Lupus in Women
Reviewed by: HU Medical Review Board | Last reviewed: January 2020 | Last updated: November 2020
Nine out of 10 people diagnosed with lupus are female, and most develop symptoms during their child-bearing years of 15 to 44. African American, Hispanic, Asian, and Native American women are more likely to have lupus than Caucasian women.1
What’s more, the LUMINA study (Lupus in Minority Populations: Nature vs. Nurture) found that African Americans and Hispanics from Texas tended to have more serious lupus with more flares and less support compared to Caucasians and Hispanics from Puerto Rico.2
Lupus can make other health problems occur at earlier ages in women with the disease, including:
Lupus increases the risk of coronary artery disease because women with lupus are more likely to have high blood pressure, high cholesterol, and type 2 diabetes. The risk is also thought to be higher simply because of the underlying inflammation that lupus causes. Many studies have found that women with lupus were significantly more likely to experience a heart attack, stroke, or congestive heart failure compared to other women of the same age.3,4
The steroids used to treat lupus can cause bone loss, which can lead to osteoporosis. Also, the pain and fatigue of lupus may discourage women with lupus from getting enough exercise, which keeps bones healthier.5
In more than 50 percent of people with lupus, the disease attacks the kidneys and causes kidney nephritis. Kidney problems are often one of the first symptoms of lupus to appear.5
Lupus and pregnancy
Women with lupus experience more pregnancy-related complications than other women. In fact, 30 years ago, many doctors advised women with lupus against having children. Today, thanks to improvements in medicine, many women with stable, mild to moderate lupus can safely get pregnant and deliver a healthy baby. However, it is still considered a high-risk pregnancy because women with lupus are at higher risk of maternal or fetal death, preterm birth, and other complications.
That is why it is important to talk with your rheumatologist and a maternal-fetal medicine specialist to create a plan for when you will try to conceive and how you will manage both your pregnancy and your lupus. It may take 2 to 3 years of planning to reduce complications for the mother and baby. Some examples of special considerations for women with lupus include:6,8
- Try to conceive after six months of well-controlled symptoms. This lowers the risk of several pregnancy complications, including flares, gestational hypertension, preeclampsia, and low birth weight.
- You may need to stop some medications or take different drugs while pregnant. For instance, you may be asked to take low-dose aspirin to decrease your risk of preeclampsia.
- Women with lupus need additional blood tests and urine tests to monitor their kidney function and antibody levels that can impact the pregnancy. For instance, anti-Ro/SSA and anti-La/SSB antibodies can affect the skin and heart of the fetus.
- Breastfeeding may be possible, depending on the drugs you take.
Lupus in older women
Researchers have found several differences in postmenopausal women with lupus compared to younger women. The good news is that some women find that the number and severity of their flares decrease significantly as they move from premenopause to post-menopause.9 Other differences are:10
- Women with late-onset lupus (diagnosed after age 50) experienced lower rates of kidney disease, arthritis, malar rash, photosensitivity, and hair loss.
- Because lupus is less aggressive in older women, it takes an average of 5 years from symptom onset to diagnosis, compared to 3 years in young women.
- Women who had a hysterectomy and oophorectomy (removal of the ovaries) were less likely to develop kidney disease and positive anti-double-strand DNA antibodies.
- Hormone replacement therapy, often prescribed to help with osteoporosis, may increase flares.