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Menstrual Periods & Arthritis

Medical Author: William C. Shiel Jr., MD, FACP, FACR

Why do many women with arthritis feel worsening symptoms before and during their monthly menstrual periods? During the course of any day in caring for women with arthritis, it is not uncommon for a number of them to complain of a monthly regular worsening of their joint pain, stiffness, and swelling. This is not just a coincidence.

Many forms of arthritis and rheumatic diseases are known to occur more frequently in women than in men. Moreover, it is not unusual for the initial presentation of these conditions to occur following a pregnancy. Why?

Researchers are finding that the immune system is influenced by signals from the female reproductive hormones. It seems that the levels of hormones, such as estrogen and testosterone, as well as changes in these levels can promote autoimmunity. "Autoimmunity" is a condition whereby the immune system (which normally wards off foreign invaders of the body, such as infections) turns and attacks the body's own tissues, such as skin, joints, liver, lungs, etc. Autoimmune diseases typically feature inflammation of various tissues of the body.

Autoimmune diseases are also characterized by a disorder of the immune system with the abnormal production of antibodies (autoantibodies) that are directed against the tissues of the body. Examples of autoimmune diseases include not only those that feature inflammation in the joints, such as systemic lupus erythematosus, Sjogren's syndrome, and rheumatoid arthritis, but also disease of other organs, such as occurs in Hashimoto's thyroiditis and juvenile diabetes mellitus.

When women report only having symptoms or having increased symptoms at monthly intervals that coincide with their menstrual periods, many doctors will recommend adjusting or adding medication to reduce inflammation selectively just before and during the period. The rationale for this short-term adjustment is that the immune system may be temporarily more active as women's hormone levels change during their periods. The additional medication can frequently help to avoid the symptom roller coaster that affects many women with arthritis.