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Menopause and RA: What to Expect

Not all women with rheumatoid arthritis experience menopause the same way. But all women with RA should know about how menopause can affect their RA. Here’s an overview of how having RA may affect your body during menopause.

The Estrogen-RA Link

Researchers are not sure why, but hormones seem to play a pivotal role in RA. Nearly three times as many women get RA as men. Many women who have RA see their symptoms improve while they are pregnant. This may be because their estrogen levels go up during pregnancy.

When estrogen levels drop around the time of menopause, RA symptoms may worsen. In addition, some women first develop RA symptoms at around the time they start menopause.

You might think that taking estrogen would reduce RA symptoms along with the symptoms of menopause, but that doesn't seem to be the case. And because hormone replacement therapy (HRT) is linked with heart disease -- another increased risk for women with rheumatoid arthritis -- it is rarely recommended for treating menopause symptoms in women with RA.     

RA, Menopause, and Osteoporosis

Rheumatoid arthritis puts women at increased risk for osteoporosis. So does menopause. So women with RA should have their bone density levels checked and make sure they get enough calcium and vitamin D.

Your rheumatologist can calculate your risk of bone fracture over a 10-year period by measuring your bone density on a DEXA scan and then determine the best treatment or prevention plan for you. Your doctor may recommend that you take drugs called bisphosphonates to maintain bone density and strength.

Sex and Intimacy

Just having RA can sometimes make it tough to maintain a good sex life, and menopause can deliver a double whammy on your libido. Menopause can increase vaginal dryness, making intercourse painful. Many women with RA also have Sjögren’s syndrome, another autoimmune condition which attacks moisture-producing glands in the body. It can cause vaginal dryness and make sex painful. Talk to your doctor about lubricants that may help.

If you’re concerned about joint pain during sex, there are various strategies that can help. Some positions -- like lying side by side with your partner -- can take the stress off your hips or other affected joints. Planning intimacy for the times of day when you usually feel less pain can also help.

Menopause and pain can affect your desire, and your partner's libido may be affected by the fear of causing you pain. It can help if both of you talk together with a doctor or counselor.

Fatigue and Depression

Menopause can make the fatigue that comes with RA worse. If you aren’t getting enough sleep at night or you don’t think your RA treatment is working as well as it should be, talk to your doctor. Also talk to your doctor if you feel depressed. Many people with RA also have depression, and it can be common during menopause as well. Antidepressants and other treatments may improve menopause symptoms, pain, and your general quality of life.

How to Feel Better

Exercise is one activity that helps most women with RA feel better, especially menopausal women. Though it may seem hard to believe if you’ve got joint pain and fatigue, exercise actually gives you more energy and joint flexibility, helps reduce depression, and fights cardiovascular disease. It helps reduce menopause symptoms such as weight gain and insomnia. And weight-bearing exercise helps protect against osteoporosis.

Your doctor or a physical therapist can help you determine a safe exercise program for you. 

WebMD Medical Reference

Reviewed by David Zelman, MD on March 18, 2013

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