Estrogen and Autoimmune Disease

Autoimmune diseases are much more prevalent in women; 75% of autoimmune diseases affect women, while 25% affect men.  This statistic makes it seem like estrogen is involved in some way.  We know that estrogen affects the immune system, because all immune cells have estrogen receptors and these hormones also encourage your immune cells to begin to make too many antibodies. The role of estrogens in autoimmune diseases has been well studied in women with lupus, where research has shown that oral contraceptives and the use of post menopausal hormone replacement therapy (HRT) increased the risk of lupus and that the incidence of lupus increases after puberty and drops after menopause when estrogen levels are lower. (1) These findings make sense because estrogen causes a shift toward Th2 (lymphocytes that make antibodies), and women with lupus are already Th2 dominant, thus the extra estrogen makes the disease worse. The severity of symptoms in patients with lupus often gets worse as estrogen levels climb, like during the menstrual cycle and during pregnancy.

We are beginning to understand that there are different kinds of estrogens in the body and they each have different effects on your cells and health. The idea that toxic (“bad”) estrogen metabolites made in the liver could be responsible for triggering lupus or making it worse has been supported by many human clinical observation studies and experimental animal studies. (2) Therefore, testing for estrogen metabolites (collectively, the 2, 4 and 16 estrones) and improving the ratios of the good to bad, should be part of the functional medicine treatment for treating autoimmune disease.  This approach is reviewed in detail in my book, The Immune System Recovery Plan:  A Doctor’s 4-Step Program for Treating Autoimmune Disease.

 

 

References

  1. Aisha Lateef and Michelle Petri.  Hormone replacement and contraceptive therapy in autoimmune diseases. J Autoimmun. 2012 May;38(2-3):J170-6. Epub 2012 Jan 18.
  2. TE McAlindon, et al.  Indole-3-carbinol in women with SLE: effect on estrogen metabolism and disease activity.  Lupus (2001) 10, 779–783.

3 Comments On “Estrogen and Autoimmune Disease”

  1. This is a valuable bite of information. Nourishing, yet leaving us hungry for more!

  2. I have seen many women that have developed IBD in the last month of pregnancy. Could the high estrogens levels be a factor. Have you noticed this clinically?

    Is estrogen dominance an antecedent, trigger, and possibly a mediator for IBD?

    • Dear Josh,

      Thanks for your comment on Dr. Blum’s post. Indeed, the risk for autoimmune disease tends to be greater in women more than men, with even more pronounced changes in women during times of hormonal flux, such as in pregnancy. A very recent meta-analysis using 14 pooled clinical studies was just published a few weeks ago indicating that there was more activity of IBD in women who became pregnant with active disease: “In patients with UC there was a significantly higher risk ratio of active disease during pregnancy in patients who commenced pregnancy with active disease (55%), when compared with those in remission at conception (36%) (RR 2.0, 95% CI: 1.5-3, P < 0.001). This risk was also higher in patients with CD (RR 2.0, 95% CI: 1.2-3.4, P = 0.006).”

      Estrogen dominance, or what we may refer to as relative estrogen excess, has been noted to be implicated in autoimmune diseases in general, so your question about the role of estrogen in this particular scenario is a good one.

      Thanks very much,
      Deanna Minich

      Aliment Pharmacol Ther. 2013 Jul 15. doi: 10.1111/apt.12417. [Epub ahead of print]
      Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease.
      Abhyankar A, Ham M, Moss AC.
      Source
      Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, MA, USA.
      Abstract
      BACKGROUND:
      The rate of exacerbation of inflammatory bowel disease (IBD) during pregnancy varies in the published literature.
      AIM:
      We sought to perform a systematic review and meta-analysis of the effects of disease activity at conception on disease course during pregnancy in women with IBD.
      METHODS:
      Published studies and abstracts from standard sources were screened for appropriate studies. Data were pooled and analysed using funnel and forest plots. Quality assessment scores were given using GRADE criteria.
      RESULTS:
      Fourteen studies were eligible for inclusion; ten studies contained patients with UC (N = 1130), and six studies contained patients with CD (N = 590). In patients with UC there was a significantly higher risk ratio of active disease during pregnancy in patients who commenced pregnancy with active disease (55%), when compared with those in remission at conception (36%) (RR 2.0, 95% CI: 1.5-3, P < 0.001). This risk was also higher in patients with CD (RR 2.0, 95% CI: 1.2-3.4, P = 0.006). Thirteen of the studies rated 'low' in all domains of a quality assessment, and there was significant statistical heterogeneity.
      CONCLUSIONS:
      Patients with IBD who conceive when their disease is active are more likely to have active disease during pregnancy than those who conceive when in remission. All studies used in this analysis had a high risk of bias therefore further studies are required.
      © 2013 John Wiley & Sons Ltd.

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