Hormones, Perimenopause, Menopause & Autoimmune Disease

Executive Summary

• Perimenopause is the transitional and often symptomatic phase that leads to menopause, which marks the end of an individual’s reproductive years after they go 12 consecutive months without a period. 
• Hormonal shifts during perimenopause, such as declining estrogen and progesterone levels, can hinder immune function, potentially triggering or worsening autoimmune disease symptoms.
• Many symptoms of autoimmune disease and perimenopause overlap, making disease diagnosis and management more complex during this life stage.
• With the right care team, lifestyle strategies, and support resources from the Autoimmune Association, patients can confidently navigate autoimmune diseases while approaching menopause.

Hormonal Changes and Autoimmune Health

Perimenopause is the several-year-long transitional period leading up to menopause, which is the total cessation of menstrual cycles and the end of an individual’s reproductive years, characterized as being period-free for 12 consecutive months. During perimenopause, estrogen and progesterone levels fluctuate unpredictably, and then once someone reaches menopause, hormone levels normally remain low. 

Many people are aware that this transitional period can result in symptoms like fatigue and abrupt mood changes. Still, they may be unaware of the correlation between hormones and autoimmune diseases. For example, when estrogen drops during perimenopause, it can cause autoimmune disease symptoms to worsen because estrogen is an immune modulator that the body is used to using as both a pro- and an anti-inflammatory.

The guide below outlines the relationship between the stages of menopause and autoimmune diseases, exploring how hormonal fluctuations can directly affect inflammation, immune signaling, and symptom patterns. It also provides tips for individuals trying to manage symptoms from an autoimmune disease and perimenopause.

Understanding the Hormone-Autoimmune Connection

To understand menopause and autoimmune diseases, it helps to start with the basics. Read through the considerations below to learn how hormones imperative to reproductive health, such as estrogen and progesterone, play a role in immune function.

Understanding Estrogen and the Immune System

Estrogen has a complex relationship with immunity. In some contexts, it enhances immune responses, which may help the body fight infections more effectively. But this heightened immune activity can also increase the risk of the body mistakenly attacking its own tissues, which is a hallmark of autoimmune disease. This helps explain why 78% of people with autoimmune diseases are women. 

Learning About Progesterone’s Role

Progesterone is typically described as having a calming effect on the immune system, as it can help regulate inflammation and balance immune responses. During perimenopause, progesterone levels decline and fluctuate, potentially disrupting that balance.

Hormonal Fluctuations and Symptoms

During autoimmune disease and perimenopause, hormone levels don’t just drop; they fluctuate unpredictably. These swings can lead to changes in inflammation, meaning perimenopause can cause autoimmune disease symptom flares or create entirely new symptoms. This is one reason patients often report that their autoimmune condition feels less stable during this phase.

Common Challenges During Perimenopause and Menopause

One of the most difficult aspects of autoimmune disease, perimenopause, and menopause is symptom overlap, meaning many hallmark symptoms of perimenopause and menopause mirror those of autoimmune conditions. Some examples include:

• Brain fog
• Fatigue
• Joint pain
• Mood changes
• Sleep disturbances

This overlap can make it difficult to determine what’s driving symptoms at any given time, creating diagnostic challenges. While looking for a diagnosis to explain their symptoms, some patients are told that new or worsening symptoms are “just menopause,” when in reality, they may be the result of an autoimmune flare, delaying appropriate treatment and leaving patients feeling dismissed or misunderstood. 

These diagnostic challenges are often complicated further by fluctuating disease activity. Some individuals notice increased disease activity during perimenopause, while others may experience temporary improvement. In addition to impeding diagnoses, these variations can make disease management more unpredictable.

Emotional and Social Impact

Beyond physical symptoms, the combination of hormonal changes and chronic illness can take a toll on emotional well-being.

Patients may experience:

• Increased anxiety or mood swings
• Changes in self-identity or body image
• Strain on relationships or work performance

When symptoms are invisible or inconsistent, it can also be difficult to explain these experiences to others.

Understanding that these challenges are not uncommon can help reduce isolation and encourage patients to seek support.

Managing Symptoms and Supporting Wellness

While the intersection of menopause and autoimmune diseases can feel overwhelming, there are practical strategies that can help patients regain a sense of control, as outlined in the three sections below.

Making Lifestyle Adjustments

Small, consistent changes can have a meaningful impact on both hormonal balance and immune health. Some things you should prioritize are:

• Well-rounded nutrition – Avoid restrictive diets; instead, reference reliable nutrition resources to build balanced, anti-inflammatory meals that support overall health.
• Regular exercise – Most individuals benefit from consistent movement. Talk to your medical provider about how you can safely exercise to improve your energy levels, joint health, and mood.
• Sleep hygiene – Prioritizing sleep is essential, especially when fatigue is already a concern. You should try to build a healthy nighttime schedule with a relaxing wind-down routine and enough time for 7-9 hours of sleep.
• Stress management – To calm your body and help regulate both hormonal and immune responses, practice mindfulness, attend therapy, or engage in relaxation practices such as low-impact yoga.

Some individuals use medicine to supplement their lifestyle changes and limit symptoms from menopause and autoimmune diseases.

Considering Hormone Replacement Therapy (HRT)

People have been using HRT to manage menopause symptoms for over 80 years. However, a recent study involving nearly 1.8 million women with a mean age of 60.5 years old found a statistical link between hormone therapy and autoimmune diseases. Still, Dr. Xuezhi (Daniel) Jiang, a Professor of Obstetrics and Gynecology at Drexel University College of Medicine, claims that the actual increase in autoimmune disease prevalence after menopause HRT use is relatively small and varies by condition, making individualized care crucial.

Taking a Personalized Approach

What works for one patient may not work for another. Since there is no one-size-fits-all solution for addressing the problems caused by autoimmune diseases and perimenopause, focus on finding the right doctor, then work with them to find a sustainable, balanced approach that supports both quality of life and long-term health for your specific situation.

Some things your medical provider should take into account before making treatment decisions are:

• Pre-existing autoimmune conditions
• Symptom severity
• Personal and family medical history

The Role of Healthcare Providers

Navigating hormones and autoimmune diseases often requires a team-based approach, meaning most patients benefit from working with multiple medical professionals. 

Although the specialists you should visit depend on your specific condition, the table below lists three types of healthcare providers most commonly used to help people juggling an autoimmune disease and perimenopause.

Each of these medical professionals brings a different perspective, helping to create a more complete picture of what’s happening in the body.

Monitoring and Adjustments

Hormonal transitions like menopause can influence disease activity, making regular monitoring vital. It is important to track symptoms over time and monitor lab values, then adjust medications as needed.

Patients play a central role in their own care, from tracking symptoms and asking questions to clearly communicating changes, which can help providers make more informed decisions.

If something doesn’t feel right, it’s important to speak to a knowledgeable provider. Not every question or concern will have a simple, clear-cut answer, but it will still spark a conversation worth having.

Community, Education, and Awareness

Simultaneously navigating autoimmune disease and perimenopause can be daunting; no one should have to do it alone. Pursue community and education to facilitate this complex stage of life.

Why Community Matters

Three things that you can get from connecting with others who share similar experiences are:

1. Emotional support
2. Practical advice
3. Validation

Hearing how others manage symptoms and navigate care can be a great way to get new perspectives while also reducing feelings of isolation. Therefore, you should consider finding an autoimmune support group near you and connect with other individuals going through perimenopause.

Viewing Education as Empowerment

Reading through research recaps can help patients make informed decisions and avoid misinformation, especially when searching for answers to loaded questions like “Can menopause trigger autoimmune disease?”

The Autoimmune Association offers a range of educational resources regarding autoimmune diseases, including webinars and videos. Engaging with these resources can help you stay informed and feel more supported throughout your journey. For a more passive way to stay up-to-date on autoimmune research, feel free to subscribe to our monthly Research Roundup newsletter.

Empowering Patient Care

The relationship between hormones and autoimmune diseases can seem complex at first, but if you take the time to understand it, it can be empowering. By recognizing how perimenopause and menopause typically affect immune function, patients can better anticipate changes, making it easier to take proactive steps in their care.

If you are going through a hormonal transition, have an autoimmune disease, or both, focus on securing medical guidance that can help you make lifestyle adjustments to minimize symptoms. It can also be helpful to have community support so you can navigate menopause and autoimmune diseases with greater confidence.

If you’re looking for trusted information, support, or ways to help others manage menopause and autoimmune diseases, the Autoimmune Association can be a valuable place to start. Check out our selection of patient resources for people with autoimmune conditions, or contact us if you have any specific questions or concerns.