The menopause

The menopause is the natural process when levels of the female hormone oestrogen gradually decline and periods eventually stop, so that a woman can no longer fall pregnant naturally.

The perimenopause refers to the time of life from when menopausal symptoms first begin until after periods have stopped. The menopausal years may last for around a decade, although everyone’s experience will be different. The average age is between 45-55 although this can also vary considerably. When a woman has gone for twelve months without having a period, she is considered post-menopausal.

Connective tissue disease and early menopause

Women with connective tissue disease will sometimes experience an early menopause, as well as early ovarian failure. There are various factors that can influence menopausal age, including:

  • Your age at the initial onset of autoimmune disease can be a factor, since women diagnosed at a younger age will sometimes start the menopause early.
  • Family history can influence menopausal age, since within the general population, women often follow a similar pattern to their mother.
  • There are certain treatments e.g., cyclophosphamide, that could also influence an early menopause.

Menopause symptoms

Most women will experience some symptoms during their menopausal journey, which can vary from mild to severe depending on the individual. Because some symptoms could also resemble certain features of autoimmune disease, it is important to tell your doctor if you have any concerns.

Common menopausal symptoms include:

  • Period changes
  • Hot flushes
  • Headaches
  • Night sweats
  • Vaginal dryness
  • Mood changes and anxiety
  • Joint pain and stiffness
  • Reduced muscle mass
  • Increased risk of developing osteoporosis

The role of hormones in scleroderma

Autoimmune diseases are far more common in women than in men. In fact, around 80% of patients with SSc are women. Female hormones are thought to be relevant, and there is a positive association between Raynaud’s and oestrogen. The initial onset of Raynaud’s often occurs around the time of the menarche, when periods start and oestrogen levels rise. Hormone changes are also significant; and attacks may be worse at mid-cycle when oestrogen levels peak.

Hormone replacement therapy

Hormone replacement therapy (HRT) is a treatment designed to help relieve the symptoms of the menopause. It works by replacing the hormones that naturally decline during the menopausal years. There are various types of HRT as well as different treatment plans, so it is important to be informed and to talk to your rheumatologist if you are considering whether it could be right for you.

For some women with autoimmune disease, HRT may be considered safe. However, SSc is a complex condition, so your doctor can provide tailored advice based on your individual situation.

The link between oestrogen and the immune system may be also relevant, and you may be advised to avoid treatment containing oestrogen, as this may make your symptoms worse. However, oestrogen-based creams and pessaries for use in the genital area are considered safe for women with SSc.

Vaginal dryness

Vaginal dryness is very common, affecting around 75% of all women at some time in their lives, although living with SSc or Sjogrens could be an aggravating factor. Whatever your age, always talk to your doctor about the best way to manage symptoms, as they will be able to help.

Read more about vaginal dryness and how to combat it here.

Boost your wellbeing

Whether or not you try HRT, taking some positive steps to preserve your health and wellbeing will be a vital part of self-management through the menopausal years and beyond. Because health and wellbeing are so closely linked, it is helpful to take a holistic view, especially with an underlying autoimmune condition. Enjoyment is key and always remember that it is never too late to try something new.

  • Exercise will help. It increases the production of feelgood endorphins and helps to reduce stress and relieve anxiety. Being active does not need to involve anything strenuous: taking the time to simply walk in a green space really can make a difference. All the evidence indicates that keeping as fit as possible helps to preserve bone health, muscle mass and general wellbeing in later life.
  • Diet is always important, although living with scleroderma may mean that some foods are difficult to tolerate, making healthy eating more challenging. If necessary, ask for a referral to a gastroenterologist or dietician. For more information, please click here.
  • Bone density becomes increasingly relevant as we get older. Taking vitamin D and calcium supplements and doing simple activities such as walking faster, climbing stairs, gardening or attending exercise classes can all help to preserve your bone health for longer. If you do have osteoporosis, remember to take the medications exactly as directed as this may affect how effectively they work. 
  • Muscle strength is also important because women can lose 10% of muscle bulk every decade, although gentle strength training exercises can help and may also reduce the risk of falling as you get older.
  • Mindfulness is about staying focused on the present moment: on your own thoughts and feelings and the world around you. This can improve mental wellbeing, by helping us to enjoy life more and understand ourselves better. For more information on mindfulness techniques, please click here.

Many women within our community have told us about the benefits of mutual support. You can call our free Helpline on 0800 311 2756 to talk to one of our volunteers. SRUK also runs a network of Support Groups designed to provide a friendly space to find friendship and support. For more information, please click here.