illustration of using a menstrual cycle monitoring app

How Your Menstrual Cycle Affects Psoriasis—and What to Do About It

By Claire Gillespie
February 25, 2021

Stomach cramps, mood swings, fatigue…getting your period can be bad enough without having a psoriasis flare-up, as well. But it’s common to have a resurgence of psoriasis around the time of menstruation—and it all comes down to hormones.

When you menstruate, your hormone levels fluctuate, and that can cause psoriasis to flare up, says Debra Jaliman, M.D., a board-certified dermatologist in New York City. Here’s how doctors explain the connection between the menstrual cycle and psoriasis flare-ups.

Chalk It Up to Hormones

“While not much research has been done on this, some research has been done on women who are pregnant,” says Jaliman. The pregnancy research helps to shed some light on why psoriatic symptoms sometimes worsen during menstruation. An article published in the British Medical Journal in 2007, based on analysis of studies, national health information and databases, and experiences of practicing dermatologists, estimated that up to 60 percent of women see an improvement in their psoriasis during pregnancy. The authors attributed this to high levels of the hormone progesterone, which “downregulates the T-cell proliferative response.” In other words, progesterone dampens the body’s immune response, which “misfires” in someone with psoriasis and causes inflammation and the overproduction of skin cells.

However, more recent studies support another hormone—estrogen—as the main driving force behind an improvement in psoriatic symptoms, says London doctor and dermatology registrar Cristina Psomadakis. “We think it is due to estrogen’s ability to influence the body’s immune response, downregulating the production of T-cells and certain chemokines, and enhancing anti-inflammatory effects,” she explains.

Estrogen levels drop markedly during menopause, Psomadakis points out. In one study, published in Cutis in 1998, almost half of the women studied reported their psoriasis flared up after menopause. Only 2 percent said their symptoms improved.

This helps explain why it’s so common to get flare-ups during your period. Estrogen and progesterone levels peak in the days before menstruation, explains Psomadakis. And that’s when psoriasis tends to improve. During menstruation, those hormone levels drop, which may explain a flare-up.

“Undoubtedly, there is a link between hormonal changes and psoriasis,” Psomadakis says.

It’s Not Always Simple

So, where does that leave you if your experience is different, and you get a worsening in your skin right before your period or during pregnancy?

“Psoriasis is a complicated multifactorial disease, in which sex hormones play only a small part and are not the causative factor,” Psomadakis says, adding that some people see psoriasis improve during pregnancy, but a substantial amount see it worsen. The relationship is definitely complex and not fully understood.

We may not have the same level of solid scientific data to rely on when it comes to psoriasis and menstruation, but it’s reasonable to arrive at the same conclusion: Some people see an improvement in their psoriasis during their period, while others experience a flare-up of their symptoms.

Take Steps to Reduce Symptoms

Although not much can be done to combat changes in hormone levels during menstruation, you can take steps to help lessen the symptoms and severity of a flare-up, says Jaliman. She recommends getting the basics right before anything else: “Eat a balanced, healthy diet and moisturize religiously.”

You can take control of the situation by establishing your personal relationship between psoriasis and menstruation, says Psomadakis. She suggests keeping a journal or log of your menstrual cycle days—there are plenty of apps designed for that. Note when you’re flaring up, too, to see if a consistent pattern emerges. “If it does, then use this to your advantage and be proactive about anticipating a flare-up,” she says. “Make sure you are dedicated to your skincare leading up to those key dates, and have active treatment on hand for the times you know you’re likely to need it.”

Psomadakis points out that there have been reports of psoriasis and psoriatic arthritis improving in those taking the oral contraceptive pill, but stresses that no type of sex-hormone regulation is recommended as a treatment option for psoriasis.

The bottom line? Pay attention to what’s going on with your skin, don’t take your foot off the gas when it comes to your treatment plan, and accept that, for many, a psoriasis flare-up goes hand-in-hand with those stomach cramps and mood swings.

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