Women and Autoimmunity

Women are twice as likely as men to have autoimmune conditions. In this article, we use "women" for people assigned female at birth and "men" for people assigned male at birth. An autoimmune condition is one in which your immune system attacks your healthy cells. The immune system is mistaking these healthy cells for something harmful.¹

More than 24 million people in the United States live with an autoimmune disease. And women make up 80 percent of that number: 19.2 million. Five to 10 percent of people with an autoimmune disease have more than one autoimmune condition.¹

More than 100 autoimmune diseases exist. Some of the most common ones include:^1,2

• Ankylosing spondylitis
• Axial spondyloarthritis
• Hidradenitis suppurativa
• Inflammatory bowel disease
• Irritable bowel syndrome
• Lupus
• Multiple sclerosis
• Myasthenia gravis
• Neuromyelitis optica
• Plaque psoriasis
• Psoriatic arthritis
• Rheumatoid arthritis
• Thyroid eye disease

So why are women more likely to have an autoimmune condition? Scientists think there are multiple factors involved, including:^1,3

• Genetics
• Hormonal changes
• Environmental factors

Genetics

Genetics have a bearing on the high rate of autoimmune conditions in women. These diseases can surface in several members of the same family. Other aspects of genes – such as the number present and their expression – also play a role.^1,3

Some research points to the sex chromosomes as one reason women have a greater chance of getting autoimmune conditions. Women have two X chromosomes. Men have one X and one Y.³

The number of genes on these chromosomes differ. The X has around 800 to 900 genes. In contrast, the Y has only 50 to 60. More genes means more chances for genetic problems.³

Problems can stem from the way the X chromosomes function in women. Some autoimmune issues occur because X chromosomes act when they should not. An overexpression of genes can give way to extra antibodies and autoantibodies that attack the person’s own body.³

A group of doctors at the University of Michigan found women’s skin cells also contain a greater amount of VGLL3. This is a protein that helps control gene expression. Further research revealed the extra VGLL3 and gene expression can elicit an autoimmune response. The symptoms mirror those of lupus, which affects both the skin and organs inside the body.^3,4

Hormonal changes

Hormonal changes also contribute to the higher rate of autoimmune conditions in women. Women have more hormones and go through more hormonal changes than men do. For women, major shifts in hormones occur during:^1,3

• Puberty
• Pregnancy
• The period after giving birth (postpartum)
• Perimenopause
• Menopause

Certain autoimmune conditions are more likely to arise or worsen with hormonal changes. Lupus and psoriasis can start as early as puberty. Rheumatoid arthritis tends to flare up more after a pregnancy and during menopause.^1,3

Changes in hormones can affect levels of inflammation in the body. Certain hormones like estrogen and progesterone combat inflammation. A decline in these hormones can occur in menopause and at other times. This can give rise to more inflammation, which underlies autoimmune conditions.³

Environmental factors

Environmental factors also play a part in the autoimmune conditions affecting so many women. Exposure to certain chemicals and germs can alter hormone levels and how the body works. Other things that impact health include amount and quality of:^1,3

• Exercise
• Nutrition
• Sleep

Stress is a major factor that drives the onset and flare-up of autoimmune diseases. Managing children, homes, relationships, work, and more can put a lot of stress on women. Some also experience abuse and other forms of trauma.^1,3

Fortunately, there are multiple resources to get support from:

• Doctors can diagnose specific diseases and advise on treatments.
• Advocates promote awareness and help advance education and research.
• Online health communities connect people who have like conditions.