Which hormones fluctuate throughout the month during my cycle – estrogen and progesterone, or just estrogen?
The menstrual cycle proceeds through a complicated and highly coordinated dance of hormones. By convention the cycle begins with menstruation. During this time, levels of estrogen and progesterone are low. During the next part of the cycle, levels of estrogen begin to rise, reaching a peak around the time of ovulation. After ovulation, levels of estrogen remain relatively high, dropping off in the days leading up to the start of a period. Progesterone levels remain fairly low before ovulation, but then remain high, dropping off just before menstruation. Other hormones change cyclically too (such as the ones triggering ovulation), but estrogen and progesterone are the hormones thought to be most important for premenstrual syndrome and possibly symptom flares in women with autoimmune disease.
If my autoimmune symptoms seem to get worse when these hormones are high or low, is this typical?
Not all women with autoimmune diseases note symptom changes with their menstrual cycle, but many do. Sometimes it may be difficult to distinguish a pattern, since symptom exacerbations may be triggered by many other factors. Many women with rheumatoid arthritis, for example, report decreased joint pain in the period right after ovulation, as well as during pregnancy—both times when levels of estrogens and progesterone are high. These women may note increased symptoms when these hormone levels are particularly low, such as during menstruation or in the postpartum period.
One questionnaire found that 70% of women with multiple sclerosis noticed cyclical changes in their symptoms, with the worst symptoms in the week before the start of their period.
Women with lupus also often note symptom flares just before and during their periods. There is not one specific pattern that applies to symptom flares in all types of autoimmune diseases, though within specific diseases there is often more of a pattern.
Have there been any research studies about why hormone level fluctuations throughout a monthly cycle can worsen autoimmune symptoms/create a flare?
More research needs to be done on the relationship between hormone levels and autoimmune symptoms. It is well understood that steroid hormones, including estrogen and progesterone, influence the development of immune cells and modulate the output of the immune system.
Many immune cells have receptors for these hormones, including many of the immune cells responsible for creating autoimmunity. It is not surprising, then, that variations in hormone levels during the menstrual cycle might lead to changes in symptom severity.
Certain hormones may tend to activate a certain part of the immune system (e.g., the TH1 response, which activates macrophages) while simultaneously tampering down another part of the immune response (e.g., the TH2 response, which promotes the activation of B cells).
Some hormones, such as estrogen, may enhance the immune response at low levels while generally inhibiting the immune response at very high levels. Sex hormones also activate specific genes, some of which may play a role in symptoms flares or symptom reduction.
Many of details about this are still being worked out, however, and most of the work that has been completed has involved animal models of autoimmune diseases or simpler cellular systems. It is a very complicated problem to study; in a human being, multiple levels of hormones are changing concurrently, each of which might have some effect on the activity of the immune system.
Could hormone therapy help regulate my hormones to assist with leveling out autoimmune symptoms?
It might. It also might exacerbate your symptoms or have little effect. At this time, there is not a general clinical recommendation supporting hormone therapy in autoimmune diseases. Research on this is in a preliminary stage, and the amount of information available varies by disease type. For example, current evidence suggests that postmenopausal women with rheumatoid arthritis who use estrogen therapy may have fewer symptoms. Other clinical trials of postmenopausal women with lupus have found increased disease activity with estrogen therapy.
Research on premenopausal women is also in a preliminary stage, but some evidence suggests estrogen therapy may lead to decreased symptoms in multiple sclerosis; clinical trials are ongoing.
Questions for your doctor:
- What (if anything) is known about whether birth control pills or other hormone therapy might help with symptom reduction in my particular autoimmune condition?
- If am pregnant, is there anything I can do to help prevent a postpartum disease exacerbation?
- If hormones are thought to exacerbate symptoms in my autoimmune condition, what other non-hormonal options for birth control are available?
Have you noticed that flares that are related to certain weeks in your cycle? Share your experience below!
About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer. She specializes in writing about medical topics for the lay public and for health science students. She can be reached at firstname.lastname@example.org or through her website: ruthjhickmanmd.com.