Rheumatoid arthritis and menopause: what you need to know

Some women may find their joint pain worsens during perimenopause and menopause – here’s what you can do about it

Rheumatoid arthritis is more prevalent in women than men and onset peaks at 45-55 years
Changing hormone levels are thought to affect flare-ups and incidence
The condition can be best managed with a combination of medication and lifestyle adjustments

Rheumatoid Arthritis (RA) is an autoimmune disease where the immune system attacks the lining of the joints, causing pain, swelling and stiffness. It usually affects your hands, feet and wrists but can also affect organs and soft tissue. Because it’s a long-term condition, over time it can damage your joints, cartilage and bone.

It’s a systemic condition, meaning it can affect your body all over, and it can cause other symptoms such as fatigue, sweating, a temperature, poor appetite and weight loss.

RA is more prevalent in women than men and there is a genetic link. You’re also at increased risk if you smoke, and being overweight is a potential risk factor for developing the disease.

How does menopause affect rheumatoid arthritis?

The peak age of incidence of RA is 45-55 [1]. According to the National Rheumatoid Arthritis Society (NRAS), hormones are thought to play an important role in the development of RA [2], which commonly develops during periods of hormonal change for women, such as postnatally or during menopause.

Studies have found that an earlier age at menopause is associated with an increased risk of developing RA – one study found that a menopause under the age of 40 more than doubles the risk [3].

For some women, when their levels of hormones drop, their RA symptoms worsen, however, other women with RA are not affected by perimenopause or menopause.

All three hormones – oestradiol, progesterone and testosterone – have anti-inflammatory effects in the body and can have a protective effect for RA. In addition, there are other complex changes that occur during perimenopause and menopause and other non-hormonal factors that may affect the immune system.

Treating rheumatoid arthritis

With appropriate treatment many people can go months or even years without a flare-up of symptoms. Early treatment can also reduce the risk of joint damage.

Treatment options include painkillers, a non-steroidal anti-inflammatory drug (NSAID), disease modifying anti-rheumatic drugs (DMARD) and biological treatments that block chemicals in your blood from activating your immune system to attack your joints. Steroids can be used in the short-term to treat symptoms while waiting for DMARDs to take effect.

Physiotherapy can help keep you mobile, can improve flexibility in your joints and help improve muscle strength.

Can I take HRT for my menopausal symptoms?

Dr Penny Ward, a GP and menopause specialist says: ‘Whilst studies offer mixed results regarding rheumatoid arthritis and hormonal changes, I suspect this is largely because research in this area is lacking. From a personal perspective I was diagnosed with rheumatoid arthritis shortly after the birth of my daughter at the age of 28, a time when my oestrogen levels had fallen postnatally.

‘My next pregnancy saw a complete remission of my rheumatoid arthritis, so much so that I did not require any medication for many years. The connection behind high oestrogen levels being beneficial and low ones triggering did not occur to me until the disease flared again, far worse than before. I was perimenopausal and the flux in hormone levels across my menstrual cycle led to a cyclical nature of symptoms.

I started HRT, the dose of oestrogen was titrated and within a few months I was able to significantly reduce the dose of my DMARDs. I have spoken to a number of women in clinic with similar experiences, one of whom was able to halve her dose of methotrexate. So, whilst studies are small, observational and proport mixed reviews, I think the response of disease to hormones will be individualised. Unfortunately, rheumatoid arthritis increases the risk of cardiovascular disease. Knowing HRT can reduce this risk and for some women reduce joint pain, swelling and stiffness, I feel it should be considered alongside other treatment modalities on offer.’

More studies are needed in this area, the limited research we have to date is looking at the association between RA and synthetic HRT [4]. This needs updating to look at the impact of natural HRT on inflammatory arthritis, it is more relevant and based on current prescribing practices. Find out more about Synthetic and natural hormones: what’s the difference?

What else can I do?

Alongside getting available support for your RA, there are steps you can take to look after your health.

Take medication as your health practitioner prescribes, and attend regular health reviews. Having RA can increase risk of other conditions, such as cardiovascular disease. Your health practitioner may suggest additional tests depending on your personal risk profile, such as cholesterol measurement.

Eating a healthy, balanced diet, avoiding smoking and keeping alcohol intake low can all help to reduce inflammation in your body. Regular exercise can also be beneficial to you muscles and joints as well as your future health. You may need to experiment with different types of exercise to find one that is comfortable for you.

Finally, don’t neglect your emotional health – talk about how you are feeling with friends or family, or seek out support groups as it can be beneficial to share experiences with those in a similar position. The NRAS has a dedicated helpline for anyone affected by RA: 0800 298 7650.

Resources

NHS: rheumatoid arthritis

References

Tedeschi S.K., Bermas B., Costenbader K.H. (2013), ‘Sexual disparities in the incidence and course of SLE and RA’, Clinical Immunology, 149 (2), pp211-218, https://doi.org/10.1016/j.clim.2013.03.003
NRAS: Possible causes and risk factors
Beydoun H.A., el-Amin R., McNeal M., Perry C., Archer D.F. (2013), ‘Reproductive history and postmenopausal rheumatoid arthritis among women 60 years or older: Third National Health and Nutrition Examination Survey’, Menopause. 20(9) pp.930-5. doi: 10.1097/GME.0b013e3182a14372.
Jiang L, Zhang R, Musonye HA, et al. (2024) ‘Hormonal and reproductive factors in relation to the risk of rheumatoid arthritis in women: a prospective cohort study with 223, 526 participants’, RMD Open. 10:e003338. doi: 10.1136/rmdopen-2023-003338