Cheryl Koehn, 56, was surprised that information about how menopause might impact her rheumatoid arthritis (RA) – and vice versa – was so hard to find. “So many of us go through these profound life experiences in units of one,” says Koehn, who co-authored the book Rheumatoid Arthritis: Plan To Win (2002, Oxford University Press). In fact, living with inflammatory arthritis can affect how women experience menopause and their health risks.
“It can be hard to dissect a flare of inflammatory arthritis versus menopause-induced symptoms,” says Bonnie Bermas, MD, a rheumatologist at the University of Texas Southwestern Medical Center, in Dallas. Overlapping symptoms can be particularly confusing when the onset of inflammatory arthritis occurs during menopause, which is often the case with RA.
Aside from being similar, the symptoms of menopause can amplify those of inflammatory arthritis. Menopause can disrupt sleep, which can worsen fatigue and increase vulnerability to pain. Fluctuating hormones can increase anxiety and depression, which are challenges already faced by many women living with inflammatory arthritis. Vaginal dryness can also be exacerbated, particularly for those with Sjögren’s syndrome, which often occurs with RA.
But the bigger concern is that menopause increases the risk of osteoporosis and heart disease – conditions that are already more likely to affect people with inflammatory arthritis than other people. “Women with inflammatory arthritis are often predisposed to osteoporosis due to underlying disease as well as medications that are used to manage disease,” says Dr. Bermas. “There are also data to suggest that women with inflammatory arthritis are more prone to cardiovascular disease.”
What You Can Do
Women living with inflammatory arthritis should work with their doctors to make sure their arthritis is as well-controlled as possible, which will help minimize risks. Dr. Bermas also counsels keeping blood pressure under control, monitoring cholesterol and quitting smoking to reduce the risk of cardiovascular disease.
To minimize the risk of developing osteoporosis, Dalit Ashany, MD, a rheumatologist at the Hospital for Special Surgery in New York City, advises monitoring for it and starting bone density screenings earlier for women with inflammatory arthritis than other women. She also recommends doing weight-bearing exercise and getting enough calcium and vitamin D.
Talking to Your Doctor
Fluctuating estrogen and progesterone levels appear to be linked with inflammatory arthritis symptoms, but the effects vary among diseases. For instance, during pregnancy, when female hormone levels are higher, some women with RA may experience remission while some with lupus may experience flares.
“When you’re dealing with a lifelong disease, the stage of life you are currently in is very relevant,” says Eliza Chakravarty, MD, a rheumatologist with the Oklahoma Medical Research Foundation. Your treatment may change along with your hormonal changes. “You don’t need to make your treatment decision [only] once; it should be a fluid conversation with your doctor that changes overtime,” she advises.
While Koehn would like her rheumatologist to raise the topic of menopause, she recognizes the importance of bringing it up if he doesn’t. “It’s a necessary conversation at this stage in my life,” she says, “and I want us to approach it as partners.”
Author: MARIAH Z. LEACH
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