Why Autoimmune Diseases Disproportionately Affect Women And What Women Need to Know

When you’re exposed to a cold virus or a stomach bug, your immune system powers up, battles the infection, and then retreats. But what if that response is misguided, and then fights you instead?

That’s what happens in autoimmune diseases, a group of conditions including rheumatoid arthritis, lupus, Hashimoto’s thyroiditis, and many more. Something triggers the immune system, designed to recognize foreign cells and fight them off, to attack your own cells. This causes a wide range of symptoms from fever and aches to skin and digestive issues.

There are more than 80 different autoimmune diseases that affect more than 24 million people in the U.S. While researchers don’t know exactly what causes autoimmune disease, many experts believe they’re triggered by infections; the immune system revs up to handle the virus or bacteria and becomes overactive. Genetics, lifestyle factors like obesity and smoking, and certain medications can also be risk factors. And, for reasons scientists don’t totally understand, women represent more than 75 percent of cases.

Why are autoimmune diseases in women so prevalent?

There are several theories about why women are more prone to autoimmune diseases. One group of theories relate to hormones, specifically the differing ratios of estrogen and testosterone that men and women have, as well as the role of changing hormones throughout life. For example, a 2018 study in Nature Communications found that testosterone suppresses a protein that makes B cells, a type of immune cell that can release autoimmune antibodies, stronger. Since women have less testosterone, those B cells are able to proliferate and release harmful antibodies. Other research finds that the immune system and hormone levels are in a delicate balance; when hormones shift during puberty, pregnancy, and menopause, the balance may be disrupted, and women become vulnerable to autoimmune diseases. Pregnancy itself may also make women more susceptible, says Dawn Jacobson, M.D., a doctor formerly with Parsley Health. When a woman is pregnant, the fetus’s cells get into her circulatory system. They can be stored in tissues, such as the bone marrow, for over a decade after the pregnancy. “One theory is that the immune system recognizes these fetal cells as foreign and creates an autoimmune response,” she says.

How does autoimmune disease testing work

Autoimmune responses occur on a spectrum, explains Dr. Jacobson. “On one end is a full-blown disease, but on the other end is someone who has a few symptoms that we know happen with autoimmune conditions, like ongoing joint pain and certain rashes,” she says. Those early symptoms can be warning signs of autoimmune disease. At Parsley Health, doctors do a test called an antinuclear antibody (ANA) test as part of a baseline panel. This autoimmune disease test looks for proteins that your immune system makes when it’s attacking your own body. If it shows that something is going on, a deeper dive into symptoms as well as symptom- and condition-specific testing can help doctors see what might be going on.

Catching an autoimmune disease early—before there are severe symptoms—may mean that you can use food and lifestyle changes to decrease the immune response in your body and keep symptoms from getting worse, says Dr. Jacobson. That’s why it’s important to pay attention to things like fatigue, joint pain, skin rashes, and gastrointestinal symptoms like abdominal pain, gas, and bloating, and seek help if they last more than a few months, she says.

While many conventional medicine practices won’t run extensive testing until you have more severe symptoms of an autoimmune disease, at Parsley Health, in addition to the ANA test, doctors will screen for Hashimoto’s thyroiditis as well as run other tests based on your symptoms. If you feel like you’re not being heard by your doctor, a functional medicine doctor could help you address your symptoms, advises Dr. Jacobson. “The goal is to create a functional or integrative team to support you with the questions you need answered,” she says.

A holistic approach to managing autoimmune disease symptoms

If you do show signs of autoimmune dysfunction or are diagnosed with an autoimmune disease, managing symptoms is important to help you feel better and also to calm potentially damaging inflammation, which is a hallmark in most autoimmune conditions.

At Parsley Health, doctors are often able to catch the early symptoms of autoimmune diseases in women and men and help them manage or reverse the condition without the need for medication. In people who are on prescription medications for autoimmune disease, they are often able to help patients reduce or eliminate the need for medication, though in some cases, medication is needed and treatment will focus on symptom management.

The lifestyle changes that your doctor may recommend for managing symptoms include an elimination diet, which can help identify food triggers for your flares, and ways to manage stress, since for many people, their diseases flare under stress. Your functional medicine doctor may also look for micronutrient deficiencies and recommend dietary changes, herbal supplements, and detox and cleanse regimens to help your immune system calm down, says Dr. Jacobson. In Ayurvedic medicine, a clean diet combined with yoga, meditation, and body treatments helps women with rheumatoid arthritis reduce their symptoms or even become symptom-free, she says, though it’s not known how food and lifestyle changes have this effect or why antibody levels go down. Body therapies like massage, acupuncture, and infrared sauna may also be helpful, she adds.

Yoga and meditation can be so important because there’s cross-talk between your immune and nervous systems, and you want them to remain balanced, explains Dr. Jacobson. “The reason I emphasize yoga is that it links breath, movement, and intent,” she says. “Breath practices get us in nervous system balance.” That’s crucial to making sure you can get in and out of a “fight or flight” state quickly, to avoid prolonged exposure to stress hormones and keep steady, because “an overactive mind revs up the body.”

In addition to herbs, another therapy being explored is a low dose of naltrexone, a drug that in higher doses helps people recover from addiction by blocking opioid receptors. In people with autoimmune diseases it might help with GI symptoms, pain, joint symptoms, and brain fog, says Dr. Jacobson. Research suggests that it may help improve quality of life in people with Crohn’s disease (an inflammatory bowel condition), rheumatoid arthritis, and multiple sclerosis (a central nervous system disease) and reduce itching in people with systemic sclerosis (a form of scleroderma, a disease that affects the skin and connective tissues).

Since the early signs of many autoimmune diseases—fatigue, bloating—may be vague and common, women commonly push them aside or think they’re not worth telling their doctor about. “People ignore GI symptoms their whole lives!” says Dr. Jacobson. But women, in particular, need to be hypervigilant, because working with a doctor before your symptoms increase in severity, is ideal, she says.

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