Inflammation

Lessons from lupus — what an inflammatory disease can teach us about menopause (and vice versa!)

by Dixie Mills, MD, FACS

• Lupus, menopause, and hormonal balance
• Lupus flares and symptoms of menopause — how are they related?
• Managing lupus flares and inflammation naturally
• What all of us can learn from women with lupus

I’m always amazed at how some women breeze right through menopause barely feeling any physical or emotional changes, while so many others have a more difficult journey. And I’ve learned that support and treatment for menopausal symptoms can come from truly unexpected places. For instance, I was surprised to discover how much severe menopausal symptoms have in common with the autoimmune disease known as lupus — and how we can use similar techniques to soothe those symptoms.

It actually makes a great deal of sense when you think about it. At its heart, lupus is an inflammatory disease — it’s like California during wildfire season, where many small brushfires are always burning and any one of them can flare into an all-out inferno. A patient of mine with lupus once told me that if inflammation were a business, she would be the CEO in charge, which is funny because I’ve heard that from women with prolonged symptoms of menopause, too! It’s also striking just how many symptoms of lupus are similar to those in menopause (see the box). Perhaps this is because estrogen and overall hormonal balance seem to be such key players in the pathogenesis (or development) of lupus, just as they can contribute to menopausal symptoms.

It’s important to be very clear: while there are similarities between lupus and menopause, a woman’s menopause is not a disease — far from it! Yet both lupus and menopause symptoms primarily (or exclusively) affect women, and both are often misdiagnosed (or dismissed). And there’s a great deal of helpful information to share, since many of the best strategies for reducing inflammation and balancing hormones can help reduce symptoms in either case. While lupus symptoms can manifest in many different ways, options for relief will vary as well. But women with lupus are truly some of the wisest — and most inspiring! — among us when it comes to restoring the body’s natural state. Understanding the inflammatory side of lupus a bit better can help us grasp the idea that inflammation during menopause can cause a cascade of symptoms, and appreciate how a natural approach to restoring the body’s cooler, more balanced state (like pouring cold water right onto hot flames) can help us find relief.

So let’s talk about what we can all learn from women with lupus about inflammation in order to help shed light on what’s going on in menopause.

Lupus, menopause, and hormonal balance

The overlap between lupus symptoms and menopause-related symptoms is striking, but those of lupus are more widespread, with more variables. You’ll notice, however, that many of the inflammatory symptoms of lupus and menopause coincide.

One major commonality for lupus patients is its connection with our sex hormones, and the ways in which our bodies metabolize them. These associations are still unclear and subject to intensive study. (Read our page on the debate around hormones and lupus.) But since most lupus patients are women (only about 10% of lupus patients are men) and since symptoms often flare before menstrual periods and during pregnancy, it’s clear that fluctuating hormones play an important role in the disease’s expression. If you are going through menopause right now and this sounds familiar, it’s because perimenopausal women are in the business of managing fluctuations in these very same hormones: estrogen, progesterone, DHEA, and testosterone. And when these hormones are imbalanced in women with lupus — just as with women in perimenopause, particularly when there’s an excess of estrogen in relation to the others — it can throw the whole system off and activate unpleasant symptoms.

And for women with lupus, excess estrogen is pretty common. In the 1980’s, researchers found that women with lupus actually are “super women” — for much of their lives they have higher-than-regular amounts of estrogen on board. While the role of estrogen in lupus is not crystal clear, we know that increased levels of certain forms of estrogen are associated with inflammation, estrogen dominance, and degenerative disease in lupus patients. Excess estradiol, for example, seems to increase activity and life-span of certain of our immune cells, which may promote the autoimmune assault that characterizes lupus. It’s also possible that certain reactive estrogen metabolites are left behind on the normal hormone detoxification pathways, where they can perturb the immune system, fuel inflammation, and damage body tissues.

But women with lupus — or anyone with estrogen dominance or elevated levels of these troublesome reactive estrogen metabolites — can take measures to change these pathways. And this is the truly wonderful news: research is beginning to show that with diet and lifestyle changes, women can better detoxify these estrogen metabolites, rebalance their hormone ratios, and quell lupus flare-ups in a similar way to balancing symptoms of menopause.

Lupus flares and symptoms of menopause — how are they related?

As in menopause, not everyone with lupus has the same symptoms, nor is the same set of problems occurring in everyone. That’s why the wildfire analogy seems so apt when talking about lupus: if the firefighters battling widespread wildfires used only the standard hook-and-ladder trucks, there’s no way they could contain the flames. They also need tanker planes, bulldozers, and trenches to isolate and extinguish a wildfire! It takes many different tactics to quell a blaze of that magnitude — and the same is true when our bodies are chronically inflamed, whether we’re talking about menopause symptoms, lupus, or any other kind of system-wide inflammation.

For a woman with lupus, we have to “bring everything to the table” to solve the puzzle of her unique condition and find an appropriate course of treatment. Could there be hormonal, detox, gastrointestinal, or adrenal imbalances at play — or is it a compilation of all those things? What emotional concerns and resources does a woman with lupus have that impact her course of treatment and recovery? At Women to Women, the same philosophy is applied when treating symptoms of menopause. Achieving hormonal balance and restoring wellness doesn’t just happen the same way for everyone, and there is no one-size-fits all medicine that can do the job for us. (I’m still waiting for someone to make the Magical Menopause Miracle Pill.)

That’s not to say I think women with lupus shouldn’t take their meds or trust the treatments they’ve been prescribed — not at all! The medications your practitioner offers you are part of your lupus toolkit. But taking an integrative approach is really the best strategy we have for managing symptoms caused by chronic inflammation. Like menopause, symptoms of lupus differ with everyone’s individual makeup, and the underlying causes may also differ from person to person. Symptoms of lupus can “flare up” and also “cool down,” and can also range from very mild to severe. Finally, symptoms can also “just suddenly appear.” And all of these patterns are very much like those in menopause.

Most research shows that women with lupus may see mild improvement in their symptoms in the few years leading up to and following menopause, after which there is (generally, at least) a modest decline in symptom activity. Some researchers attribute this general improvement at perimenopause to a natural decrease in estrogen, while others believe it is not due to the change in menopausal status, but just due to the natural aging process. And this points to one major difference that distinguishes lupus and menopause: our age. Symptoms of lupus typically present in younger women, ages 15 through 45. Though it can present in menopause, this is the exception. This is why women with lupus are genuine authorities on hormonal balance and cooling their inflammation: they have often been managing these symptoms for a great deal longer than women who are in menopause.

Managing lupus flares and inflammation naturally

It’s pretty common for conventional practitioners to offer antidepressants for women’s menopause symptoms, but I don’t agree with this approach — medicating depression that doesn’t actually exist isn’t going to resolve the underlying causes of women’s symptoms. The same is not true of lupus, though — I’m not going to advocate that a woman should refuse her lupus medications! But even with these medications, there are natural ways to support your body so you experience fewer symptoms (and need less medication). Whether the symptoms come from lupus or from menopause, relief can be gained by working toward hormonal balance and reducing inflammation overall. We tell women to consider all of the following recommendations when they want to eliminate symptoms of systemic inflammation — and while you can begin many of these practices on your own, we also encourage women with lupus to have a trusted healthcare provider oversee their care, someone they can turn to for guidance when necessary.

Nutritional treatment. We often say that a good nutritional foundation is so important for restoring health, and that’s true in lupus too. These measures can help quiet inflammation and the autoimmune response in lupus.

• Examine your gut — literally! Cooling inflammation often begins in a place you might not suspect: the bread box. So many foods are packed with gluten, a common but underrecognized food allergen. You can read our article on gluten intolerance, then try a gluten-free diet to see how you feel. Or you can speak with your healthcare practitioner about ALCAT testing, to check your overall food sensitivities. If you are experiencing persistent digestive discomfort as part of your inflammatory symptoms, you can ask for a comprehensive digestive stool analysis, or CDSA/CPx2.
• Optimize your vitamin D levels. I’m thrilled by the growing scientific research connecting vitamin D with healthy immunity, and the link being made between low levels and lupus. If you experience flare-ups with sun exposure, limit your skin exposure to a few minutes early or late in the day to help replete your levels. If this is still problematic, then do avoid the sun — but either way, it’s wise to test your vitamin D levels and to take a vitamin D3 supplement daily. It’s so easy to prevent vitamin D deficiency and its far-reaching negative effects on your immunity and bones.
• Have your homocysteine levels tested regularly. High homocysteine levels, which are a risk factor for blood clots and hardening of the arteries, are found in about a third of patients with lupus (SLE). The great news is that for most people, the effects of elevated homocysteine are easy to reverse by supplementing with folic acid (vitamin B9).
• Eat plenty of omega-3’s. Stacks of research support the cooling effects of omega-3’s in our bodies. (We’ve written several articles about this in our nutrition section!) You can up your intake by eating wild Pacific salmon and other fatty fish with high omega-3 levels, and by supplementing with high-grade EPA/DHA capsules.
• Eat more foods from the Brassica genus. This includes crops like broccoli, cauliflower, cabbage, bok choy, Brussels sprouts (or any tasty leafy greens that you enjoy), to promote healthy detoxification of estrogens in the liver. You can also talk with your practitioner about taking DIM, a natural phytonutrient that promotes healthy estrogen metabolism.
• Do some nutritional research on your own. There are many other dietary and supplement changes you can make to reduce inflammation and support immune system functioning. To get started, see the range of choices outlined in our article on reducing inflammation with the natural approach.

Emotional support. While making key nutritional changes to reduce inflammation, whether for symptoms of lupus or menopause, you can also make time to talk with your family, to help them understand that your symptoms are real — even if they’re thinking “She doesn’t look sick!”

Women know that we are not just “chronic complainers.” Actually, the opposite is true for many women, who think that if they show the true extent of their discomfort they will be seen as weaklings! But learning to ask for (and receive) emotional support from your friends and family as you work to reduce inflammation and restore balance to your body does absolute wonders for the healing process.

Any physical symptoms or illnesses, whether from lupus or menopause or some other source, provide an opportunity for us to examine our emotional lives. In other words, if your heart feels besieged by your mind, your physical body can react in the same way. There is abundant research demonstrating the effects of long-term stress on our immune systems, and if we can learn to quiet the stress-related immune response within ourselves we’ll experience fewer flare-ups and greater emotional peace.

There are many ways to give yourself the emotional support you need to restore hormonal balance:

• Be honest with your friends and family. Let everyone know that the daily fatigue and exhaustion you might feel is not an excuse — your desire to slow down isn’t to get out of daily tasks, but rather to give yourself the time and energy to live your life as fully and healthily as possible.
• Heal emotional wounds. Take some time to think about the connections that you’ve had with family and friends at all stages of your life, especially those formed in childhood. So many of us carry deep feelings about our past relationships, and making the time to heal may mean reconciling a deep wound from long ago. If you would like a bit more guidance for how to achieve this step, you can visit our article on emotional healing.
• Lower your stress levels. As I said above, there is ample data showing how worry, stress, and negative emotions can aggravate our physical symptoms. But research also indicates that women with lupus have an altered HPA axis (the hypothalamus/pituitary/adrenal circuit in our bodies) — the primary mechanism for relaying internal stress messages in their bodies. It has also been found that the hormones of stress (primarily epinephrine, also known as adrenaline) enable lupus antibodies to alter behavior, and can damage cognition. This is clear evidence showing how closely our bodies and minds are connected — much more so than many previously believed. And because of the relationship between stress and adrenal status, it might be a good idea for a woman to consider having an Adrenal Stress Index in order to evaluate how her body is physically responding to stress.
• Exercise. Aim to maintain muscle strength and flexibility — be sure to go at your own pace, and keep your exercise as balanced as your diet, your emotions, and any other treatment aspect. This doesn’t mean necessarily a dreaded return to the treadmill or the gym — you can begin slowly with yoga, massage, qi gong, or gentle walks. These and other forms of meditative body movements can help with fatigue, blood flow, inflammation, balance, and overall emotional well-being — more proof of the mind-body link.

What all of us can learn from women with lupus

In our view, the “wise woman” status we achieve in menopause carries even greater weight with a woman who has been diagnosed with lupus. Women with lupus spend a lifetime practicing ways to give their bodies the balance they need to create symptom-free, energetic lives. Their dedication and success in achieving physical and emotional harmony is inspiring to all of us, and we have a great deal to learn from them.

But women don’t need to have lupus to experience the erosive effects of inflammation on the body. If you have a great deal of worry or stress in your life, juggling the many roles women fill each day at work and at home, the emotional cost of your daily demands can play out physically as menopause symptoms. Our bodies were built to heal themselves, but at times they overwork, and become like a fire that is never fully contained. Chronic inflammation is just that — a well-intentioned immune response that becomes a slow-smoldering fire with intermittent eruptions. The great news is that with all of the treatments options available, hope for reducing inflammation and restoring balance to our lives is not only possible, but within your reach today. And it’s nice to know that whether you have lupus, or are in perimenopause, or even both at the same time, you can make choices to help put out the fire.

Our Personal Program is a great place to start

The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.

• To learn more about the Program, go to How the Personal Program works.
• To select the Program that's right for your symptoms, go to Choose the plan that works for you.
• To assess your symptoms, take our on-line Hormonal Health Profile.
• If you're ready to get started, learn about our risk-free trial.

If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.

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Related to this article:

References & further reading on lessons from lupus and menopause

 

Original Publication Date: 09/21/2009
Last Modified: 09/29/2009
Principal Author: Dixie Mills, MD, FACS