PsA and Menopause: what You Need to Know

The time period leading up to menopause is known as perimenopause. This time period varies among women and lasts about 4 years on average. Hormonal changes in your body during this time period may lead to uncomfortable symptoms, such as hot flashes, sleep disruptions, and mood changes.

Menopause can also interact with other health conditions, including psoriatic arthritis (PsA). Understanding how menopause and PsA affect each other can help you to manage flares and reduce your risk of related diseases, including osteoporosis.

You may go through menopause earlier

Menopause typically occurs between the ages of 45 and 55. Symptoms start about 4 years before a woman’s final period.

Psoriatic arthritis is a chronic condition involving inflammation of the joints. Most people with PsA also have psoriasis.

Menopause may start earlier for people with PsA. A 2011 study of more than 1.7 million women of reproductive age found that participants with chronic inflammatory diseases including psoriasis were up to five times more likely to experience menopause before the age of 45 or premature ovarian failure before age 40.

PsA and psoriasis flares may get worse

You might already be aware of some of the most common triggers of PsA and psoriasis flares. These can include stressful life situations, trauma to the skin, alcohol use, smoking, and infections.

Research suggests that fluctuations in female hormones during menopause may also cause PsA and psoriasis flares to worsen. Other studies have found that a reduction in estrogen after menopause may exacerbate psoriasis.

Symptoms of menopause and PsA flares can overlap. This makes it difficult to pinpoint the source. For example, you may have trouble sleeping or have changes in your mood leading up to a PsA flare. Those symptoms may also occur during perimenopause.

Common menopause symptoms can also make PsA flares feel worse. Sleep disruptions linked to menopause may make you fatigued. This may in turn increase your perception of pain from PsA.

Tracking your symptoms, diet, sleep, and stress levels can help you to pinpoint and manage your potential PsA triggers. If you notice more frequent or more severe PsA flares during menopause, check in with your doctor about adjusting your medication or lifestyle.

You may be at greater risk of osteoporosis

Osteoporosis is a disease that causes weak and brittle bones. Around 80 percent of the 10 million Americans who have osteoporosis are women.

Estrogen plays an important role in protecting bone. The reduction in estrogen levels during menopause increases a woman’s chances of developing osteoporosis. Chronic inflammation in PsA may increase these risks. Several pro-inflammatory proteins involved in psoriatic disease are also involved in osteoporosis.

Research suggests that women with PsA may be at an even greater risk of osteoporosis after menopause. A 2016 review of 21 studies found that low bone mineral density was a significant problem for people with PsA in more than half the research. Another report showed that people with PsA and psoriasis had an increased risk of bone fractures.

Talk to your doctor about strategies to minimize your risk of osteoporosis if you have PsA. They may recommend starting bone density screenings earlier than usual, supplementing with calcium and vitamin D, and doing weight-bearing exercises.

Can hormone therapy improve PsA symptoms?

Hormone therapy can provide relief from hot flashes and other symptoms of menopause. It can also help prevent bone loss that could lead to osteoporosis.

There appears to be a link between reduced estrogen levels and PsA flares. But early research suggests that hormone therapy won’t improve PsA symptoms. Other research suggests the complexity of psoriasis makes it difficult to study the potential impact of hormone therapy. More studies are needed.

Talk to your doctor to determine if hormone therapy is right for you.

How to manage PsA during menopause

Managing your PsA, limiting your exposure to potential triggers of PsA flares, and controlling your menopause symptoms can help keep you as comfortable as possible during this time in your life.

If you’re experiencing menopause symptoms, talk to your doctor about exploring other ways to manage your PsA. The following tips may help:

• Limit stress when possible. Stress can trigger a PsA flare. Stress-reduction techniques such as yoga and meditation may be helpful in the years leading up to menopause.
• Focus on sleep. Sleep disruptions can occur during menopause and have been associated with PsA flares. Try to stick to a sleep schedule, keep your bedroom as comfortable as possible, avoid caffeine in the afternoon, and avoid screen use leading up to bedtime to improve your chances of getting a good night’s rest.
• Keep moving. Staying physically active can help you keep your PsA symptoms at bay. Resistance training and weight-bearing exercises such as walking also promote bone health and may potentially reduce your likelihood of developing osteoporosis during menopause.
• Talk to your doctor. Explore what you can do during menopause to improve your PsA symptoms. Your doctor may recommend switching or adjusting your medications or making other lifestyle changes so that you’re more comfortable.

The takeaway

The months and years leading up to menopause may impact your PsA and increase the frequency and severity of flares. People with PsA may also be at greater risk of osteoporosis during menopause. You may also be more likely to go through menopause earlier than women who don’t have PsA.

Hormone therapy doesn’t seem to improve PsA symptoms, but it may help with hot flashes and other menopause symptoms. Avoiding triggers and making lifestyle changes can help you avoid PsA flares. Getting plenty of rest and reducing stress have been shown to help with PsA.

Check in with your doctor about your medication and your lifestyle to develop a strategy to manage your PsA during menopause.

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