RA diagnosis at 50: Is It linked to menopause?

Rose27

Hi everyone,

I’ve recently been diagnosed with rheumatoid arthritis (RA) with CRP 10, Anti-CCP 43, and RF 79. My doctor has recommended starting Methotrexate (15mg/week) early to slow progression, but I feel a bit anxious about beginning such a strong medication, especially one that might be for life.

My symptoms (stiffness and pain in hands, feet, elbows…) have worsened since I started experiencing menopause symptoms (I’m 50), and I’ve also noticed other changes in my body, as an ongoing rhinosisusitis . I’m wondering—could this be linked to menopause, and will things improve once those symptoms settle? Or is RA something I will have forever?

I would really appreciate hearing from others who have been through a similar process. How was your experience starting Methotrexate? Did anyone notice a connection between menopause and RA symptoms? My doctor explained everything well, but I’d love to hear from people who have lived through it.

Thanks so much for any advice!

Bryony

Menopause / perimenopause seems to be linked with quite a number of autoimmune conditions, either for exacerbating it or for first appearance, and also a range of other conditions. A bit similar to pregnancy in this respect. I don't have RA, so can't help you there, but did develop cervical dystonia ( a neurological condition of the neck muscles) as I was approaching menopause. I then had a hysterectomy a year or so after - big fibroids - and was offered HRT, which I did take up. I insisted on having bio-identical oestrogen (gel) and progesterone (tablets), and, what I didn't expect, my cervical dystonia was significantly improved after I started it, and has remained so. That is a condition that does seem to be connected in some way to hormonal change in women.

That was a few years ago when doctors were still rather reluctant to prescribe HRT, and knew little about bio-identical, though they were available on the NHS. I had to over-exaggerate the hot flushes side of my symptoms, as that was the only thing then that they would prescribe HRT for, and ignored other symptoms. Things are probably better these days, there is better understanding of HRT risks and benefits, and more options, but it all comes down to individual GPs, some of whom are still very dismissive of menopause symptoms and HRT.

There is a recent paper (2023) from Australia where they found women with RA were more likely to achieve remission if they are on HRT or oral contraceptives.

Rose27

@Bryony thank you very much for your kind and comprehensive email. It’s very helpful listening to people like you and your experiences with disease. I’m glad that your cervical dystonia improved with HRT. I’m exploring at the moment the HRT pros/cons but as you said there’re different and even conflicting opinions from clinicians. Definitely I’m looking at bio-identical options. Thank you for the paper you mention, I’ll have a look. All the best !

Hermione

Hi Rose27
My RA started at exactly the same time as the menopause and it was almost impossible to separate out which symptoms were due to which. I had severe pain, stiffness, sleeplessness, hot flushes, low mood, etc. I started methotrexate 20mg weekly, with folic acid 5mg once a week, as well as hydroxychloroquine 200mg five days a week. I also had one steroid injection to bridge the gap while the MTX and HCQ took effect, which can take several months. This seems to be the standard recommended combined treatment. All this had a very positive effect, although it took a while to work, and a few years later I am in remission with hardly any flare-ups of RA and deeply grateful. In fact I feel a bit of a fraud to say that I “have RA” when I have hardly any symptoms. I did go on to develop other conditions such as osteoarthritis, osteoporosis and Sjögren’s Disease though. I’m still on MTX 7.5mg weekly but have come off the HCQ. I believe the recommendation is usually to stay on MTX even in remission, because studies have shown that about half the people in remission who stop MTX find it flares up again, but this is of course negotiable and I must say taking MTX really doesn’t bother me at all now. In fact, taking even a low dose of immunosuppressant medication has a side benefit (which some might think counter-productive!) that you are then eligible for a number of vaccinations including pneumovax, Covid, etc, even if you are not otherwise in the age bracket to get them normally. If MTX does not work for you there are many other alternatives, but it might take a while to see what works and what doesn’t, so don’t expect instant results. MTX initially made me feel very nauseous and I lost quite a bit of weight (actually no bad thing as I was getting a bit of middle-aged spread!) as I didn’t feel like eating. I persevered though and came through the initial discomfort.

The thing about RA is that the earlier you start treatment, the better the outcome, and that is proven by many studies. I would not be frightened by the prospect of taking a medication “for life” – after all, taking no treatment could have a disastrous effect. I had a relative about 30 years older who obviously had no access to modern treatments when it started for her, and she was very severely disabled by her RA and in great pain for years. See whether there is any improvement in 3-6 months. If not, they may suggest an alternative treatment.

I recently took part in a research study for the University of Cambridge which looked at the combination of menopause and onset of autoimmune disease, and the researcher said that many, many people said it happened at the same time, so there is clearly a connection somehow. Whether this is to do with hormonal changes or just coincidence that these two things just happen to us at the same stage of life, I don’t know. I didn’t take HRT because I think I was concentrating so much on the RA, and the hot flushes were bothersome but not as bad as the RA pain. However, this might be something you could discuss with your doctor.

Rosiebella

I developed RA 2 years ago and it was the same time the menopause started and having the two is a complete nightmare!!