The Hormonal Flare-Up: Why Autoimmune Symptoms Could Spike Before Your Period
The intricate dance of hormones in the body plays a big role in our health, and for people that live with autoimmune disease, this connection can feel even more significant. In my twenty plus years since receiving a Lupus diagnosis, and speaking with hundreds if not thousands of other women, there was a connection none of us could deny: our symptoms seemed to flare up around the same time each month, often in sync with our menstrual cycle. More specifically, the three or four days before our menses would begin. Then, as our cycles came to an end, the symptoms would back off. This phenomenon had many of us asking: why does this happen exactly, what does science have to say about it, and how we can track and manage these patterns to feel more in control of our health?
The Science: How Hormones Affect Autoimmune Diseases
Hormones are like messengers in the body, controlling everything from energy levels to how your immune system works. Estrogen and progesterone, the main female hormones, are particularly powerful. These hormones can influence the immune system, sometimes calming it down and other times stirring it up.1
Estrogen, for example, can boost immune activity. This is helpful for fighting off infections, but in autoimmune diseases—where the immune system attacks healthy tissue—it could make symptoms worse. Progesterone, on the other hand, tends to calm the immune system, which might explain why some women feel better during certain phases of their cycle when progesterone is higher.2
Hormonal changes can also affect inflammation by influencing cytokines, which are proteins that regulate the immune response. In conditions like lupus, rheumatoid arthritis, or multiple sclerosis, these shifts could lead to noticeable changes in how you feel.
The Menstrual Cycle’s Impact on Symptoms
For many women with autoimmune disease, the days leading up to our period might bring more than just typical PMS symptoms. Personally, about three days before my period would begin, like clockwork, I would have an increase in frequency of fevers, increased joint and muscle pain, relentless fatigue (worse than my already challenging fatigue), rashes, and an overall feeling that I was coming down with something.
If, like me, you have noticed a shift in symptoms before your period, you might be wondering why this is happening. After ovulation, during the luteal phase, estrogen levels drop, and progesterone rises. As the cycle gets closer to menstruation, progesterone levels fall too, which can make the immune system more active and trigger flares. By the time your period starts, symptoms might peak, only to ease off as the cycle resets.
If you haven’t recognized this pattern yet, it’s understandable. With literally dozens of hospital and doctor’s visits during my first few years after diagnosis, not one medical professional mentioned this to me. In fact, each month I questioned myself if I was exaggerating how worse I felt just before my period. And then…thanks to social media, communities of autoimmune warriors were talking about it. The stories were so similar, and many of us questioned why this information wasn’t readily discussed in the medical setting. It’s a valuable insight, and one that every patient needs to be made aware of, because understanding when you’re likely to feel worse can help you plan and manage your symptoms better.
How Can Tracking Symptoms Help
One of the best ways to understand if your menstrual cycle affects your health is to track your symptoms on a regular basis. You can use something as simple as a notebook, or a more in-depth app like Folia Health’s app – designed to help you see patterns over time.
I would suggest tracking the following:
Your Cycle: Record when your period starts and ends, and note ovulation or any premenstrual symptoms.
Your Symptoms: Keep a log of pain levels, fatigue, fevers, rashes, stomach troubles or anything else that feels significant and/or different than your baseline. Also, maintain your tracking on non-cycle days so you have something to compare it to.
Other Triggers: I found it is also helpful to track external factors like stress, poor sleep, new medication or supplements, dietary changes, and even things like travel or sunlight/heat that might influence how you feel. Often times, until we see hard data of specific symptoms increasing in severity after a trigger, we may not even consider that event or factor to be harmful to us.
After a few months, you might notice that your symptoms consistently ramp up at certain points in your cycle. Through consistent tracking, I was able to determine that my menstrual cycle, sunlight/heat, stress and even certain foods were my greatest triggers. If you notice your symptoms worsening each month in sync with your cycle, there are some steps you can take to better manage it. Here are some ideas:
Planning Around Your Cycle: If you recognize that you feel worse right before your period, try to avoid overloading your schedule during that time. Thanks to journaling over time, I knew the three days before my expected period I was typically unable to get out of bed. I altered my work schedule in order to work from home those days and I also made sure I didn’t schedule any doctors appointments or procedures on these days (whenever possible). Plan ahead to give yourself grace during these time periods.
Supporting Your Body: This will be unique to each person, but I found that increasing my intake of anti-inflammatory foods and fresh green juices ensured I was hydrated with plenty of electrolytes. If my pain level wasn’t too severe, I would try to engage in some restorative yoga poses to help my nervous system calm down and help with sleep.
Speaking with Your Practitioner: In the past few years, I have noticed more physicians and alternative care providers recognize the correlation between menstrual cycles and an increase in symptoms. By working with my functional medicine M.D., I was able to add in certain supplements and tinctures that would help my hormones, essentially decreasing my symptoms. If symptoms become severe before your period, speak to your doctor, or consider trying a nutritionist, acupuncturist, functional medicine practitioner etc. to help provide therapies that work for you.
Manage Stress: Hormonal shifts can amplify stress, which in turn can make autoimmune symptoms worse. Techniques like meditation, deep breathing, or even just taking a walk can help keep stress in check. Personally, I find the most relief from stress through art and music therapy, cooking, and honestly, placing solid boundaries in key relationships and learning how to say “no” without feeling guilty (that one took me a while!).
Bridging Science with Everyday Life
While the connection between hormones and autoimmune diseases can feel complicated, I promise you, it’s also something you can and will learn to navigate. Managing an autoimmune disease is a journey, and every bit of understanding you gain along the way can make a difference. So, grab a notebook or download Folia Health’s tracking app, and start observing the rhythms of your body. You might just uncover patterns that help you feel more balanced and in better control of what triggers your symptoms.
And last but not least, remember, you’re not alone. Many women share this experience, and with a little knowledge and preparation, you can turn these hormonal shifts into an opportunity to care for yourself in new and meaningful ways.
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About the Author:
Marisa Zeppieri is a former journalist, Mrs. New York 2015, author of the award-winning memoir, Chronically Fabulous, and the founder of global 501c3, LupusChick. Originally from New York, she currently calls the mountains of the Carolinas home, where she enjoys cooking, reading, and painting.
