Case Study on Menopause and Autoimmune Disease

How Menopause Affects Autoimmune Disease

Menopause and Autoimmune – What You Need to Know?

Menopause and Autoimmune Disease and how this affects women transitioning through the menopause. In the intricate tapestry of a woman’s life, the transition through menopause represents a profound biological shift, a recalibration of the hormonal symphony that has orchestrated their physiological rhythms for decades. For women navigating the complexities of autoimmune disease, this natural phase of life introduces an additional layer of intricacy, a potentially significant intersection where hormonal fluctuations can profoundly influence the delicate balance of their immune systems.

The intricate interplay between the declining levels of oestrogen, a key hormonal player, and the underlying autoimmune dysregulation can manifest in a myriad of ways, underscoring the critical need for a nuanced and individualised understanding of this coming together. It is paramount to recognise that the effects of menopause on autoimmune conditions are far from uniform; they are as diverse and individual as the women experiencing them, shaped by the specific autoimmune disease in question, its inherent characteristics, and the unique biological landscape of each woman. 

To delve deeper into this multifaceted relationship, we must meticulously dissect the various avenues through which menopause can exert its influence on women living with autoimmune diseases. This exploration will illuminate the potential alterations in disease activity, the diagnostic challenges posed by overlapping symptoms, the chance of new autoimmune conditions arising, and the specific impacts on a spectrum of autoimmune disorders, the influence on co-existing health conditions, the considerations surrounding therapeutic interventions, and the pivotal role of lifestyle factors in navigating this transitional period. https://my.clevelandclinic.org/health/diseases/21624-autoimmune-diseases

Let us take a deep dive into my client’s autoimmune disease and the challenges she has faced over the last 30 years, and how this now affects her during her journey into perimenopause. I would like to say a huge thank you to Poppy for being so honest and open which mad this case study so interesting. 

Poppy, a 48-year-old female, working single mum, who has suffered from autoimmune disease, since her first symptoms started in her late teens. Just to note, there does not appear to be any hereditary links. 

Her first symptoms were in the form of Reynolds syndrome and Sharp’s syndrome together, as they are both considered overlap syndromes in the realm of autoimmune rheumatic diseases. However, they are distinct conditions characterised by the overlapping features of different “classic” autoimmune diseases. Reynolds is triggered by spasms of small blood vessels that supply blood to the fingers, toes and other extremities like the nose and lips.

When Poppy finds herself in a situation of stress or significant temperature differences this can affect the flow of blood to the affected areas, which leads to skin colour change. Poppy showed me a picture of her hand, and one of her fingers was completely white. She also mentioned that in her late teens she experienced chill blains, lack of feeling and fatigue. Another side effect of autoimmune disease is recurrent UTI’s, which was something she has suffered with for many years. https://www.nhs.uk/conditions/raynauds/

Then Poppy hit her 20s, and the first signs of her autoimmune becoming more evident were changes in her hair, which was becoming more brittle, thinning, accompanied swollen eyes and eye lids.  

Direct inflammation of eye tissues in certain autoimmune diseases directly target the tissues around the eyes, including the eyelids. This inflammation can lead to swelling, redness, pain, and other symptoms. 

This can include: 

Thyroid Eye Disease (TED), this occurs in people with Graves’ disease (an autoimmune thyroid condition) and causes inflammation of the muscles and tissues around the eyes, leading to swollen and bulging eyes, and eyelid retraction.  

Dermatomyositis is a rare inflammatory muscle disease can cause a characteristic reddish-purple rash on the eyelids (heliotrope rash) which can be accompanied by swelling.  

Lupus (Systemic Lupus Erythematosus – SLE, while the butterfly rash is more well-known, lupus can also cause inflammation around the eyes, including the eyelids.  

Sarcoidosis, this condition causes the growth of small collections of inflammatory cells (granulomas) in various parts of the body, including the eyes and surrounding tissue. 

Then when Poppy entered her 30s the symptoms of autoimmune disease become more noticeable, in that she would suffer severally from what is known as a butterfly rash. The term “butterfly rash” refers to a distinctive facial rash that gets its name from its shape, resembling a butterfly’s wings. It typically spreads across the bridge of the nose and both cheeks. Poppy kindly showed a picture of what she looks like, and it looked extremely sore.  

The photo below is for visual purposes and illustrates the appearance of the butterfly rash.

This has a strong association with Lupus it is a well-known symptom of Systemic Lupus Erythematosus (SLE), an autoimmune disease. In fact, this is one of the criteria doctors often look for when diagnosing lupus.

However, it is important to note that not everyone with lupus develops this rash, and it can come and go. 

The rash itself is usually red or purplish and can be flat or slightly raised. It might also be scaly. A key characteristic that helps distinguish it from other facial rashes is that it typically spares the nasolabial folds (the creases between the nose and the corners of the mouth). 

Another symptom that Poppy would experience also came along in her 30s was skin infections, on her hands and feet, dry eyes and eye infections, her nails became very brittle and hard for her to grow to any length.  Poppy went on to say the rashes can appear all over her body. 

I could see from our meeting that she was suffering with back issues that have also caused her pain and discomfort for many years, which can sometimes impair her day-to-day activities. She told me that her back feels so stiff at the bottom of her spine, this is known as Myositis. Later in our meeting she took her steroid tablets, and after a short while, she seemed so much more comfortable. 

Poppy also spoke about Polymyositis, which is a rare inflammatory disease that affects the skeletal muscles, causing muscle weakness, pain, and fatigue. It is classified as an autoimmune disease, where the body’s immune system mistakenly attacks its own muscle tissues. 

Polymyositis (PM) is one of the idiopathic inflammatory myopathies. “Idiopathic” means the cause is unknown. Polymyositis is a specific autoimmune disease where the body’s immune system mistakenly attacks healthy muscle tissue, leading to inflammation and weakness, typically in the muscles closest to the trunk of the body. https://my.clevelandclinic.org/health/diseases/12053-polymyositis

Here is a breakdown of key aspects of polymyositis, where symptoms can develop gradually over weeks or months and often affect muscles closer to the trunk of the body (proximal muscles). Common symptoms include: 

Muscle weakness, this is the hallmark symptom, typically affecting both sides of the body and making it difficult to perform everyday activities like:  

Climbing stairs 

Getting up from a chair 

Lifting objects 

Reaching overhead

Muscle pain or tenderness, although weakness is the primary symptom, some individuals may experience muscle aches or tenderness. Here you can see the muscles affected.Fatigue – Feeling unusually tired. 

Voice changes – Weakness in the voice box muscles can cause a hoarse or nasal voice. 

Shortness of breath – Weakness of the chest muscles can affect breathing. 

Joint pain – Some people may experience pain in their joints. 

Fever and weight loss – These can occur in some individuals. 

Poppy, now in her late forties, has noticed an increase in her mood swings, from being happy one minute and of low mood and snappy the next. This is something many women face when navigating their perimenopause journey, she also mentioned that she has been suffering with gastric problems, that have also joined the party since entering perimenopause.

Gastric problems are frequently connected to autoimmune diseases. The immune system, in its attempt to fight off perceived threats, can mistakenly attack healthy tissues in the gastrointestinal (GI) tract, leading to a variety of issues. Mouth ulcers are also something that Poppy suffers with, which come from the Lupus side of autoimmune disease. exposure to sunlight can also be another effect of Lupus, which Poppy said she suffers with.  

How Sunlight Affects Lupus 

Between 40% and 70% of people with lupus experience photosensitivity, meaning they are unusually sensitive to ultraviolet (UV) rays from sunlight and sometimes even artificial light sources like fluorescent or halogen bulbs.  

Triggers skin Rashes, due to exposure to UV rays can cause new skin rashes or worsen existing ones. This includes the characteristic butterfly rash (malar rash) across the cheeks and nose, as well as other types of lupus-related skin lesions.  

Induces flare ups, sunlight can trigger systemic lupus flares, leading to a worsening of other lupus symptoms such as:  

Joint pain    

Fatigue    

Fever    

Flu-like symptoms    

Skin tingling or numbness 

Inflammation in other organs 

I asked Poppy how she copes and the coping mechanisms she uses to live a full life alongside her ever-present autoimmune flare up’s. She continued, by saying she tries to fight the disease and just gets on with your daily tasks, however this can lead to further flare ups or she says, not believing I have this condition and to do the best I can. Some of the medication that she takes, can also make her feel unwell, and is therefore, sometimes reluctant to take them, having a negative effect on her symptoms. 

I asked her what helps her to maintain as healthier lifestyle as possible while living every day with an autoimmune disease. 

She told me that getting 30 minutes to an hour’s nap during the day, to boost her energy levels, which is hard for her, when parenting and working. Taking iron tablets also helps with the fatigue and eating balanced meals. I spoke to her about the kind of foods she needs to be eating, especially whilst going through the menopause. Fuelling the body is crucial for anyone, but especially so with an autoimmune issue. 

These foods would include, colourful fruits and vegetables, omega-3 fatty acids from oily fish and flax seeds, low processed meats, herbs, and spices. 

I asked her what makes the symptoms of her autoimmune disease worse, and she replied, some medications, picking up a virus will worsen her autoimmune symptoms. Some foods, and stress. Another issue Poppy suffers with is the healing of wounds, such as cuts, they take much longer than an average person to heal. I could see from the area see showed me, healing from the smallest of wounds takes much longer, than it would for someone like me to heal. The steroid cream that she uses to help is Dermovate which is a brand name for a topical steroid cream or ointment that contains the active ingredient clobetasol propionate. 

This cream is a very potent corticosteroid used to reduce inflammation and itching in various skin conditions. 

Another drug that Poppy takes is the medication most given to autoimmune sufferers alongside folic acid to help reduce sickness (nausea and vomiting) and other side effects is Methotrexate. 

Here is why 

Methotrexate and folic acid are a common disease-modifying anti-rheumatic drug (DMARD) used to treat various autoimmune diseases. It works by inhibiting folic acid metabolism, which can unfortunately also affect healthy cells, leading to side effects like nausea, vomiting, and mouth ulcers. 

Folic acid’s role is a synthetic form of folate (vitamin B9). It is often prescribed with methotrexate to help replenish folate levels and protect healthy cells from the drug’s effects, thereby reducing the incidence and severity of these side effects. 

Poppy will continue to take trips to the hospital for iron infusions, hen required and two of the supplements that she takes and are commonly taken by autoimmune sufferers which are: 

Vitamin B, particularly B12, can be more common in autoimmune sufferers due to malabsorption issues or specific autoimmune conditions like pernicious anemia.

Supplementation is often necessary, vitamin D plays a significant role in immune regulation, and deficiency has been linked to increased risk and severity of autoimmune diseases. Supplementation is frequently recommended to ensure adequate levels. 

Menopause, Autoimmune and Collagen   

Poppy spoke of a family member that had recently overcome cancer and had been taking collagen in the form of a drink, and this had noticeable benefits for her, so Poppy is now taking this collagen drink and has herself have noticed an improvement. I have heard other women, who don’t have autoimmune disease also say that drinking collagen has had positive results, and that they will continue to drink it.

The relationship between collagen and autoimmune diseases is complex and still being researched. A summary of potential benefits and important considerations: 

Potential Benefits of Collagen for Autoimmune Sufferers

May help regulate the immune response: Some research suggests that specific collagen peptides can interact with immune cells and may help modulate the inflammatory response in the body. 

May support gut health

Collagen contains amino acids like glutamine, which is important for the health and repair of the gut lining. Since a significant portion of the immune system resides in the gut, supporting gut health might indirectly benefit autoimmune conditions. 

May have anti-inflammatory effects

Certain amino acids in collagen, such as glycine, have demonstrated anti-inflammatory properties, which could be beneficial for managing autoimmune-related inflammation. 

Potential role in oral tolerance

Some theories suggest that oral intake of collagen might help the body develop tolerance to certain antigens, potentially dampening down the autoimmune response. 

During menopause, declining oestrogen levels can lead to a decrease in collagen production, which can affect various tissues in the body. Here are the potential benefits of collagen supplementation for menopausal individuals: 

Potential Benefits in Menopause

Improved skin health

Studies suggest that collagen supplementation may improve skin elasticity, hydration, and reduce wrinkles, which are common concerns during and after menopause due to collagen loss. 

Support for bone health

Collagen is a major component of bone tissue. Some research indicates that collagen peptides may help improve bone mineral density, which is particularly important as women are at higher risk of osteoporosis after menopause. 

Joint health

Collagen can support cartilage health, and some studies suggest it may help reduce joint pain and stiffness, which can be relevant for menopausal women experiencing joint issues. 

Hair and nail health

Anecdotal evidence suggests that collagen may improve the strength and appearance of hair and nails, which can also be affected by hormonal changes during menopause. 

Menopause, Periods and Autoimmune Disease 

Let us get into the more personal side of Autoimmune disease and how it affects a women’s periods, particularly Poppy’s. 

Poppy kindly, spoke openly and was very frank about per periods and Adenomyosis (d-uh-no-my-O-sis) which is a gynecological condition where the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus (the myometrium). This misplaced tissue continues to act as it normally would during the menstrual cycle – thickening, breaking down, and bleeding. 

https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138

I know from past conversations that women often tell of having to wear 3 or 4 sanitary pads in one go, or wearing a tampon and 1 or 2 pads for good measure, Poppy included, as their periods are so heavy. This has been ongoing for Poppy for many years, and she is still awaiting an outcome as to why they are so heavy, and sometimes not regular. Not being regular could well be the premenopause / perimenopause creeping in, but she had been experiencing irregular periods before. Finding the underlying cause of her extremely heavy and painful periods, which include large blood clots, that can be debilitating, seems difficult to determine by healthcare providers to date, why this is happening. 

Key aspects of Adenomyosis 

What happens – Endometrial tissue invades the uterine muscle 

Impact – This can cause the uterus to enlarge (sometimes significantly) and lead to painful, heavy, and prolonged menstrual bleeding

Symptoms can include 

Heavy or prolonged menstrual bleeding (menorrhagia)    

Severe cramping or sharp pelvic pain during menstruation (dysmenorrhea) that may worsen over time    

Chronic pelvic pain

A feeling of heaviness, pressure, or bloating in the lower abdomen    

An enlarged and sometimes tender uterus

Anemia (due to heavy blood loss)

How Menopause and Autoimmune Interplay 

Women suffering with an autoimmune disease such as my client Poppy may experience a complex interplay of factors as they go through menopause. The hormonal shifts, particularly the decline in oestrogen, can significantly influence their autoimmune conditions in several ways. It is important to understand that the effects can be different for each individual and can vary depending on the specific autoimmune disease. 

The Impact on Disease Activity in Menopause 

The ebb and flow of hormonal tides during perimenopause and the subsequent decline in oestrogen that marks menopause can exert a tangible influence on the very activity of autoimmune diseases, potentially leading to divergent outcomes for different women. 

Worsening Symptoms and the Threat of Increased Flares 

For some women with autoimmune conditions, the diminishing presence of oestrogen can unfortunately correlate with an exacerbation of their existing symptoms and a heightened susceptibility to disease flares. Oestrogen, far from being solely a reproductive hormone, wields considerable influence over the intricate network of the immune system. Its intricate interactions help maintain a delicate balance, modulating the activity of various immune cells and inflammatory pathways.

As oestrogen levels wane, this finely tuned balance can be disrupted, potentially tipping the scales towards increased inflammation and a heightened state of immune activation. Conditions such as Rheumatoid Arthritis (RA), a chronic inflammatory disorder primarily affecting the joints, some studies suggest that the onset of RA may be more common after menopause, and early menopause may be a risk factor. Postmenopausal women with RA may also experience greater joint damage. However, some women may find their RA symptoms worsen during menopause due to fluctuating hormones. 

Systemic Lupus Erythematosus (SLE) while some studies show indications of a decrease in SLE flare frequency after menopause, other suggest that the overall disease severity and damage from each flare might be higher. Hormone Replacement Therapy (HRT) in women with SLE needs careful consideration as oestrogen can sometimes trigger flares. 

Poppy had tried the copper coil, but found that this was not suitable for her, as it triggered her SVT. SVT is a type of abnormally fast heartbeat that originates in the upper chambers (atria) of the heart or the atrioventricular (AV) node, which is the electrical gateway between the upper and lower chambers, something Poppy also suffers with. She also tried the contraceptive implant in her arm, which caused her moods to be more unpredictable. 

Conversely, the narrative is not uniformly one of worsening. Some women with autoimmune diseases may experience a welcome reduction in the intensity and frequency of their symptoms following menopause. This counterintuitive phenomenon is also intricately linked to the decline in oestrogen. In certain autoimmune diseases, oestrogen has been implicated in stimulating the immune response, potentially contributing to the underlying pathology.

As oestrogen levels decline, this stimulatory effect may diminish, leading to a dampening of the overactive immune system and a subsequent improvement of symptoms. For instance, some research suggests that women with SLE, despite the potential for increased damage during flares, may experience fewer overall flares in the postmenopausal years. This highlights the disease-specific nature of the menopausal impact and the need for tailored understanding. 

No Significant Change in Disease Trajectory 

It is equally important to acknowledge that for several women living with autoimmune diseases, the menopausal transition may unfold without any noticeable or momentous alteration during their underlying condition. Their disease activity may remain stable, unaffected by the hormonal shifts occurring within their bodies. This underscores the inherent variability in individual responses and the multitude of factors beyond hormonal influence that contribute to the pathogenesis and progression of autoimmune diseases. 

Overlapping Symptoms and Diagnostic Dilemmas

The menopausal transition itself is often accompanied by a constellation of symptoms that can, unfortunately, mirror those commonly experienced by individuals with autoimmune diseases. Symptoms such as pervasive fatigue, aching joint pain, fluctuations in mood, and subtle cognitive changes can be hallmarks of both menopause and a wide range of autoimmune disorders.

This significant overlap in clinical presentation can create a challenging diagnostic landscape, potentially obscuring the true origin of new or worsening symptoms. It can become exceedingly difficult to discern whether a particular symptom is a manifestation of the evolving hormonal changes of menopause, an exacerbation of the underlying autoimmune disease, or indeed a confluence of both.

This diagnostic ambiguity can, in some instances, lead to under diagnosis of either condition, delaying appropriate management and potentially impacting the overall well-being of the affected woman. Conversely, it could also lead to misdiagnosis, where menopausal symptoms are mistakenly attributed solely to an autoimmune flare or vice versa, resulting in suboptimal treatment strategies. 

Living with Autoimmunity: A Gateway to New Conditions? 

Menopause is increasingly recognised as a period of significant hormonal upheaval that can potentially act as a trigger for the onset of new autoimmune conditions in individuals who possess a genetic predisposition. The profound shifts in the hormonal environment, particularly the decline in oestrogen, are hypothesised to play a crucial role in this heightened risk by disrupting the delicate regulatory mechanisms that govern immune tolerance.

The precise mechanisms by which this occurs are still being actively investigated, but theories involve the alteration of immune cell populations, the modulation of cytokine signalling pathways, and the potential unmasking of previously dormant autoimmune tendencies in the context of altered hormonal influence. This underscores the importance of heightened clinical vigilance during and after menopause for women with existing autoimmune conditions or a strong family history of autoimmunity. 

A Disease-Specific Lens: Impact on Individual Autoimmune Disorders 

The impact of menopause is far from uniform across the spectrum of autoimmune diseases. Each condition, with its unique pathogenic mechanisms and target organ systems, may exhibit a distinct response to the hormonal shifts of menopause. 

Rheumatoid Arthritis (RA) – Emerging evidence suggests a potential link between the menopausal transition and RA. Some studies indicate that the initial onset of RA may be more prevalent in the years following menopause, and the occurrence of early menopause may even represent a potential risk factor for developing the disease. Furthermore, postmenopausal women with established RA may be more susceptible to experiencing greater joint damage progression. However, the perimenopausal period, characterised by fluctuating hormone levels, may also be associated with a transient worsening of RA symptoms in some women, highlighting the complex interplay of hormonal dynamics. 

Systemic Lupus Erythematosus (SLE) – The relationship between menopause and SLE is particularly intricate and contradictory. While some studies have reported a potential decrease in the frequency of SLE flares in the postmenopausal years, others suggest that the overall disease severity and the extent of organ damage resulting from each flare might be more pronounced during this period.

This discrepancy underscores the need for further research to fully clarify the complex hormonal influences in SLE. Moreover, the use of Hormone Replacement Therapy (HRT) in women with SLE necessitates meticulous consideration and careful consultation with healthcare providers, as the introduction of external oestrogen can, in some individuals, trigger disease flares, potentially outweighing the benefits for menopausal symptom management. 

Multiple Sclerosis (MS) – For some women living with MS, the postmenopausal period may be associated with a reported worsening of their neurological symptoms. This deterioration may potentially signal a transition towards a more progressive form of the disease, characterised by a more insidious and less relapsing-remitting course. The underlying mechanisms for this potential shift are not fully understood but may involve the loss of oestrogen’s neuroprotective effects or alterations in the inflammatory environment within the central nervous system. 

Hashimoto’s Thyroiditis – Hashimoto’s thyroiditis, an autoimmune disorder targeting the thyroid gland, can also be influenced by the hormonal changes of menopause. The lower levels of oestrogen during this period may potentially disrupt thyroid function and exacerbate the symptoms of hypothyroidism, which are often associated with this condition, such as fatigue, weight gain, and cognitive difficulties. Careful monitoring of thyroid hormone levels and appropriate adjustments to thyroid hormone replacement therapy may be necessary during this time. 

Scleroderma – A chronic autoimmune disease characterised by the hardening and thickening of the skin and internal organs, may also exhibit a relationship with menopause. Some observations suggest a potential association between menopause and increased skin thickening in women with scleroderma. Furthermore, the development of pulmonary arterial hypertension (PAH), a serious complication of scleroderma affecting the blood vessels in the lungs, might be more common in the postmenopausal years, although the direct causal link remains under investigation.

How Risks Drive These Medical Conditions 

Both the menopausal transition and the presence of autoimmune diseases can independently elevate the risk of developing certain co-existing health conditions, known as comorbidities. For instance, both menopause due to oestrogen deficiency, and some autoimmune diseases, through chronic inflammation and immune dysregulation, can increase the risk of cardiovascular disease and osteoporosis, a condition characterised by weakened bones and increased fracture risk.

The unfortunate convergence of these independent risk factors can potentially have an additive or even synergistic effect, further amplifying the overall risk of these comorbidities in women experiencing both menopause and autoimmune disease. This underscores the critical need for proactive screening and management of these potential comorbidities in this vulnerable population. 

Exploring Treatment Options 

The management of both menopausal symptoms and the underlying autoimmune disease requires careful consideration of the potential interactions and influences of various therapeutic interventions. 

Hormone Replacement Therapy (HRT)

The use of HRT, a common treatment for managing menopausal symptoms such as hot flashes and vaginal dryness, in women with autoimmune diseases necessitates a cautious and individualised approach, involving thorough discussion with healthcare providers. While HRT can effectively alleviate menopausal discomfort, its potential impact on the autoimmune disease, both beneficial and detrimental, must be meticulously evaluated based on the specific autoimmune condition, its current activity, and the individual woman’s overall health profile. As previously mentioned, in certain autoimmune conditions like SLE, the introduction of oestrogen through HRT may, in some cases, trigger disease flares, potentially outweighing the benefits for menopausal symptom relief. Therefore, a careful risk-benefit assessment is paramount. 

Disease-Modifying Anti-rheumatic Drugs (DMARDs) and Other Immunosuppressants 

The cornerstone of managing the underlying autoimmune disease remains the consistent and appropriate use of disease-modifying anti-rheumatic drugs (DMARDs) and other immunosuppressive medications. During the menopausal transition, healthcare providers may need to closely monitor disease activity and make necessary adjustments to these medications based on any observed changes during the autoimmune condition and the emergence or worsening of menopausal symptoms. The potential for interactions between medications used to manage both conditions must also be carefully considered. 

Symptom Management Strategies 

Addressing bothersome menopausal symptoms is crucial for enhancing the overall well-being and quality of life of women with autoimmune diseases. However, the selection of symptom management strategies may need to be tailored to avoid potential interactions with the underlying autoimmune condition. Non-hormonal options for managing hot flashes, sleep disturbances, and mood changes may be preferred in some cases to minimise the risk of exacerbating the autoimmune disease.

The Foundation of Well-being: Lifestyle Factors 

Maintaining a healthy and balanced lifestyle plays an indispensable role in supporting the overall health and well-being of women with autoimmune diseases as they navigate the menopausal transition. Adhering to a nutritious and balanced diet, engaging in regular physical activity that is appropriate for their individual limitations, implementing effective stress management techniques, and prioritising adequate sleep hygiene can all contribute significantly to managing both menopausal symptoms and the activity of the autoimmune disease. These lifestyle modifications can help to modulate inflammation, support immune function, and improve overall resilience during this significant life stage. 

In conclusion, the menopausal transition represents a significant period of physiological change that can exert a profound and often varied impact on women living with autoimmune diseases. The intricate interplay between declining oestrogen levels and the underlying immune dysregulation necessitates a comprehensive and individualised approach to care. It is of paramount importance for these women to forge strong collaborative relationships with their rheumatologists, gynecologists, and other healthcare providers.

Regular monitoring of autoimmune disease activity, proactive management of menopausal symptoms, and thoughtful consideration of treatment options, including the potential risks and benefits of HRT, are essential. Individualised care that considers the specific autoimmune condition, the unique biological profile of each woman, and her overall health goals is paramount in ensuring optimal health and well-being during this transformative phase of life. 

For further information on menopause, please visit – https://menopausestudio.co.uk/free-resource/