INTRODUCTION

Hormones are unique messengers that maintain and regulate numerous bodily functions. For the last several decades, more research has suggested the sex hormone estrogen, in particular, is believed to play a role in not only being a possible lupus trigger, but also with increasing lupus symptoms.  Interestingly enough, both men and women produce estrogen, although estrogen production is much greater in females.  And though lupus is not classified as a “women’s disease” a disproportionate amount of women have it.  This leads scientists to believe that estrogen somehow either regulates the severity of the disease or is a possible catalyst for developing the disease itself.  

In this blog, we will talk about not only estrogen, but other hormone connections, hormone therapy and the effects of hormones on both men and women’s health and disease activity.   

HIGH ESTROGEN LEVELS

When estrogen levels are high, for example: before menstruation and during pregnancy, many lupus patients express an increase in symptoms. Fatigue, pain, and cognitive dysfunction are some of the common complaints during these times of hormonal surge.  That is why there is believed to be a connection between hormones and the age of which most individuals are diagnosed with lupus – the childbearing years of 15 through 44.  

Recent data from the NCBI suggests that there is now evidence that hormonal fluctuations of B cells (B-lymphocyte, a subset of white cells associated with SLE) can have a huge impact on the disease.  This evidence suggests and explains the sex bias associated with lupus.  If a rise in estrogen levels promotes survival and maturation of the cells that are causing an increase of lupus disease activity, it is important to understand how to prepare yourself if you have times of high estrogen levels, or precursors to higher estrogen levels.  

What causes high levels of estrogen:

  • Pregnancy
  • Puberty or early puberty
  • Ovarian or testicular cancer
  • Klinefelter Syndrome

Now, you may be wondering, “Well, there is really nothing I can do to prevent some of the things listed above” and yes, on some level that may be true. But, there are some things that you can do to be provocative with your health to possibly aid in lowering your estrogen levels.  These include:

  • Eating organic and fiber-rich foods
  • Eating cruciferous vegetables like broccoli, bok choy, collard greens, and cauliflower.  
  • Eating foods that contain polyphenols.  These foods include: flax, chia and sesame seeds.  As well as,  whole grains like oats, barley and millet.  
  • Avoiding excessive alcohol
  • Avoiding unfermented soy products
  • Avoiding junk food, too much caffeine and too much dairy.   

HORMONES AND THE IMMUNE SYSTEM

Sex hormones have been known to play a role in not only SLE, but other autoimmune diseases like rheumatoid arthritis and multiple sclerosis as well.  Scientists believe that hormones can influence the immune system by acting on certain “target sites” such as the skeletal system, the central nervous system and the non-thymic lymphoid organs (like the lymph nodes and spleen).  From their studies, they have discovered that estrogen enhances autoimmunity, while androgens (male sex hormone) and progestins suppress the immune system.  

All this, leads scientists to conduct further research on the possibility of using hormone modulation of immune responses for the treatment of autoimmune diseases.  This is a promising notion for the future of both women and men with higher estrogen levels and lupus.  

MEN AND HORMONES

Above the disorder Klinefelter Syndrome is mentioned.  It is important to delve into this subject a little deeper when discussing men and hormone related issues regarding lupus.  When a man is diagnosed with Klinefelter Syndrome, it is due to the fact that he has lower levels of testosterone and higher levels of estrogen.  Traditionally, a man has a single X and single Y chromosome.  With KS, men have more than one X chromosome.  This can lead to symptoms such as sterility, having a high voice, and little facial hair.  Though the incidences of KS is rare, (affecting one in every 500 to 1,000 at birth), the sex hormone parallels between women and men with Klinefelter’s is an argument in favor of their being an increased susceptibility to lupus.   

Additionally, about two in 50 men with breast cancer, have Klinefelter’s.  Certain testicular cancer or Leydig cell tumors, are estrogen producing as well and sadly, this may lead to an increased risk to developing lupus in some cases as well.  

For an in depth analysis of lupus, men, and the hormone connection by Dr. Robert LaHita, click here.

HORMONE THERAPY

Because of the highly suspected hormone connection between women and SLE, females should be well informed about hormonal contraceptive use and hormone replacement therapy.  Some doctors are apprehensive to prescribe oral contraceptives to lupus patients due to the possible risk of triggering a lupus flare.  However, a recent study discovered that women who suffer from mild lupus, are generally safe taking it and if it is a lower estrogen dose.  Those individuals with an increased risk of blood clots, who have antiphospholipid syndrome, renal lupus, or those with severe lupus should have a serious conversation about what the best form of birth control or hormone therapy is most safe.   Progestin only oral contraceptives, Depo-Provera (a progestin that is injected through the muscle), and estrogen free Intrauterine Devices like Mirena, ParaGard and Skyla, are highly effective forms of birth control.  It is important to have an open and honest talk with your rheumatologist and OB GYN before starting any oral hormone therapy, so that you can optimize your well-being and find the right contractive for you.

Also, it has been noted that women who take fertility hormones have been reported to develop lupus as well.  Speaking with a fertility specialist about all your questions and concerns is not only appropriate, but highly beneficial before starting fertility treatments if you have lupus.

One out of five SLE women are postmenopausal, based on research by John Hopkins Arthritis Center and require hormonal replacement therapy.  Due to the fact that generally, disease activity is more mild during peri- and postmenopausal periods, hormonal replacement therapy can, in this case, be of benefit.  As with any treatment, the use of menopause hormonal therapy should coincide with treatment goals, and individual risks and benefits per person.

LUPUS AND PREGNANCY/POSTPARTUM

The rapid production of estrogen during a woman’s first trimester of pregnancy is associated with many symptoms: morning sickness, mental fuzziness and lightheadedness.  It can also cause for some, lupus symptoms.  Dr. Thomas, who wrote The Lupus Encyclopedia states that approximately 25% of women experience more disease activity due to the hormonal changes with pregnancy or soon after delivery.  Thankfully,  the sudden surge may also have the reverse effect on some patients and trick the body into thinking it is okay.  Some patients actually experience a quinessence after the first trimester.  

However, there has been data to suggest that lupus flares can appear soon after pregnancy or postpartum. This may be partly due to the sudden hormonal shift after birth.  Many doctors administer a “stress dose” of corticosteroids to offset any rise in symptoms.  The increased dose of steroids helps the body to cope with the additional physical stress your body experiences during labor.

For more information about lupus and pregnancy, click here.

CONCLUSION

We, at Molly’s Fund realize that this blog is merely scratching the surface regarding the influence of sex hormones on the immune system and lupus.   We are excited about future research on this connection, and will keep you abreast on any further studies.  

Sources:

https://lupusnewstoday.com/2016/01/21/the-immune-system-is-a-natural-target-for-estrogen-action-opposing-effects-of-estrogen-in-two-prototypical-autoimmune-diseases/
https://www.frontiersin.org/articles/10.3389/fimmu.2015.00635/full
https://www.ncbi.nlm.nih.gov/pubmed/10503654
https://www.ncbi.nlm.nih.gov/pubmed/16896282
https://www.livestrong.com/article/137679-causes-high-estrogen-levels/
https://www.ncbi.nlm.nih.gov/pubmed/18668569
https://www.wikihow.com/Lower-Estrogen-Levels
https://www.ncbi.nlm.nih.gov/pubmed/3907369
https://www.healthline.com/health/birth-control/mirena-paragard-skyla#introduction1
https://www.livestrong.com/article/137679-causes-high-estrogen-levels/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824898/
https://www.hopkinsarthritis.org/physician-corner/rheumatology-rounds/round-29-menopause-in-women-with-systemic-lupus-erythematosus-a-clinical-perspective/
The Lupus Encyclopedia, Donald E. Thomas, Jr. M.D. FACP, FACR, Johns Hopkins University Press,2014 p. 48,49

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Article by : Kelli Roseta

Kelli Roseta is the Client Services Coordinator for Molly’s Fund Fighting Lupus and facilitates the patient and caregiver support groups. She is also a 26-year lupus survivor. Connect with Kelli at [email protected].