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How the Stages of Menopause Can Affect Your Psoriasis

By Claire Gillespie
Reviewed by Allison Truong, M.D.
November 21, 2022

Menopause is a completely normal part of life—it’s when a woman stops having periods and can no longer get pregnant naturally. For most women, menopause happens during their 40s or 50s, and it’s preceded by a stage known as perimenopause, which usually lasts for about four years.

During perimenopause, women may experience hot flashes, sleep disruptions, and mood changes. But that’s not all. If you have psoriasis, you may also find that your psoriatic symptoms worsen before or during menopause. Why? And what can you do about it?

The Connection Between Psoriasis and Menopause

In one study, published in Cutis, almost half of the women studied reported their psoriasis flared after menopause. Only 2 percent said their symptoms improved.

Scientists still don’t know exactly how psoriasis and menopause may be connected, but research suggests that it’s the hormone changes of menopause that impact psoriasis flares.

During perimenopause, a woman’s ovaries make less of the hormone estrogen, explains London doctor and dermatology registrar Cristina Psomadakis.

“We think it is due to estrogen’s ability to influence the body’s immune response, down-regulating the production of T-cells and certain chemokines, and enhancing anti-inflammatory effects,” she says. The fact that estrogen levels drop markedly during menopause and that some women see an increase in psoriasis symptoms during menopause supports the hypothesis that psoriasis can be affected by fluctuating sex hormones, she says.

By comparison, the majority of pregnant women with psoriasis notice an improvement in their psoriatic symptoms during pregnancy—another time of life that’s characterized by significant rises in both estrogen and progesterone levels. Women with psoriasis sometimes report psoriasis flares immediately post-delivery, when hormone levels drop sharply.

“When women are pregnant and estrogen levels are high, we tend to see an improvement clinically in some patients’ psoriasis,” says board-certified dermatologist Janiene Luke, M.D., F.A.A.D., a member of the Skin of Color Society Board of Directors. “The evidence in the literature tells us that female hormones—estrogen, in particular—can affect the severity of psoriasis in some patients.”

Can Psoriatic Disease Cause Early Menopause?

Most women experience menopause between ages 40 and 58, with the average age being 51, says The North American Menopause Society. According to the Mayo Clinic, about 1 percent of women experience menopause before age 40, which is known as premature menopause. This may happen when the ovaries stop producing typical levels of reproductive hormones, which may stem from genetic factors, autoimmune disease, or, in many cases, may have no known cause. There are other causes of early menopause, too, for example, when a surgeon has to remove the ovaries for a medical reason.

There’s still not enough research to say definitively whether psoriatic disease can cause early menopause, but one study of more than 1.7 million women of reproductive age, published in Fertility and Sterility, found that participants with chronic inflammatory diseases—including psoriasis—were up to five times more likely to experience menopause before the age of 45 or premature ovarian failure before the age of 40.

If you have any personal concerns about early menopause, it’s worth discussing with your OBGYN.

Psoriatic Arthritis and Menopause

Up to 30 percent of people with psoriasis develop psoriatic arthritis, a type of inflammatory arthritis that causes stiff and painful joints. So anyone with psoriasis should be on the lookout for signs of psoriatic arthritis.

Thing is, symptoms of menopause, such as trouble sleeping or mood changes, may overlap with psoriatic arthritis, since joint pain and discomfort can lead to trouble sleeping or mood changes. So it may be hard to know what’s causing them.

Also know that reduced estrogen levels during menopause increase your chances of developing osteoporosis, a disease that causes weak, brittle bones. Chronic inflammation in psoriatic arthritis may also increase the risk of osteoporosis; a review of 21 studies published in Seminars in Arthritis and Rheumatism found that low bone-mineral density was a major issue for people with psoriatic arthritis in more than half the research. Another report, published in Annals of the Rheumatic Diseases, found that people with psoriatic arthritis and psoriasis had an increased risk of bone fractures. In 2016, a study from Photodermatology, Photoimmunology, and Photomedicine showed that women who had both psoriasis and osteoporosis tended to have low blood vitamin D levels and high levels of inflammation.

Cardiovascular Disease and Psoriasis

Psoriasis and menopause both raise the risk of cardiovascular disease. And so you may wonder if having both those risk factors puts you at even higher risk. A study from the Journal of The European Academy of Dermatology and Venereology explored this question and found that rates of psoriasis and cardiovascular disease in women did increase with age, but there was no evidence that menopause increases the risk of psoriasis.

Treating Psoriatic Disease During Menopause

Going through menopause adds another dimension to your psoriasis treatment plan, so it’s important to keep a close eye on your symptoms and stress levels and stick to a healthy diet and sleep habits. Also, keep your healthcare provider in the loop. Your doctor might suggest tweaking your prescribed treatments, taking supplements like calcium and vitamin D, or making lifestyle modifications, like adding resistance training and weight-bearing exercises to your exercise regimen. Staying physically active may bring relief from psoriatic arthritis symptoms and also potentially reduce your likelihood of developing osteoporosis during menopause.

Some women are prescribed hormone therapy to deal with symptoms of menopause, like hot flashes and mood changes. But there’s very little research on using hormone therapy to treat psoriatic arthritis symptoms, and more studies are needed to determine whether it could be helpful or harmful.

“We’re currently trying to better understand the role of sex hormones in the inflammatory and immune pathways responsible for psoriasis,” says Luke. “We need more research in this area to better delineate the complex interplay between hormone levels and how their fluctuations throughout a woman’s life can influence various skin conditions, such as psoriasis.”

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