For women with RA, menopause and the loss of estrogen can increase the intensity of symptoms. Learn what can help.

Key Takeaways

Declining estrogen may be the link between rheumatoid arthritis and menopause.      

Having RA and going through menopause can cause other health challenges, including osteoporosis and fatigue. 

Weight-bearing exercise can help alleviate symptoms of RA and menopause. 

The link between rheumatoid arthritis and menopause is complicated. Women with rheumatoid arthritis may feel that symptoms of menopause affect their arthritis pain.

But research has not been able to precisely pinpoint whatever direct links may exist between menopause and rheumatoid arthritis symptoms.

"There is no clear evidence that menopause positively or negatively affects rheumatoid arthritis,” says Alana Belfield Levine, MD, a rheumatologist at the Hospital for Special Surgery in New York City.

“I haven’t seen clinically that menopause makes a big difference in RA,” adds Scott Zashin, MD, clinical associate professor of medicine at the University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospital, both in Dallas.

But women who have early onset menopause — before age 45 — may be more likely to develop RA, Dr. Levine says. More women who went through menopause in their early forties tested positive for antibodies found in their blood that indicated RA than women who went through menopause after 45, according to a May 2015 study in Arthritis Care & Research.

What Role Does Estrogen Play?

The possible connection between rheumatoid arthritis and menopause appears to be estrogen, the female reproductive hormone that decreases in menopausal women.

Researchers base this suspicion on certain key facts about rheumatoid arthritis: Women are two to three times more likely to develop RA than men, according to the National Institutes of Health, indicating that the disease likely has something to do with female biology.

Pregnancy floods the body with estrogen, and pregnancy is known to suppress rheumatoid arthritis symptoms, according to the Arthritis Foundation. Most pregnant women with rheumatoid arthritis experience fewer arthritis symptoms by the beginning of the second trimester and through delivery, the Foundation states.

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After they give birth, when their estrogen levels return to normal, most women experience recurring rheumatoid arthritis symptoms, and the symptoms can be more severe than before.

Symptoms of Menopause and Rheumatoid Arthritis

The symptoms of menopause might increase rheumatoid arthritis pain, if only because they make a woman feel that much worse, Dr. Zashin says.

Interacting symptoms can also create specific health challenges for menopausal women with rheumatoid arthritis. These include:

• Osteoporosis. Your body is constantly breaking down and making new bone, Levine explains. But once you’ve gone through menopause, you have less estrogen, and low estrogen levels cause your body to lose bone faster than it can replace it. This can lead to osteoporosis, a disease characterized by a serious loss of bone density. Rheumatoid arthritis already leads to worsening bone density loss, with the inflammation around the joints causing the bones to deteriorate, Levine says. Inactivity due to arthritis pain and long-term use of corticosteroids for rheumatoid arthritis treatment might also lead to loss of bone density in patients with RA. Menopause may hasten this process, creating even more joint pain and increasing the potential for bone fractures.
• Loss of muscle mass. Menopause can cause a woman to lose some of her muscle mass. Muscles are crucial for supporting joints that are aching and inflamed as a result of rheumatoid arthritis.
• Fatigue. The inflammation of rheumatoid arthritis can create severe fatigue in some people. Feeling tired is also a common symptom of menopause. “Menopause doesn’t cause fatigue, but indirectly it does if you don’t sleep well because you’re having hot flashes or night sweats or insomnia,” says Wulf Utian, MD, PhD, medical director of the North American Menopause Society. Sleeplessness can compound the fatigue caused by rheumatoid arthritis symptoms.

How to Find Symptom Relief

Taking estrogen may provide some relief. Women taking estrogen who were menopausal but not living with RA reported a modest but sustained reduction in the frequency of joint pain, according to a 2013 study in Menopause.

Want a treatment that doesn’t involve taking medication? The answer is exercise, which is an excellent therapy that can help you deal with symptoms of menopause as well as rheumatoid arthritis symptoms, particularly since they intersect. Exercise helps battle bone density loss, increase muscle mass, and improve sleep. The best exercises are weight-bearing ones that make you work against gravity, such as brisk walking and lifting light weights, Levine says.

Also, make sure you get enough calcium and vitamin D, Levine says. Vitamin D helps you absorb calcium, which is crucial for strong bones. Good sources of calcium include milk, yogurt, and other dairy products; leafy green vegetables; and canned sardines with bones. Good sources of vitamin D include fatty fish, such as salmon and tuna; egg yolks; and fortified foods, including cereal and milk.

To improve sleep, don’t eat a heavy meal before bed. Skip all caffeinated beverages and alcohol close to bedtime. Keep your bedroom cool, quiet, and dark, and make it a place for sleep and sex only.

“Clearly, there is a lot more we need to understand about menopause and about RA, although we know a lot,” Dr. Utian says. As researchers continue to delve into the connections between these two medical conditions, keep in mind that you have the ability to take action and combat these symptoms.

Additional reporting by Beth W. Orenstein.