A 2020 study suggests both inflammation and medications used to treat both conditions might be to blame.

The study's authors conclude the value of screening people with PsA and psoriasis for osteoporosis, especially those treated with methotrexate or cyclosporin. Chronic steroid use, as may be given for inflammatory arthritis such as PsA, can also lead to osteoporosis.

Managing Hormonal Changes and Inflammation  

There is plenty you can do to manage hormonal changes and inflammation. These include both lifestyle tips and medications that can help.

Lifestyle Tips

Lifestyle changes can be beneficial for managing both PsA and menopause.

Diet: Eat a healthy diet that includes anti-inflammatory foods—fruits, vegetables, lean proteins, healthy fats, and whole grains. You may wish to avoid foods that increase inflammation, such as refined carbohydrates (white bread and pasta), fried foods, sugary beverages, red meat, and saturated fats (margarine and other shortenings).

Boost calcium and vitamin D: Calcium and vitamin D are both critical for bone health, and your diet is the first place you can start improving your intake. Great sources of vitamin D include spinach, kale, okra, white beans, some fish (sardines, salmon, and perch, for instance ), and calcium-fortified foods (such as orange juice and breakfast cereal).

Foods that provide vitamin D include fatty fish (tuna, mackerel, and salmon), egg yolks, cheese, beef liver, and dairy and plant milk fortified with vitamin D. Check with your healthcare provider before you start taking vitamin D or calcium supplements.

Exercise: Reduced estrogen can make it easier to gain weight. Increased weight on the joints can trigger PsA symptoms and joint damage. You will want to stay as active as you can to manage both PsA and counter the stress effects of menopause.

Different exercises, including weight-bearing ones (walking, stair climbing, dancing, etc.), can promote bone health and reduce your risk for osteoporosis.

Manage stress: Stress can trigger PsA flares and systemic inflammation. Try stress-reduction techniques, like yoga, meditation, and deep breathing, to manage stressors in your life, especially in the years leading up to menopause.

Try to get restful sleep: Symptoms of menopause, including night sweats and mood changes, can disrupt your sleep. Poor sleep can contribute to PsA flares.

To improve your sleep quality, try sticking to a sleep schedule, avoid caffeine too close to bedtime, keep your bedroom and bed comfortable, and leave the electronics out of the bedroom. Talk to your healthcare provider if you have improved sleep habits and still have difficulty getting a good night's sleep.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) might be an option for managing both inflammation and the effects of menopause. Increased estrogen might also prevent bone loss.

But the research on HRT in psoriatic arthritis is limited and mixed. For example, research on HRT in psoriatic disease showed no symptom improvement. Other studies mention a potential benefit but don't detail information about participants, dosing, and adverse effects.

When deciding whether HRT is right for you, you should consider all the benefits and risks.

The main benefit of HRT is to reduce symptoms of menopause, including hot flashes, night sweats, mood swings, reduced sex drive, and vaginal dryness. HRT might also help to prevent bone thinning and osteoporosis.

Side effects of HRT might include:

• Abnormal bloating
  
• Breast pain, tenderness, and swelling
• Leg cramps headaches
• Digestive troubles
• Vaginal bleeding
• Weight gain
• Hair thinning

Risks of HRT might include:

• Endometrial cancer
• Blood clots
• Stroke
• Breast cancer
  

Your healthcare provider is in the best position to advise you on the potential benefits of HRT, whether it be for managing menopausal symptoms, reducing inflammation, or another health condition. They will take specific factors into consideration, such as:

• Whether HRT will benefit you
• If it might worsen PsA or psoriasis symptoms or lead to PsA disease progression
• Whether HRT could pose additional health risks
• What other options might be available
• How much monitoring is needed, especially in the first few months of treating with HRT

Once you and your healthcare provider have discussed these issues, you can decide whether HRT is a viable option for managing inflammation and hormonal changes.

You Have Options

Your healthcare provider is in the best position to help you manage the effects of PsA during menopause. If you find your PsA has worsened since entering your 40s, your healthcare provider can help you find solutions or treatments to make you feel more comfortable and reduce inflammation.

You will want to make sure your PsA is as managed as possible, which can minimize risks associated with both PsA and menopause. You might also consider discussing with your healthcare provider when to start bone density screenings to check your bones for signs of osteopenia or osteoporosis.

If you find you are experiencing frequent flares, especially around the time of your period, reach out to your healthcare provider to find ways to better manage PsA during those times.

If your healthcare provider doesn't bring up issues related to menopause, it is OK to speak up. You and your healthcare provider are partners in your healthcare, and they will want to know about health issues that are important to you.

Summary

Estrogen works to reduce inflammation in the body, offering a proactive effect for people with psoriatic arthritis and other types of autoimmune arthritis. But during the years leading to menopause, reduced estrogen could mean more inflammation and increased PsA flares. People with PsA might also be at an increased risk for osteoporosis and low bone density during menopause.

Fortunately, there is plenty you can do to manage hormonal changes and inflammation. Steps to take include eating a healthy diet that promotes bone health, staying active, managing stress, and getting a good night's sleep.

Hormone replacement therapy might also be an option for managing symptoms of menopause, but it likely won't improve PsA symptoms. Talk to your healthcare provider if you think HRT might be beneficial to you. You will also want to make sure your PsA is well-managed.

A Word From Verywell 

The emotional effects of PsA and menopause can be just as complex as the physical, and both can lead to stress, mood swings, and mood disorders like anxiety and depression. You need to find the best ways to cope and manage stress. Activities like yoga, meditation, and rhythmic breathing can be helpful.

It is also helpful to build a social support network to help you deal with the effects PsA and menopause on your daily life. That way, when you feel overwhelmed, you can reach out to a family or friend.  

You might also consider joining a support group for PsA. Chances are you will meet people who are coping with the effects of both conditions. And if you find yourself struggling to cope or feel anxious and depressed frequently, ask your healthcare provider for a referral to a mental health counselor.