The influence of endogenous and exogenous sex hormones on systemic lupus erythematosus in pre- and postmenopausal women

Abstract

Systemic lupus erythematosus (SLE or lupus) is a chronic inflammatory disease that occurs mainly in women. Typically, symptoms appear within the first few years of adolescence, but currently an increase can be observed in the percentage of postmenopausal women with this condition. This is possibly due to the sophisticated treatment of the disease, which significantly improves the survival curve and prognosis. Genetic and environmental factors are involved in the development of SLE. Both regulation of the immune system and the activity of this disease are influenced by a variety of hormones, including: 17β-estradiol, testosterone, prolactin, progesterone and dehydroepiandrosterone (DHEA). Early menarche, menstrual cyclicity, the total number of years characterized by ovulatory cycles and early menopause are correlated with the development of SLE.Because of the health risks, attempts are increasingly being made to evaluate the impact of exogenous hormones (especially those applied exogenously) on the course of SLE. In particular, the role of estrogens is being highlighted, either endo- or exogenous, including oral contraceptives (OC), therapy used in the treatment of infertility, and hormonal replacement therapy (HRT). The purpose of this manuscript is the revision of the literature concerning the impact of both endo- and exogenous estrogens on the development of lupus, inducement of flares and any possible complications.

Clinical implications of systemic lupus erythematosus without and with antiphospholipid syndrome in peri- and postmenopausal age

“…A prompt initiation should be considered for an increased benefit for bone protection in cases where menopausal symptoms necessitate HRT. The benefit of HRT was observed predominantly in vasomotor symptoms (hot flashes, sweating at night) and not in other menopausal symptoms [ 6 , 27 ]. The shortest possible duration of treatment in patients with APS-related SLE should be recommended [ 28 ].…”

Developing a Continuous Quality Improvement Assessment Using a Patient-Centered Approach in Optimizing Systemic Lupus Erythematosus Disease Control

“…Based on the demographics of the data analysis, there were only self-reported females who completed the survey. It is well known that autoimmune diseases are much more frequent in women, in which female hormones may interact with the immune response and play a role in its pathogenesis [ 20 ]. The greatest population of respondents resided in the United Kingdom, and most patients reported their ethnicity as Caucasian.…”

Antinuclear antibodies in autoimmune and allergic diseases

“…Moreover, during normal pregnancy there is an extensive exposure to nuclear antigens and inflammatory activity escalates, which is related to elevated ANA titres [ 23 ]. Interestingly, administration of oestrogen in the form of oral contraceptives or postmenopausal replacement therapy might induce high ANA levels in healthy individuals [ 24 ].…”