Rheumatoid arthritis (RA), an often-destructive inflammatory joint disease, seems to get worse with menopause—likely due to lower hormone levels. RA on its own is hard enough with effects including joint pain, stiffness, swelling, and fatigue. Add menopause and all its symptoms—hot flashes, mood swings, vaginal dryness, and more—and the combination can negatively affect a person’s quality of life.

Here is what you need to know about the connection between RA and menopause, including the effect of female hormones on RA, how menopause may affect function and disability, and related comorbidities and complications.

What Is Menopause?

Menopause begins naturally for most women around the age of 50. At this time, menstrual periods stop. Menopause occurs because the ovaries stop producing estrogen and progesterone.

You are considered having reached menopause when you have not had a period for at least one year. Symptoms and changes start years earlier and may include:

  • Changes to menstrual periods—periods that are shorter, lighter, longer, or heavier, with more or less time between them
  • Hot flashes and/or night sweats
  • Sleep problems
  • Vaginal dryness
  • Mood swings
  • Concentration troubles
  • Hair loss on the head
  • More hair on the face

Some of these symptoms will require treatment. Your healthcare provider is in the best position to offer advice on how to manage symptoms of menopause. Make sure that person knows your medical and family history. This includes risk for heart disease or other serious health conditions, such as rheumatoid arthritis.

RA and Female Hormones

Women experience rheumatoid arthritis at a rate that is 2 to 3 times higher than men, and they also have more severe declines in health and increased risk for disability from RA. Unfortunately, the reasons for any differences between the sexes and RA are not truly understood, but researchers speculate reproductive and hormonal events, along with estrogen levels, play a part.

Reproductive and Hormonal Events

Previous studies have found women with rheumatoid arthritis experience varying disease shifts based on reproductive and hormonal life events. For example, during pregnancy, women have a decreased incidence of RA, including symptom reduction and remission (little or no disease activity), and seem to experience increased disease progression and flare-ups following childbirth. Additionally, those who experience early menopause are more likely to develop RA in comparison to those with normal or late menopause timelines.

Estrogen Connection

Researchers know the decrease in estrogen plays a part in the development of RA. They also believe estrogen offers a protective measure for RA—in preventing the disease and in reducing its effects in women who have been diagnosed with RA.

One combined animal-human study reported in 2018 by the journal Arthritis Research & Therapy aimed to determine what effect both reduced estrogen and estrogen therapy had on women with RA. The study’s researchers examined postmenopausal mice (female mice whose ovaries had been removed) who were given injections of specific inflammation producing autoantibodies related to RA and then treated with estrogen therapy. The mice were studied to determine what effect the estrogen therapy had them.

The researchers also examined women with RA receiving hormone replacement therapy (HRT), including estrogen, and women with RA who were not receiving HRT. HRT uses medications containing female hormones to replace the ones your body is no longer making because of menopause. It can also be used to treat menopausal symptoms, including hot flashes and vaginal discomfort. The researchers confirmed the data obtained could provide an explanation as to why the risk of RA for women changes during a woman’s life and seems to increase significantly in menopause.

The 2018 animal-human study also finds additional estrogen is a protective factor rather than a risk factor for triggering inflammation. The researchers suggest higher levels of estrogen can actually inhibit inflammatory proteins in the body. The study also confirms low estrogen levels are to blame for higher rates of RA flare-ups after pregnancy and during menstrual cycles. The researchers further speculate treatment with estrogen may have a beneficial effect for some women with RA, especially those who experience high disease severity, including ongoing symptoms and pain.

Function and Disability

The menopause-RA connection has led researchers to determine how menopause and estrogen decreases affect function in women with RA. One study reported in 2018 in the journal Rheumatology finds menopause actually has a significant impact on the levels and rates of disability and functional decline in women with RA. In fact, menopause is associated with increased potential for disease progression and worse quality of life outcomes.

The study’s authors note that further study is needed to understand why this is the case. Not only are these women struggling with the effects of RA, but the condition in of itself becomes more costly and harder to treat. Further research is needed to determine what interventions can take place to improve outcomes for menopausal women living with RA.

Comorbid Conditions

Having RA while menopausal can increase your risk for both osteoporosis and heart disease. These conditions appear as comorbidities—the presence of more than one condition in a person at the same time. Comorbidities are common in people living with RA.

RA increases the risk for osteoporosis and so does menopause. Osteoporosis causes bones to become weak and brittle, making them more susceptible to fractures. It is a good idea for women with RA to get their bone density checked often and to make sure they are getting enough vitamin D and calcium.

The reason for the increased risk for osteoporosis in menopause is reduced estrogen. With RA, the increased risk for bone loss is related to the inflammation-causing structural joint damage and the medications used to treat the condition, especially corticosteroids.

Your healthcare provider can estimate the odds of your getting a bone fracture over the next 10 years using a DEXA scan that measures the density of bones. If your healthcare provider decides your risk for osteoporosis is concerning, they will develop a prevention plan for you, which may include prescription treatments to maintain bone density and strength.

Heart Disease

Heart disease is another possible complication of both RA and menopause. Heart disease is also one of the leading causes of death in women with RA. This is because the same inflammation that attacks the joints and other body tissues can also damage the heart. What is more, hormonal changes and getting older also increase the risk of heart troubles.

Having RA, menopause, or both, means you need to prioritize preventive care for heart disease, including eating a healthy diet, being active, and not smoking. Your healthcare provider may recommend you see a cardiologist to monitor for signs of heart disease. Your healthcare provider may also consider aggressive treatment for RA to keep inflammation levels down.

Other Complications

In addition to co-morbidities, menopausal women with RA may also experience other difficulties that affect their physical and emotional health, comfort, and happiness.

Your Sex Life

Rheumatoid arthritis can sometimes make it harder to enjoy your sex life. And menopause can cause vaginal dryness, leading to painful sex. Many women with RA also have Sjogren’s syndrome, an autoimmune disease that attacks the moisture-producing glands of the body. Just like menopause, Sjogren’s can cause vaginal dryness and painful sex.

Ask your healthcare provider about using a lubricant to reduce vaginal dryness and keep sex enjoyable. If you are worried about joint pain during sex, try positions easier on the joints—such as side by side with your partner—to take the stress off the hips and affected joints. You can also plan intimacy with your partner for times of the day when you are feeling less pain.

Both menopause and RA may also affect sexual desire. Talk to your healthcare provider or a counselor about ideas to preserve your sexual drive.

Fatigue 

Menopause can increase the amount of fatigue you are already experiencing with RA. Menopause can also cause sleep problems, and if you are not getting enough sleep, RA pain can become exacerbated. If you are struggling with sleeping well at night or you think your RA treatment is not working well, talk to your healthcare provider about the best ways to manage fatigue, sleep problems, and RA symptoms.

Depression

The American Psychiatric Association defines depression as a common, serious medical condition that negatively affects how a person feels, thinks, and acts. Depression causes feelings of persistent sadness and loss of interest in activities you once enjoyed. It also leads to physical and emotional problems that make it harder to function in your daily life.

Menopause is also associated with depression. Up to 20% of women will experience depression during menopause. For women that experience depressive symptoms with menopause, risk factors include a prior history of depression and fluctuations in reproductive hormone levels that were previously associated with a depressed mood.

Depression is common in people with RA and up to one-third of women with RA experience depressive symptoms.

Talk to your healthcare provider or a mental health professional if you feel depressed. Depression is treatable and it is not something you have to live with. Talk therapy, exercise, behavioral therapies, and anti-depressants can all treat depression.

A Word From Verywell

Work with your rheumatologist to keep RA under control before, during, and after menopause. Treatment can help reduce your risk for comorbidities, complications, and disability. In fact, staying on top of your medications and taking them as instructed by your healthcare provider is the best way to manage RA symptoms. Self-monitoring is equally important, and this could be as simple as writing down when flares occur and what causes or improves them, changes in RA symptoms and severity, and medication responses. You also include other care providers, including a cardiologist, to help manage specific symptoms and risk factors related to RA and menopause.

Being active is one of the simplest ways to feel better with RA and also improve and reduce the effects of symptoms and changes related to menopause. Exercise gives you more energy and improved joint flexibility. It also reduces the risk of depression and heart disease. Additionally, it helps you maintain weight and sleep better at night. Weight-bearing exercises can protect against osteoporosis. Talk to your healthcare provider or a physical therapist about creating a safe exercise program for your unique situation.