What to Know About Psoriatic Arthritis (PsA) and Menopause

Psoriatic arthritis (PsA) is an inflammatory form of arthritis linked to the autoimmune disease psoriasis. Psoriasis typically causes itchy, scaly, discolored patches to appear on the skin and scalp.

Perimenopause, the time leading up to your final period (menopause), is a time of hormonal changes that lead to symptoms such as hot flashes, sleep disruptions, and mood changes.

Understanding the link between menopause and PsA can help you to manage flare-ups and reduce your risk of related diseases, such as osteoporosis. In this article, the connection between PsA and menopause will be explored, along with what can help relieve symptoms.

Woman with hand pain

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Hormones and Joint Pain

Inflammation is the immune system’s natural response to injury and illness. But sometimes, the immune system triggers an inflammatory response inappropriately. 

This is the case with autoimmune diseases like PsA. The body compensates by attacking its own healthy tissues, acting as if they are infected or abnormal. The inflammatory process eventually leads to pain, swelling, and stiffness in the joints.

Hormonal shifts, especially rising and falling estrogen levels, can have a deep impact on your joints. The female hormone estrogen can have an anti-inflammatory effect on the body. As levels decline naturally due to age, it can increase the symptoms of chronic inflammation, including joint pain.

How Many People With Psoriasis Have PsA?

In a 2013 study in the Journal of the American Academy of Dermatology, researchers found 285 of the 949 study participants with psoriasis—around 30% of participants—had PsA.

Estrogen Changes 

Estrogens are hormones that play various roles in the body. In people born with uteruses, these hormones help develop and maintain both the reproductive system and female characteristics, such as breasts and pubic hair.

Certain estrogens may help stimulate an inflammatory response in your body, which scientists believe is the reason why there is a higher rate of autoimmune diseases in women than in men. Research has shown chronic inflammatory activity related to the menstrual cycle, pregnancy, and menopause.

During Periods

One possible trigger of arthritis symptoms for people born with uteruses seems to be hormones. Some women report an increase in joint pain around their period. According to the Arthritis Foundation, the drop in estrogen that occurs before your period is what's to blame for extra pain.

During Pregnancy

For some pregnant people, PsA symptoms improve during pregnancy. Researchers believe this may be due to the increase in estrogen while expecting.

One 2017 study looked at 42 pregnancies in 29 women with psoriatic arthritis. It found PsA either improved or stayed stable in 58% of pregnancies. In almost 90% of cases, skin symptoms improved or stayed stable. 

However, PsA worsened in 32% of the pregnancies. The remainder of the pregnancies had a mixed pattern of improvement that later got worse.

During Menopause 

During menopause, estrogen levels drop, which can cause symptoms including hot flashes and night sweats. Some women get PsA joint pain for the first time after their periods end.

Your skin may be affected, too. In one study, almost half of women reported their psoriasis flared after menopause. Only 2% said their symptoms got better.

PsA Can Intensify Menopause 

Symptoms of menopause and PsA flares can overlap. For example, you may have hot flashes while also experiencing joints that are warm to the touch from a PsA flare.

Common menopausal symptoms can also make PsA flares feel worse. For instance, sleep disruptions linked to menopause may make you fatigued. Fatigue is one of the most common and debilitating symptoms of a PsA flare.

Tracking your symptoms can help you to pinpoint and manage any potential PsA triggers.

PsA Can Change Bone Density 

Osteoporosis is a disease that causes weak and brittle bones. Osteoporosis is four times more common in women than it is in men.

The reduction in estrogen levels during menopause increases a woman’s chances of developing osteoporosis. Autoimmune diseases like PsA may increase these risks. Research suggests that women with PsA may be at an even greater risk of osteoporosis after menopause.

A 2016 review of 21 studies found that low bone mineral density was a significant problem for people with PsA in more than half the research, although the researchers stated more studies were needed in this area.

Managing Hormonal Changes and Inflammation  

A combination of lifestyle changes and medication is typically needed to manage your PsA while navigating the hormonal changes of perimenopause and menopause. Managing your PsA, limiting your exposure to potential triggers, and controlling your menopausal symptoms can be a great help.

Lifestyle Tips

Being proactive in your treatment and practicing self-care is important with PsA and menopause. In addition to taking medications as prescribed, here are some ways you can help cope with the conditions: 

  • Get regular exercise: Physical activity, such as walking and stretching, can help keep joints flexible and improve health and well-being. Exercise is also great for menopausal symptoms. According to a study in the journal Maturitas, lifting weights and other resistance training could have a significant impact on hot flashes.
  • Stick to a sleep schedule. Sleep disruptions can occur during menopause and have been associated with PsA flares. Try to stick to a sleep schedule, limit caffeine and screen time leading up to bedtime and avoid daytime napping.
  • Limit alcohol: Research shows alcohol consumption interferes with the effect of PsA medications and may cause more flare-ups. Alcohol can also impact menopausal symptoms. In some people, alcohol can increase the occurrence of hot flashes and night sweats.

Hormone Replacement Therapy

A 2018 study published in Korea suggests that hormone replacement therapy (HRT) may improve symptoms of another type of arthritis—osteoarthritis, in the knee specifically. But there is little research into PsA and hormone replacement therapy.

HRT can provide relief from symptoms of menopause such as hot flashes. It can also help replace the lost estrogen that could lead to osteoporosis.

However, while there appears to be a link between reduced estrogen levels and PsA flares, there is little evidence to suggest that hormone therapy will improve PsA symptoms.

You Have Options

As well as medication and lifestyle remedies, you may want to explore complementary and alternative medicine (CAM) for menopause and PsA.

Stress is one of the most common triggers for psoriatic flares. Stress affects as many as 50% of people with psoriasis, according to a 2014 review of studies from Europe. Mind-body therapies may be beneficial to relieve stress and sleep disturbances. These may include:

Acupuncture can also help reduce stress. There is preliminary evidence that it can reduce acute pain associated with arthritis.

CAM is a popular treatment for menopause too. Approximately 51% of menopausal people use complementary therapy and more than 60% perceive it to be effective for menopausal symptoms such as hot flashes.

Summary

The period leading up to menopause (called perimenopause) may impact your PsA and increase the number of flares you get. People with PsA may also be at greater risk of osteoporosis during menopause. 

There are a number of complementary therapies, lifestyle factors, and medications you can take to manage both menopausal symptoms and PsA.

A Word From Verywell

If you have PsA and are nearing menopause, you may find yourself having more flares. Know you are not alone.

Learn your PsA triggers so you know what to avoid and make lifestyle changes to decrease the amount of PsA flares. Speak to your healthcare provider about treatments available to treat both conditions.

Frequently Asked Questions

  • Do women with psoriatic arthritis have a harder time during menopause?

    Every woman is different, but some find they have a harder time during menopause. During perimenopause, your estrogen level falls, which can set off hot flashes, night sweats, and can make your PsA symptoms worse.

  • What’s the connection between hormones, joint pain, and inflammation?

    The primary female hormone, estrogen, has an anti-inflammatory effect on the body, and as it declines naturally during menopause, it can increase the symptoms of chronic inflammation, including joint pain.

  • How do you manage PsA and menopause at the same time?

    There are many medications, lifestyle factors, and complementary therapies that can help both PsA and menopause. For example, regular exercise can help with PsA and menopausal symptoms. Acupuncture has also been found to be helpful for both menopause and PsA.

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