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Nearly 80% Of Autoimmune Cases Affect Women — But Why?

Hannah Frye
Author:
June 13, 2024
Hannah Frye
Assistant Beauty & Health Editor
By Hannah Frye
Assistant Beauty & Health Editor

Hannah Frye is the Assistant Beauty Editor at mindbodygreen. She has a B.S. in journalism and a minor in women’s, gender, and queer studies from California Polytechnic State University, San Luis Obispo. Hannah has written across lifestyle sections including health, wellness, sustainability, personal development, and more.

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Imagine your immune system as your personal bodyguard, always ready to defend you against threats to your health. Now, picture that bodyguard turning against you—this is the essence of an autoimmune disease.

In the United States, approximately 23.5 million people are affected by autoimmune disorders, with a staggering 80% being women1.

While rising stress levels and increased exposure to toxins are known factors in the growing prevalence of these diseases, the question remains: Why are women so disproportionately affected?

Here's what leading experts have to say and what steps can be taken next.

But first, what is an autoimmune disease?

There are more than 80 types of autoimmune diseases, including Type I diabetes, arthritis, multiple sclerosis (also known as MS), and Graves' disease. Each of these comes with its own unique symptoms.

However, "The most common autoimmune disorder symptoms are fatigue, joint swelling and pain, skin issues, abdominal pain or digestive issues, and swollen glands," explains board-certified regenerative medicine doctor Seema Bonney, M.D.

Given the broad nature of these symptoms, it's often difficult to spot an autoimmune disease from the start. "There isn't just one test to take that tells you which one you have or if you have one at all," Bonney says.

She adds, "These symptoms are also linked to many other conditions, and diagnosing an autoimmune disorder [requires] having the right symptoms, blood markers, and even tissue biopsies in some cases." 

The diagnostic process can be especially challenging for women, considering that symptoms like acne, digestive problems, and lethargy are commonly considered just another part of the experience of being a modern-day woman.

This may mean that even more women than we realize are suffering from an undiagnosed autoimmune disorder.

Summary

When we refer to women in this article, we refer to those assigned female at birth. The health-related correlations are exclusive to hormonal and chromosomal differences, not gender identity or expression.

A few reasons women are more likely to have an autoimmune disease

We don't yet have a clear understanding of why women are disproportionately affected by autoimmune diseases, but experts say it could be partially due to the following factors:

Chromosomes

"The X chromosome has been associated with certain autoimmune disorders2, and since women have two X chromosomes compared to men (XY), this may potentially be a reason why females are more prone to autoimmune disorder," says board-certified lifestyle physician Poonam Desai, D.O.

However, she adds, much more research is needed to understand the complexity and reach of chromosomal relations in autoimmune diseases.

Research update (!)

Since the original publishing of this article, more research has surfaced. According to a new study from Stanford Medicine, a molecule called Xist, made by one X chromosome in every female cell, can generate antibodies to a woman's own tissues, thus contributing to heightened autoimmune disease risk. While men do have the gene for Xist, it requires two X chromosomes to be produced. The researchers note that there are other factors contributing to autoimmune disease risk both in men and women, but this is a significant finding. You can read more about the new research here.

Hormones

Many autoimmune disorders (like MS and lupus) are driven by estrogen, Bonney says. Increased estrogen can cause inflammation in the body3, so when women go through puberty4 and pregnancy5 (and their estrogen levels rise), they may be at a higher risk of developing an autoimmune disease.

"Not to mention, many oral contraceptives and hormone replacement therapies (HRT) increase the amount of estrogen in the body," Bonney says, adding to the occurrence of excess estrogen beyond the natural fluctuations.

Editor's note

This estrogen spike with contraceptives applies to combination approaches that include both progestin and estrogen, like some birth control pills, skin patches, and vaginal rings, not progestin-only contraceptives like hormonal IUDs and progestin-only pills. 

In one 2017 systematic research review6, there was an association between hormonal contraceptive use and increased risk of autoimmune diseases like MS, Crohn's disease, lupus, ulcerative colitis, autoimmune thyroid disease (hypothyroidism), immune skin diseases, and rheumatoid arthritis (RA).

There's less research about HRT and autoimmune disease risk, which makes sense given HRT includes significantly less estrogen than traditional oral contraceptives. Still, one study did find that those using HRT did have a higher rate of lupus7.

This isn't to say taking oral contraceptives, or HRT will cause an autoimmune disease—the current research is all associated data, not a display of cause and effect. There could be plenty of other contributing factors.

Immune response

Plenty of research shows that women have a higher immune reactivity8, making them better at fighting off infections than men. 

While this may be a benefit in many ways, it also raises the risk for hyperimmune responses, which can lead to autoimmune disease predisposition. 

Chronic stress

We know that chronic stress can harm the immune system and cause inflammation, making it another risk factor for many things, including autoimmune diseases.

While both men and women experience psychological stress, the effect it has on the brain is different—some research7 suggests the different responses have to do with testosterone, which can buffer the negative effects of stress on mental health. These are animal studies, so more research is needed.

Even so, women also tend to face certain stressors in their personal and professional lives that men just don't. 

In the latest APA polling, women in America reported a higher average level of stress than men (5.3 versus 4.8 out of 10) and were more likely to rate their stress levels between an 8 and a 10 than men (27% versus 21%).

Other risk factors unrelated to sex

There are plenty of other risk factors for autoimmunity that are unrelated to sex, such as smoking, exposure to toxins, and infections. Genetics can also play a role.

Not every autoimmune disease has a genetic component, but many do, says Bonney. "Two examples of this are lupus and multiple sclerosis, which run in families."

Bonney adds, "Interestingly, but not surprisingly, already having one autoimmune disorder makes you predisposed to getting another one." This makes sense, given the self-attacking nature of the immune system in any autoimmune disease. 

What can we do about it?

There's no guarantee that you can fully prevent the onset of an autoimmune disease (or any disease, really), given many of the factors above aren't directly in your control. 

However, the experts agree there are steps women can take to reduce their risk—all of which will have a positive effect on overall well-being and longevity as well. Here's a brief summary of what they suggest:

  1. Aim for a balanced diet: "[Eat] a healthy, well-balanced nutritious diet composed of a variety of proteins, fruits, and vegetables to ensure adequate micronutrient intake," says Desai. "Micronutrients, which include vitamins and minerals, play a crucial role in supporting the proper functioning of the immune system," she adds. 
  2. Get enough vitamin D: Kaitlyn Isabella Randall, RDN, points to one nutrient that should be at the top of your list: vitamin D. She notes that research shows that vitamin D insufficiency has been associated with an increased risk of autoimmune disease9 and other health issues10.
  3. Find an exercise plan that doesn't stress your body out: While no one exercise can cause or prevent autoimmunity, it's worth noting that methods like high-intensity interval training (HIIT) may cause an unhealthy increase in stress hormones in some people. So, if you're dedicated to HIIT workouts, consider sprinkling in less taxing forms of exercise like yoga and zone 2 cardio.
  4. Make sleep a priority: Not getting enough sleep can stimulate your body to release cortisol11 throughout the day, contributing to feelings of emotional stress. While it's not always easy, keeping a regular sleep schedule and working to improve your sleep quality can make a noticeable difference in your stress (and immunity) levels.
  5. Have stress-relief tactics ready: "The increase in circulating stress hormones in response to societal demands and our overstimulating environment means that women need to pay extra attention to mitigating stress where they can and not putting too much on their plates," Randall says. When life gets overwhelming, have stress-relief techniques you enjoy on deck, like meditationyoga, journaling, exercise, therapy, etc. 
  6. Schedule regular checkups: Finally, speak up when something feels off in your body. "If you notice any of these symptoms, don't downplay them or let people tell you you're 'fine' when indeed you do not feel fine," Bonney asserts. Again, the symptoms of autoimmune diseases aren't always as obvious as you might think—feelings of exhaustion, aches and pains, gut issues, and skin concerns should be flagged to your physician.

Stay tuned for more research

While there's more research on autoimmune disease today than there was even three or four years ago, there's still much we don't know.

When I asked Desai how the medical industry can advance the current knowledge of autoimmune diseases, she pointed to financing endeavors for both diagnostics and treatment. 

She says we should be "Allocating more funds and research to autoimmune disease, the discovery of biomarkers involved in autoimmune disease, prevention, education, genetics, and more."

The takeaway

Autoimmune diseases disproportionately affect women. Some of the prevalence in women can be attributed to chromosomal, hormonal, and immune system differences, while others are more related to lifestyle factors like increased stress.

We need more research on how women can protect themselves from autoimmune diseases. In the meantime, the best we can do is prioritize some basic pillars of health and well-being: eat a balanced diet, exercise regularly, manage stress, and get high-quality sleep.

It's also essential to consult your physician when something feels off. The more women speak up openly and honestly about their health, the closer we can get to closing the gender gap in autoimmunity and beyond.

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