How can menopause both ease and worsen autoimmune conditions in women?

It’s one of the most surprising questions many women ask their doctors as they approach midlife: Does menopause bring any relief from autoimmune diseases like lupus, rheumatoid arthritis, or multiple sclerosis?

The rather complicated answer, according to medical experts, is both yes—and no.

As Dr. Rohit Jacob, Specialist in Internal Medicine at Aster Clinic, Business Bay explains, women undergo sweeping hormonal transitions throughout their lifespan. And one of these transitions, is menopause, which marks the end of monthly menstruation, typically occurring around the age of 51. During this time, there are significant hormonal changes, most notably, a decline in estrogen and progesterone.

Moreover, these hormonal shifts don’t just impact reproductive health, they play a major role in how the immune system behaves, which is why autoimmune conditions often intersect with menopause in rather nuanced ways.

What really happens in an autoimmune disease?

These kind of diseases occur when the immune system mistakenly attacks the body’s healthy cells. The result: Chronic conditions that range from skin issues to joint pain, nerve damage, and even organ dysfunction. “Autoimmune diseases arise when the immune system targets healthy cells in the body, leading to chronic conditions like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), multiple sclerosis (MS), type 1 diabetes, psoriasis, and more,” says Dr. Jacob.

And here’s the kicker: Nearly 80 per cent  of people affected by autoimmune diseases are women, a statistic often tied to hormones. “The fluctuations in hormones like estrogen, progesterone, androgens, leptin, oxytocin, and prolactin during menopause—along with the immune system’s internal responses—together maintain a critical balance in women’s health and autoimmunity.”

Given this complex interplay, a natural question arises: Do women experience relief from autoimmune disease during menopause?

The short answer: It depends. While some autoimmune conditions may ease slightly during menopause, others can worsen—and the reason lies deep within the body’s shifting hormonal and immune landscape, as Dr. Krithi Raju of Medcare Orthopaedics & Spine Hospital explains.

Menopause doesn’t just bring mood swings, hot flashes, or concerns about bone health—it also triggers profound changes in the immune system. At the heart of this shift is estrogen, a hormone that does far more than regulate menstruation. Estrogen plays a critical role in modulating immune function, influencing the behavior of key immune cells like T-cells and B-cells, and regulating cytokines—the signaling proteins that control immune responses.

When estrogen levels drop, as they do during menopause, this immune regulation can falter. Moreover, recent research titled The Impact of Menopause on Autoimmune and Rheumatic Diseases also shows: Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)—two autoimmune diseases where menopause has very different effects. In RA, symptoms often get worse, while in SLE, flares may become less frequent. However, we still know very little about how menopause affects other types of inflammatory arthritis and connective tissue diseases, which is a big gap in current research.

One of the most significant immune changes during menopause is an increase in pro-inflammatory cytokines, such as TNF-α and IL-6. Normally released in response to infection or stress, these molecules can become overactive in menopausal women—even when there’s no real threat.

This hyper-inflammatory state may:

However, some women may find partial relief from specific autoimmune conditions—especially Systemic Lupus Erythematosus (SLE). “SLE tends to be more prevalent in women,” says Dr. Jacob.  “With declining estrogen levels during menopause, many women experience fewer lupus flares. However, the damage from earlier episodes can still accumulate over time.”

So while menopause may reduce the frequency of flare-ups in some cases, it doesn’t reverse the damage already done. Chronic fatigue, joint pain, and organ complications often persist.

Other diseases, however, tend to intensify. “Conditions like rheumatoid arthritis and psoriasis often become more progressive after menopause, with increased joint destruction, skin flare-ups, and physical disability,” says Dr. Jacob.

This worsening is often tied to the loss of estrogen’s anti-inflammatory effects, and the resulting rise in inflammatory activity.

Despite the challenges, there are proven, practical ways to reduce flare-ups and strengthen immunity during menopause. Dr. Jacob recommends a four-part strategy:

Eat a balanced diet

A nutrient-rich diet can help regulate inflammation and strengthen immune defences.

Get moving

 Engage in 30–45 minutes of aerobic activity daily—whether it’s walking, jogging, cycling, or swimming. Regular exercise boosts immune function and reduces flare-ups.”

Prioritise sleep

Manage stress

Activities like yoga, can help lower cortisol levels, improve circulation, and reduce the risk of immune flare-ups.