Other evidence calls into question estrogen’s role as a trigger for RA. For instance, up to two-thirds of female RA patients go into partial or total remission if they become pregnant—a time when their estrogen levels soar in order to support the placenta and developing baby. After pregnancy, estrogen levels drop and the risk for developing RA rises.

“It is difficult to make heads or tails of all this,” says rheumatologist Elliott Rosenstein, MD, medical director of the Institute for Rheumatology and Auto-immune Disorders at Overlook Medical Center in Summit, N.J. Dr. Rosenstein believes that investigators studying the link between RA and hormones may have devoted too focused on estrogen. He notes that levels of other hormones could have effects that act independently or in concert with estrogen. For example, women’s levels of another important reproductive hormone, progesterone, drop at menopause. At the same time, levels of hormones known as gonadotropins (including follicle-stimulating hormone and luteinizing hormone) rise. 

“It’s not simply estrogen” that appears to be influencing the risk and severity of RA, says Dr. Rosenstein. “It’s estrogen in balance with these other hormones, some of which we haven’t adequately looked at.”

When RA Precedes Menopause

To make matters just a bit more puzzling, many women who develop RA during their child-bearing years notice that their symptoms improve after menopause—yet others experience a worsening of pain, joint damage, and other symptoms, instead. “It’s a coin toss,” says Dr. Goddard, who has seen both responses in RA patients at midlife. 

Just as people who have arthritis often claim that certain types of weather or foods aggravate their symptoms, claims about how menopause affects RA, or vice versa, are interesting, but tough to confirm, says Dr. Goddard. “There’s not a whole lot of objective, controlled data to support these assertions,” he says.

One of the only certainties about menopause for RA patients is that it marks an important time to address some critical preventive-health measures. Having RA and taking certain common RA medications (such as corticosteroids) increases the risk for osteoporosis, or fragile bones. The loss of estrogen production that occurs at menopause further accelerates loss of bone density, notes Dr. Goddard. 

Talk to your doctor about bone-density testing and whether you should be taking bone-building supplements; Dr. Rosenstein recommends 1,000 to 1,500 milligrams of calcium and 800 International Units (IUs) of vitamin D daily.

Having a conversation with your doctor about heart health when you reach menopause makes sense, too. RA patients have an increased risk for cardiovascular problems, due both to the disease and medications you might be taking; again, corticosteroids can have adverse effects on the heart, such as raising cholesterol and other blood lipids (or fats). 

Loss of estrogen may further boost cholesterol levels, says Dr. Goddard. Your physician can prescribe medications to help manage high cholesterol and other lipid problems, but regular exercise and a healthy diet—which will help ease RA symptoms, too—are a must.