Can Menopause Cause Autoimmune Disease?
When it comes to autoimmunity, menopause is a wildcard. In some cases, the hormonal shifts that occur during menopause can improve autoimmune disease.
However, we find that most of the time, menopause makes autoimmune issues worse. Menopause can even trigger the development of an autoimmune condition in someone who previously didn’t have one. In these cases, menopause is the last straw that causes somebody to get diagnosed with an autoimmune condition in the first place.
The research supports what we’ve seen at the Caplan Health Institute. For example, science shows that menopause aggravates multiple sclerosis (MS) symptoms.
Other research says early menopause is a risk factor for rheumatoid arthritis (RA), and rheumatoid arthritis and menopause occurring together leads to greater damage and disability in RA patients.
Menopause influences inflammation and cytokines, inflammatory proteins produced in the body. With these changes to the immune system, it makes sense that menopause can make an autoimmune disease worse or make a woman more vulnerable to the development of autoimmune conditions.
The Cause of Menopausal Symptoms—It’s Not What You Think
Most people think menopausal symptoms are caused by a dramatic drop in estrogen. But that’s not the main problem. At least, not exactly. In reality, it’s actually poor adrenal function that is the culprit behind hot flashes, brain fog, night sweats, and other menopausal symptoms.
During and after menopause, your ovaries phase out producing estrogen and progesterone. That’s when the adrenal glands come to the rescue. They take over the function of the ovaries in that they manufacture some of your sex hormones like estrogen. Adrenals are triangular-shaped glands. One sits on top of each kidney. They produce hormones like estrogen, progesterone, and the stress hormone, cortisol. The adrenal glands help your body cope with stress. The adrenals play an important role in the hypothalamic-pituitary-adrenal (HPA) axis, which is your body’s stress response system. It also regulates your daily sleep and wake cycles.
If you want to know how to get rid of hot flashes, look to the adrenals. If you don’t have good working adrenals, you’ll likely have issues going through the menopausal transition. On the other hand, if your adrenals are working fine, you won’t have major issues during menopause. Your adrenals should pick up where your ovaries left off, in regards to producing estrogen and progesterone.
Adrenal Fatigue and Menopause
There are two types of issues that happen to the adrenals during chronic stress. The first is when the adrenals make too much cortisol. The second is when you develop adrenal fatigue or adrenal burnout, and have low cortisol. Adrenal fatigue and hot flashes often happen together, along with other menopausal symptoms. Autoimmune disease and adrenal fatigue also often go hand in hand.
We test adrenal function through salivary testing to find out if your adrenals are producing too much or too little cortisol as well as dehydroepiandrosterone (DHEA), another hormone made in the adrenal glands. Your body converts DHEA into estrogen and testosterone. If your DHEA levels are low, you might not be making enough of this hormone to fuel your estrogen production.
Estrogen Dominance
On the other end of the spectrum from too little estrogen is the concept of estrogen dominance, when your progesterone levels drop during menopause. Estrogen dominance causes an inflammatory response and is one of the root causes of autoimmune issues. In a healthy woman, estrogen and progesterone balance each other perfectly. However, estrogen dominance happens when your progesterone levels decline at a rate greater than estrogen, so you end up with a lot of estrogen in comparison to progesterone. Estrogen dominance can make autoimmune problems worse and activate the immune system.
So what triggers a drop in progesterone? One reason is the body’s use of progesterone to make the stress hormone cortisol. When you’re going through the change, your body may need to work harder. At this point, your cortisol levels are in high demand. If you are stressed and your body is busy making cortisol, then progesterone is getting used up in the process. Now you have a lack of progesterone to keep your estrogen levels in check.
Another cause of estrogen dominance symptoms is poor detoxification. If detox pathways aren’t working efficiently in your body, that means estrogen cannot be broken down and cleared out of the system. This causes estrogen to build up in the body along with estrogen metabolites. Both estrogen and its metabolites can be harmful in excess. Certain estrogen metabolites can cause even more problems than estrogen itself.
Other Factors That Can Impact Menopause Symptoms
Another factor that can throw your hormones off kilter during menopause, especially cortisol and estrogen, is unsteady blood sugar and insulin resistance. Insulin resistance is a condition that happens when your body starts ignoring insulin’s message to lower blood sugar. Your body has to make more and more insulin to “hear” the message it’s sending to lower blood sugar. During insulin resistance, your body becomes deaf to those messages that insulin is sending.
A lot of times, women going through menopause complain to us that they’re gaining weight and they can’t lose it no matter what they do. They start to eat less and work out more. But that can backfire. Why? Because it can cause blood sugar drops. If your adrenals are weak and not producing enough cortisol, going long periods without eating can put more stress on the body. Using a continuous glucose monitor is an easy way to monitor your blood sugar response to foods.
Another hormone that can be a troublemaker in women going through menopause is dihydrotestosterone (DHT). Women who ask us for help with issues like hair loss, skin changes, and acne often have high levels of DHT. Its levels can rise if your cortisol levels or insulin are imbalanced.
Menopause also can impact levels of the hormone DHEA. Remember, DHEA is made by the adrenals. The cortisol pathway and DHEA pathways are competing pathways that come from the hormone precursor pregnenolone (see diagram). The cortisol pathway is our body’s stress survival pathway, whereas the DHEA pathway is involved in sex hormone production.
During menopause and postmenopause, libido and reproduction becomes less important, so the cortisol pathway wins out most of the time. We want to calm that cortisol pathway so that there’s enough fuel to go around to supply the DHEA pathway. By fueling the DHEA pathway, the body can make more of the sex hormones that make you feel happy, energized, and interested in sex.
Reverse Engineering the Problem
The strategy? Finding out what imbalances are at play and where those imbalances are stemming from. That way we can reverse engineer the problem and get to the root cause of why the adrenals are not working right. A lot of root causes of autoimmune disease also harm the adrenals.
Root causes of autoimmune disease that affect the adrenal glands:
• Blood sugar problems
• Gut issues like digestive problems, leaky gut, or gut microbiome imbalances
• Nutrient deficiencies
All of these factors can trigger the immune system and create stress, which impact your autoimmune disease, your adrenals, and ultimately your menopausal symptoms.
Strategies for Supporting Your Adrenals
During menopause, you might not even need to take supplemental estrogen, progesterone, or DHEA. Reducing menopausal symptoms in patients with autoimmune disease may be as straightforward as checking adrenal function. We do this by ordering salivary testing and blood tests. If the results show that your adrenals are not working efficiently, you’ll want to use stress-coping techniques. You can never avoid stress completely, but you can give your body enough outlets for the stress. Here are some lifestyle approaches to reduce stress:
• Get enough moderate exercise, but don’t overexert your body.
• Prioritize sleep and rest. High cortisol levels can play a role in insomnia, so work with a functional medicine doctor to improve your sleep.
• Use mental-emotional stress management like mindfulness meditation and breathing exercises.
• Practice gratitude.
• Eat a nutrient-rich diet throughout the day to balance blood sugar.
Stress Relief Supplements
The two most important stress management supplements for adrenal support are magnesium and a blend of adaptogens. Most people benefit from additional magnesium, even if their blood levels are within normal ranges. Magnesium plays a role in the stress response and can calm you down and even help you sleep. Stress also can lower your magnesium levels, at a time when you need it the most.
Adaptogenic botanicals support your adrenal glands in times of stress and balance cortisol levels. One of the most common adaptogens is ashwagandha. Scientists have found it has anti-stress actions, in part through its beneficial effects on the adrenals. Other adaptogens include ginseng, rhodiola, holy basil, schisandra, and astragalus.
Hormone Balancing Is Complicated—Let Us Help
As you can tell from this article, balancing hormones during menopause is complicated. At the Caplan Health Institute, we can help you find out if adrenal fatigue and autoimmune disease is affecting your menopausal symptoms or even if you’re making too much cortisol. We’ll balance your hormones to ensure your menopause transition goes smoothly while uncovering the root cause of your autoimmune issues.
The first step? Schedule a free 15-minute discovery consultation, by phone or video. If you come on board as a practice member, we’ll order a salivary test to address adrenal function as well as other tests that determine which hormones need to be balanced. The result is your hot flashes will go away, you’ll think clearer, you’ll have a more comfortable night’s sleep, and you’ll say goodbye to your other menopausal symptoms like weight gain or hair loss. We’ll not only conquer your menopausal symptoms, we’ll get at the root cause of your autoimmune disease, too.
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