Autoimmune Diseases in Women
by Lisa DiFalco
According to the recent article, Are Autoimmune Diseases on the Rise in Women?, a disproportionate number of people being diagnosed with an autoimmune disorder are women. Healthcare practitioners and case workers should be aware of this consistent trend and know how to best support women that may have health conditions with symptoms not immediately visible or easily diagnosed. The immune systems of many women are not functioning as they should, and doctors need to become increasingly sensitive to the feelings and expression of symptoms in female patients.
As healthcare professionals may be seeing more cases of patients with autoimmune disorders in their practice, it is necessary to develop a better understanding of the conditions impacting the lives of incoming patients. Learn more about three autoimmune conditions often seen in female patients.
According to the American Autoimmune Related Diseases Association or AARDA, ten women to every one man develop Hashimoto’s thyroiditis. Hashimoto’s thyroiditis, or chronic lymphocytic thyroiditis, is currently found to be the most common cause of hypothyroidism.
In this autoimmune disorder, antibodies are created within the body and directed at the thyroid gland. Patients are left to deal with a chronic state of inflammation. Over the long-term, the disorder:
- Reduces production of thyroid hormones; and
- Creates an underactive thyroid (hypothyroidism).
Middle aged women are at the highest risk of developing Hashimoto’s thyroiditis. However, the disorder can develop at any time, and children and men may develop the condition. Some individuals with normal thyroid function tests and elevated TPO antibodies may not need treatment. Patients with hypothyroidism may benefit from:
- Thyroid hormone replacement; and
- Testing with TSH regularly after any dose adjustment to find the correct dosage.
The correct dosage is important. Those that receive insufficient amounts of synthetic levothyroxine may still show symptoms of hypothyroidism. Excessive amounts may result in indications of hyperthyroidism. A balanced diet may help to support the needs of the body, but there is little evidence that it will be able to reverse changes due to the hypothyroidism without additional intervention. Symptoms of patients with hypothyroidism include:
- Weight gain;
- Constipation; and
- Joint and muscle pain.
Even with medication, hormone levels should be tested at least once a year.
Sjogren’s syndrome also occurs disproportionately in women. For every nine women, only one man develops the condition. The two most commonly seen symptoms are dry eyes and dry mouth. The disorder usually occurs in people with autoimmune conditions such as lupus and rheumatoid arthritis. Those with Sjogren’s syndrome will experience decreased production of saliva and tears. Generally, people 40 and older develop the condition, but it may happen at any age.
Treatments for Sjogren’s syndrome include:
- Additional hydration;
- Over-the-counter eyedrops or prescription eyedrops;
- Pilocarpine (Salagen) or cevimeline (Evoxac) to increase saliva and tear production; and
- NSAIDs or nonsteroidal anti-inflammatory drugs.
Treatment depends on the symptoms expressed. For some, surgery may be necessary to provide relief for dry eyes. A number of self-care measures such as increasing humidity in the home, drinking more fluids and incorporating lemon juice in water may help. Additional attention to oral health is recommended for those experiencing dry mouth.
In autoimmune hepatitis, a person’s liver becomes inflamed due to the constant attack from the body’s immune system. Eight women for every man develop the condition. There are two types of autoimmune hepatitis:
- Type 1 is more common and generally affects young women. It may be seen along with other autoimmune diseases.
- Type 2 shows up in females between 2 and 14.
Hereditary factors and previous infections may place people at a higher risk of developing the disorder. However, no one knows why the immune system decides to attack the liver cells in this condition.
Relatively minor symptoms include:
- Spider angiomas;
- Enlarged liver;
- Aching joints;
- Abdominal discomfort;
- Dark urine;
- Pale stools;
- Loss of appetite; and
- Absence of menstruation.
Worsening complications include:
- Mental confusion; and
- Ascites or fluid in the abdomen.
For up to 20 percent of cases, symptoms may be similar to those in acute hepatitis.
Individuals with the disorder may first feel as if they have experienced a mild flu. Diagnosis is confirmed with a blood test and liver biopsy. Co-occurring conditions may include other autoimmune diseases such as Sjogren’s syndrome, vitiligo, ulcerative colitis, thyroiditis and type 1 diabetes. Suggested treatments for autoimmune hepatitis include:
- Prednisone; and
- Azathioprine (Imuran).
Serious side effects are known to occur with long-term steroid use. Additional medications may be used to treat or control for additional symptoms. Management of autoimmune hepatitis varies and what is still found is that management is “still expert based rather than evidence based.”
More Research Necessary
Additional research into autoimmune disorders and treatment protocols may help provide additional insights and more consistency in management and results. The three autoimmune disorders presented occur at unusually high levels in women and may be present with other autoimmune disorders. Patients may have been misdiagnosed if the current treatment approach and correct dosage do not seem to provide any benefit. Learning more about Hashimoto’s thyroiditis, Sjogren’s syndrome and autoimmune hepatitis can help with diagnosis and effective management of symptoms.