AUTOIMMUNE

ARE YOUR FEMALE HORMONES CAUSING YOUR AUTOIMMUNE DISEASE?

Apr 01, 2024

Quick Answer

Hormones do not directly cause autoimmune disease, but shifts in estrogen, progesterone, and cortisol change how active your immune system is, and that can raise your risk or trigger a flare. About 4 in 5 people with autoimmune disease in the United States are women, and hormone-linked thyroid conditions like Hashimoto’s thyroiditis and Graves’ disease are among the most common examples.

Key Takeaways

  • Hormones influence immune activity, they do not directly cause autoimmune disease on their own.
  • About 4 in 5 people with autoimmune disease in the United States are women.
  • Hashimoto’s thyroiditis and Graves’ disease are the most common hormone-linked autoimmune conditions.
  • Puberty, pregnancy, and perimenopause are key hormonal windows for autoimmune risk and flares.
  • Managing chronic stress and knowing your family history are two of the few risk factors you can actually influence.

Usually, our immune system does a great job at protecting us from bacteria, virus, and parasites that can cause illness in our bodies. It even helps us fight against cancerous cells and other elements that can weaken our bodies. When the body senses danger from a microorganism such as a bacteria or virus, the immune system steps up to keep things under control. However, sometimes, problems in the immune system, like a hormonal imbalance, can cause our defense system to begin attacking our healthy cells.

On a basic level, autoimmune disorders occur when the body’s natural defenses attack the body’s own healthy tissues. When this happens, an autoimmune disease develops. Each hormone out of balance can contribute to the development of autoimmune diseases. There are about 80 known autoimmune diseases. More than 23.5 million people in the United States live with one, according to the U.S. Department of Health and Human Services, and women carry most of that burden. A 2024 NIH-funded study out of Stanford Medicine found that about 4 out of 5 people living with autoimmune disease in the United States are women.

What Causes Autoimmune Disease in Women?

Although the exact cause of autoimmune diseases is unknown, some factors increase the risk of autoimmune diseases or trigger an autoimmune disorder. Numerous factors including infections, family history, medications, diet, hormones, genetics, toxic chemicals, environment, and lifestyle can all lead to the development of autoimmune disease.

For instance, an infection caused by a bacteria or virus can trigger changes that confuse the immune system and prompt an abnormal immune response. Family history can make you more susceptible to autoimmune disease, and some medications can cause antibodies to develop that confuse the immune system and create an abnormal immune response. Stress-related disorders such as post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) increase the risk of developing an autoimmune condition.

Hormones can also be a significant factor in the development of autoimmune disorders in women. Women undergo several significant endocrine changes throughout life, especially during puberty, pregnancy, and menopause. These critical periods associated with massive hormonal shifts correlate with when women have the highest risk of developing autoimmune diseases.

Diet plays a part in the development of autoimmune disease. Our typical diet, especially our “western diet” in the United States, is low in good fiber but high in sugar, fat, salt, and artificial additives. Salt increases immune cells and can cause inflammation and autoimmunity. Food additives as well as processed sugars and oils are inflammatory and can lead to autoimmune disorders.

Why are Women at Higher Risk for Autoimmune Diseases?

This tracks with the numbers above, women make up the large majority of autoimmune cases in the United States. Many factors, including hormonal differences, immune response type, genetic differences, and lifestyle, seem to play a role in the increased incidence of autoimmune diseases in women.

Women’s hormones fluctuate throughout their lifetime, especially during childbearing years. Incidentally, most autoimmune diseases are diagnosed around this period, which means that hormones do have a role in the development of autoimmune disorders. Also, autoimmune diseases tend to get better or worse as hormones fluctuate.

Puberty, pregnancy, and the shift from perimenopause into menopause are the biggest hormonal transitions most women go through, and they line up closely with the ages when autoimmune disease is most often diagnosed or flares. If you are weighing hormone replacement therapy (HRT) during perimenopause or menopause and you already have an autoimmune condition, or a strong family history of one, this is worth bringing directly to your OB/GYN. A 2025 analysis from The Menopause Society found that hormone therapy was linked to a higher likelihood of several autoimmune diseases, though not Graves’ disease or autoimmune hepatitis. That does not mean HRT is off the table for you, it means the decision should be individualized with your provider.

A woman’s immune system tends to react differently to triggers than a man’s system. Women tend to have a stronger response to triggers, which can often lead to inflammation that can damage tissues and organs, increasing the risk of autoimmune diseases.

Genetic differences also play a role in the development of autoimmune diseases. A mother can pass on the genes for an autoimmune disorder to her daughter. Since autoimmune diseases have a genetic component and women tend to have more autoimmune diseases than men, being a woman intrinsically increases the risk factor of developing autoimmune diseases dependent on genes.

Stress, lack of sleep, and overall poor health can also lead to autoimmune diseases. Women are more likely to be stressed than men. Women are also more likely to have sleep orders (such as insomnia) than men. These negative lifestyle choices can increase the risk of autoimmune disease in women compared to men.

Facts About Autoimmune Disease in Women

  • Women most often develop autoimmune disorders between the ages of 15 and 60; however, some disorders are more common earlier in life than later. For example, systemic lupus erythematosus (SLE) and psoriasis tend to start earlier in life, while Sjogren’s and rheumatoid arthritis are often seen in middle age.
  • According to the National Institute of Health, common early symptoms of autoimmune disease include joint pain and swelling, fatigue, skin problems, swollen lymph nodes, and fever.
  • Autoimmune diseases are infamously challenging to diagnose because many symptoms can also be attributed to other disease processes.
  • Blood tests can help to narrow down what kind of autoimmune disorder you might have.
  • Pregnancy can trigger some autoimmune disorders. Interestingly, people who already have autoimmune disease may see some improvement of their symptoms during pregnancy.
  • Menopause and aging can increase the risk of developing certain autoimmune disorders.

FEMALE SEX HORMONES AND AUTOIMMUNE DISORDERS

Female sex hormones including estrogen, progesterone, and to a lesser extent, androgens (such as testosterone) have a direct impact on our immune system. If you want the fuller picture of what each of these hormones does day to day, I break it down in 16 Essential Facts About Female Hormones.

Estrogen plays many vital roles in the body, including enhancing different elements of the immune system. For instance, estrogen can stimulate an inflammatory response in your body, which can increase the risk of developing autoimmune disorders. When estrogen is high, such as during certain phases of the menstrual cycle and pregnancy, people already genetically susceptible are at increased risk of developing autoimmune disease.

Interestingly, some autoimmune diseases, such as rheumatoid arthritis and Sjogren’s syndrome, are more likely to occur during the menopause transition when estrogen levels drop. This is likely because estrogen protects joint health and acts as an anti-inflammatory. When these protections stop, the symptoms of these autoimmune diseases become more apparent. Thus, estrogen seems to be able to stimulate and suppress the immune system.

Progesterone, another important reproductive hormone, is anti-inflammatory and helps modulate the immune system as a potent suppressor of inflammatory response. Progesterone levels increase during certain phases of menstruation and pregnancy and then permanently drop during menopause – this can correlate to when a woman has more protection against autoimmune disorders.

Androgens such as testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone (DHEA) protect against autoimmunity and can suppress the immune system like progesterone. They target several parts of the immune system to dampen the immune response.

Other hormonal considerations include the use of hormonal contraception which is a risk factor for the development or worsening of many autoimmune disorders like systemic lupus erythematosus (SLE), Crohn’s disease, Multiple sclerosis (MS), thyroid disease, and many skin conditions. Regardless of the type of hormonal contraception (estrogen-progesterone hybrid or progesterone-only), these contraceptives predispose users to subsequent development of autoimmune diseases.

Cortisol, our stress hormone, also plays a role in autoimmune disorders. Cortisol is overproduced under chronic stress and this stress can trigger or worsen autoimmune diseases. High cortisol levels can also disrupt the production of some protective hormones such as progesterone. People with stress-related disorders are more likely to develop autoimmune disorders. I go deeper into how chronic stress drives cortisol and what that does to your body in The Stress Hormone: Let’s Talk About Cortisol.

Hashimoto's and Graves' Disease Are the Most Common Hormone-Linked Autoimmune Conditions

The thyroid is one of the most common targets when the immune system misfires, and two conditions come up again and again in my practice.

Hashimoto’s thyroiditis happens when the immune system slowly attacks the thyroid gland, and over time that lowers how much thyroid hormone your body makes. It is 4 to 10 times more common in women than men, and it is the most common cause of an underactive thyroid in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases. If you want to understand how this connects to everyday stress and energy, I go deeper into that in Easily Embrace and Understand Ways Stress Affects Thyroid Function.

Graves’ disease works the opposite way. An antibody called thyroid-stimulating immunoglobulin (TSI) binds to your thyroid and pushes it to make too much hormone, which speeds nearly everything in your body up instead of down. It affects close to 1 in 100 Americans, according to the NIDDK, and a woman’s lifetime risk runs roughly six times higher than a man’s, per research indexed by the National Library of Medicine. I cover the full symptom picture in Let’s Talk About an Overactive Thyroid, and the wider view of thyroid autoimmune disease in Thyroid Diseases in Women.

Both conditions are manageable once identified, which is exactly why naming your specific hormone pattern matters more than guessing at it. Starting with the Ultimate Hormone Assessment or a simple thyroid panel with your OB/GYN is the fastest way to find out which one, if either, is driving your symptoms.

How Can You Protect Yourself from Autoimmune Disease?

Certain factors contribute to autoimmune disease including genetics, dietary components, toxic chemicals, and infection. To reduce the risk of autoimmune disorders:

  • Manage chronic stress, and don’t hesitate to get professional help if needed.
  • Eat a healthy, fiber-rich, fruit and vegetable-dense diet since a bad diet increases the risk of developing an autoimmune disorder.
  • Know the signs and symptoms of autoimmune disorders so you know when to seek medical help.
  • Avoid potential sources of toxic chemicals, especially those found in foods, the environment, and beauty products.
  • Infections are a major cause of autoimmune disorders, so practice good hygiene.
  • Know your genetic risk; be aware of your family history and inform your healthcare provider of any close relatives with autoimmune disease.
  • If you are already being treated for an autoimmune disorder, take your medications as prescribed to keep things under control.
  • Talk to your healthcare provider and ask about testing if you notice joint pain or swelling, unexplained fatigue, or skin or hair changes that last more than a few weeks, or any new symptom pattern that does not add up. Autoimmune diseases are easier to manage the earlier they are caught.
  • If you are not sure where your own hormone levels stand, starting with the Ultimate Hormone Assessment is a simple way to identify your specific pattern before your next appointment.

Frequently Asked Questions

Can hormone imbalance cause an autoimmune disease?

Hormone imbalance on its own does not cause autoimmune disease. What the research shows is that hormones like estrogen, progesterone, and cortisol change how active parts of your immune system are, which can raise the risk of an autoimmune disorder developing or getting worse in someone who is already genetically susceptible. Genetics, infections, and environment still play a role alongside hormones.

Not directly. Both are autoimmune conditions where your immune system attacks or overstimulates the thyroid gland itself. Hormonal shifts, especially during pregnancy and the years around perimenopause, are one of several factors that can influence when these conditions appear or flare, alongside genetics and family history.

It can help with symptoms, but it will not cure an underlying autoimmune condition. Supporting stable hormone levels through sleep, stress management, and nutrition can ease flares for some women, but any existing autoimmune disorder still needs its own medical treatment plan alongside that support.

The years around perimenopause and menopause are one of the hormonal windows where autoimmune disease is more likely to be diagnosed or to change in severity, since estrogen and progesterone are shifting significantly during that time. That does not mean menopause causes autoimmune disease, but it is a good time to pay closer attention to new or changing symptoms with your OB/GYN.

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