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How Do Sex Hormones Affect Arthritis?
If you are a premenopausal woman who has experienced some menstrual irregularities or PMS, or if you are a postmenopausal woman whose joint pain developed or worsened with the "change of life," there is a good chance that your estrogen or progesterone levels have been influencing your symptoms. Likewise, if you are a man who has experienced a decline in sex drive, muscle mass, or general energy, your testosterone may be low, and contributing to your joint pain. All of the sex hormones — estrogen, progesterone and testosterone — can affect the health of your joints and can encourage the development of various autoimmune diseases.
Arthritic conditions are more common in women than in men. In fact, this incidence increases steadily from the start of the menses up through menopause. You may have had a pregnancy in the past in which you noticed your arthritic symptoms improve. If so, you were experiencing first-hand the powerful influence of estrogen and progesterone (at their highest during pregnancy) on inflammation in the body.
Our immune systems are quite complex, consisting partly of compounds called "cytokines," which can either stimulate inflammation (important for driving out infectious organisms, e.g.) or keep the inflammation in check. These two sides need to stay in balance with each other so that we stay free of infections, yet also free of the pain and tissue damage that result from too much inflammation. The "inflammatory" side of immune response is believed to be critical in the development of bone and/or joint conditions. Estrogen and progesterone profoundly affect this balance. When levels of estrogen and progesterone are higher, as in pregnancy, hormone replacement therapy, or oral contraceptives, these "inflammatory" cytokines are suppressed and the "inhibitory" cytokines are enhanced, causing the symptoms of arthritis to diminish.
Testosterone is important for both men and women. In men, levels may decline over time, leading to symptoms such as low libido, low energy, less muscle and more fat, and even difficulty thinking. Like the other sex hormones, testosterone also appears to have a role in arthritis. Although uncommon in men under the age of 45, the incidence tends to increase in older men, approaching the incidence rate in women. Low levels of testosterone are seen in most men and appear to contribute to the bone loss that often goes along with the condition. Some studies have found that testosterone can reduce symptoms of arthritis.
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References:
- Elenkov IJ, Hoffman J, Wilder RL. Does differential neuroendocrine control of cytokine production govern the expression of autoimmune diseases in pregnancy and the postpartum period? Mol Med Today 1997 Sep;3(9):379-83.
- Felson, DT, Nevitt MC. The effects of estrogen on osteoarthritis. Curr Opin Rheumatol 1998 May;10(3):269-72.
- Lahita RG. The connective tissue diseases and the overall influence of gender. Int J Fertil Menopausal Stud 1996 Mar-Apr;41(2):156-65.
- Mateo L, et al. Sex hormone status and bone mineral density in men with rheumatoid arthritis. J Rheumatol 1995 Aug;22(8):1455-60.
- Van Vollenhoven RF, McGuire JL. Estrogen, progesterone, and testosterone: can they be used to treat autoimmune diseases? Cleve Clin J Med 1994 Jul-Aug;61(4):276-84.
- Wilder RL. Hormones, pregnancy, and autoimmune diseases. Ann N Y Acad Sci 1998 May 1;840:45-50.
- Wilder RL. Adrenal and gonadal steroid hormone deficiency in the pathogenesis of rheumatoid arthritis. J Rheumatol Suppl 1996 Mar;44:10-2.
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