Rheumatoid Arthritis Hormone Imbalance & Its Treatment Options

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Rheumatoid arthritis (RA) is a chronic disease that causes inflammation of body joints.

The exact cause of this illness has not been discovered, but experts believe that hormonal imbalance (low levels of estrogen and progesterone) may play a part in causing RA or worsening its symptoms.

This article explains how hormonal imbalance affects rheumatoid arthritis in women and how they can reduce its symptoms through different treatment options.

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Rheumatoid arthritis

Rheumatoid arthritis is an inflammatory disease in which swelling of joints occurs, which leads to pain and some degree of disability of the affected joint.

It is an autoimmune disease, meaning your body’s immune system – whose role is to protect you from foreign invading particles – starts attacking healthy body cells.

In the case of rheumatoid arthritis, the immune system attacks joint cells.

When the condition gets severe, it changes the shape of the joint and affects more joints in the body. Rheumatoid arthritis affects other body organs and tissues.

The exact cause behind this activation of an autoimmune response is not clear yet. However, experts believe some environmental and genetic factors may cause it.

Women have three times more risk of developing rheumatoid arthritis compared to men, especially menopausal women.

Symptoms of rheumatoid arthritis

Rheumatoid arthritis symptoms are symmetrical – they occur on both sides of the body equally. This disease first affects small joints like finger joints. Then it moves to the other joints like the hip joint, shoulder joint, etc.

The common RA symptoms are given below:

• Painful joints (pain in more than one body joint)
• Swollen joints
• Stiffness and immobility of joints
• Formation of lumps under the arm skin
• Loss of weight
• Weakness and tiredness
• Fever

Can hormonal imbalance cause rheumatoid arthritis?

Hormonal fluctuations don’t directly cause RA but they can contribute to its development and progression in different ways.

Some experts believe women with healthy levels of sex hormones (progesterone and estrogen) are less likely to develop this illness. It is because these hormones have a protective effect on bone and joints.

In one research, scientists discovered that women going through pregnancy and the postovulatory stage (a menstrual stage that occurs before menses start) reported having very few joint symptoms.

The reason they described was the high levels of sex hormones (your body naturally produces these hormones more than usual during these phases).

In the same research, it is also mentioned that the same women reported having more joint symptoms after pregnancy and when the second week of the menstrual cycle started.

It may be because the female body produces less sex hormone during these stages.

Rheumatoid arthritis and menopause

Naturally, women experience a reduction of reproductive hormones with age. During menopause, these hormones reach their lowest points.

Experts believe that it might be the reason why menopausal women are at a higher risk of developing rheumatoid arthritis or postmenopausal rheumatoid arthritis.

A 2022 study showed that low estrogen during menopause is associated with rheumatoid arthritis risk and severity in menopausal women.

Comparatively, non-menopausal women experience fewer and less severe rheumatoid arthritis symptoms compared to menopause women. It shows the role of estrogen and progesterone in the protection of joints.

Women who maintain their estrogen levels even after developing rheumatoid arthritis may experience less severity of the disease.

Rheumatoid arthritis and menstruation

Rheumatoid arthritis symptoms fluctuate throughout the menstrual cycle most likely because of the changing estrogen and progesterone levels as these hormones have anti-inflammatory and immunomodulatory effects.

During the pre-menstrual and menstrual phase, estrogen and progesterone levels are low. Many women with RA experience more fatigue, joint pain and disease activity during these phases.

Comparatively, levels of these hormones surge after periods and many women report experiencing fewer symptoms of RA.

Why are joints affected due to the low levels of estrogen and progesterone?

The hormonal imbalance can have a direct effect on different body joints.

There are receptors of estrogen present in your joint tissues. In this way, estrogen helps maintain the function and structure of joints. It also helps keep the levels of lubricant normal to avoid friction between joints, creating a protective effect.

Progesterone and estrogen also show anti-inflammatory effects. So, when there levels decline, people with RA generally experience more joint pain, inflammation and issues like osteoarthritis.

Increasing and maintaining normal levels of these hormones can help reduce the symptoms of arthritis in menopausal women.

How to treat rheumatoid arthritis hormonal imbalance naturally?

RA has no cure, but it still has several treatment options. These treatments are particularly used to reduce flare-ups and prevent further damage by maintaining a healthy hormonal balance.

Increasing the levels of estrogen and progesterone naturally should be the first option that one should consider.

For this purpose, you can eat estrogen-rich foods and adopt healthy eating habits.

It is also important to maintain a healthy weight and avoid stress. Women with excessive weight often develop an imbalance between progesterone and estrogen. Their estrogen levels increase while progesterone levels stay the same.

Similarly, stress can also trigger your body to change hormones, including progesterone to cortisol. It also leads to hormonal imbalance, which can trigger rheumatoid arthritis flare-ups.

You should also avoid over-exercising. Even though regular exercise is good for your health as it burns fats and helps you stay fit, doing it excessively can force your body to produce more cortisol and less progesterone. So, do exercise but only in moderation.

When natural ways are not enough

There are different treatment options available to reduce the impact of arthritis. Your doctor will suggest these options and then help you choose the one that suits your condition the best.

Below are the common treatment options for rheumatoid arthritis.

Surgery

This option is suitable for women with a severe form of rheumatoid arthritis. In this surgery, their damaged joints are replaced with healthier ones to allow the person to start moving them again.

It may help with joint pain, swelling and overall functioning.

Joint fusion

This surgical option is chosen when the other options are not possible. In it, the damaged joint is fused with the other joint or bone to increase its mobility and reduce pain.

Tendon repair

A tendon is a connective tissue that attaches a bone to a muscle. A damaged tendon can affect your joint’s mobility and pain. So, in this surgical treatment, tendons that have been damaged are repaired.

Total joint replacement

As the name indicates, in total joint replacement, the damaged joints are replaced with artificially developed joints called prosthetic joints. They are made up of plastic and metal.

Physical therapy

Physical therapy is also effective in reducing the signs of rheumatoid arthritis. Keeping your muscles and bones moving helps them stay fit and flexible. It is one of the easiest options that you can even do on your own or with a little assistance from a professional.

Medication

Some women are prescribed anti-inflammatory drugs to reduce inflammation and its impact. Ibuprofen is an example of such a drug. Some are also prescribed disease-modifying drugs. They relieve pain and also manage the underlying rheumatoid arthritis mechanism.

Hormone replacement therapy

In hormone replacement therapy (HRT), FDA-approved bio-identical hormones (hormones that are biologically similar to the hormones that naturally exist in the body) are given to increase low serum hormone levels.

If your estrogen is low, then you may be given only estrogen. But if levels of both estrogen and progesterone hormones are down, then you will likely be given a mixture of these hormones.

Studies suggest that using this treatment option is effective in reducing the symptoms of rheumatoid arthritis in women.

A large study conducted in 2023 revealed that rheumatoid arthritis women who took HRT or oral contraceptives with RA medicines like tocilizumab and DMARD had a greater chance of achieving remission.

HRT may also be helpful in preventing RA or joint damage in patients susceptible to developing it due to hormonal imbalance.

Similarly, if you are a menopausal woman, then hormone therapy can also help you reduce common symptoms of menopause.

If your rheumatoid arthritis is due to a hormonal imbalance, HRT can be a good option to try to improve hormone balance and improve RA. It has helped many RA patients relieve joint pain and increase their activity levels.

Besdies offering benefits, HRT comes with potential side effects as well.

For example, it may cause headaches, breast swelling, mood swings, skin issues and an increased risk of cardiovascular disease or heart disease.

That is why HRT is not for everyone.

Discuss your treatment options with your healthcare provider and choose the one that offers more pros with fewer to no cons.

FAQs about rheumatoid arthritis and low estrogen

Can hormone therapy cause joint pain?

Hormone therapy can cause joint pain when used for breast cancer treatment.

Joint pain and stiffness are also signs of menopause in women. Menopausal or postmenopausal women may experience it because of declining estrogen levels.

Can low estrogen cause rheumatoid arthritis?

Low estrogen is not a direct cause of RA but it can contribute to this health issue by negatively impacting immunity, inflammation and other factors.

The direct connection between hormone levels and RA is not clear yet.

Summing up

Rheumatoid arthritis is a chronic disease that has no cure so far. It mostly affects menopausal women who have low estrogen and progesterone levels.

That is why hormone replacement therapy, in which a combination of both hormones is used, is effective in alleviating rheumatoid arthritis symptoms.

Talk to your doctor about the benefits and other potential side effects of HRT before choosing it for menopausal symptoms and RA.

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References

Namavari, N., Jokar, M., Ghodsian, A., Jahromi, H.K. and Rahmanian, V., 2024. Menopausal state and rheumatoid arthritis: a systematic review and meta-analysis. BMC rheumatology, 8(1), p.48.

Daraghmeh, D.N., Hopkins, A.M., King, C., Abuhelwa, A.Y., Wechalekar, M.D., Proudman, S.M., Sorich, M.J. and Wiese, M.D., 2023. Female reproductive status and exogenous sex hormone use in rheumatoid arthritis patients treated with tocilizumab and csDMARDs. Rheumatology, 62(2), pp.583-595.

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