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The Menstrual Cycle and Rheumatoid Arthritis Flares

Updated on March 10, 2021
Medically reviewed by
Diane M. Horowitz, M.D.
Article written by
Max Mugambi

Do you experience worsened rheumatoid arthritis (RA) symptoms during your menstrual cycle? You’re not alone. Many women with RA experience flares, or periods when their symptoms worsen, over the course of their menstrual cycle. As one member shared, “When my menstrual cycle appears, I have rheumatoid flare symptoms. My feet swell, I feel very tired, and my hands and wrists are nearly disabled by the stiffness and pain.”

Here’s why symptoms may flare around your period and what you can do to manage them.

How Do Periods Relate To RA Flares?

According to the Arthritis Foundation, women with various types of inflammatory arthritis, including rheumatoid arthritis and psoriatic arthritis, experience flare-ups during their menstrual periods. As one myRAteam member shared, “When my cycle starts, I feel 10 times worse.” Another noted, “It's very common among the RA warriors I know.”

It is thought that fluctuations in estrogen and progesterone, the primary female reproductive hormones, can influence the immune system as well as pain perception. Women have been found to experience more pain when the levels of these hormones in their bodies are low. This finding explains why women are more likely to experience flares during menstruation, when the body’s hormone levels are lower. On the other hand, women may also experience a decrease in symptoms during the times when estrogen and progesterone levels are known to be highest, such as right after ovulation and during pregnancy.

How To Manage RA Flares During Menstruation

Medication, therapy, and home remedies may help manage RA flares during menstruation.

Birth Control or Hormone Therapy

A recent study found that oral contraceptive pills (which contain estrogen and progesterone) could reduce the severity and activity of RA symptoms in women. Estrogen therapy may also reduce symptoms in postmenopausal women. However, evidence for the benefit of birth control or hormone therapy in RA is mixed.

Keep in mind that birth control may offer the additional benefit of reducing period pain in general. According to one member: “I use an IUD. It doesn’t interfere with the disease — I like it. Fewer periods and less cramping gives me more time to focus on staying well,” she said.

Another myRAteam member shared that she used continuous birth control pills to skip periods, which helped prevent period-related flares.

Talk to your doctor if you think contraceptives could help your RA symptoms or overall pain.

Medications for RA

Certain medications may be recommended or prescribed depending on the severity of a woman’s symptoms and the duration of her RA. Commonly used medications include nonsteroidal anti-inflammatory drugs, steroids, and disease-modifying antirheumatic drugs.

Nonsteroidal Anti-Inflammatory Drugs

These over-the-counter pain relievers can be taken during flares to ease pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are available without a prescription and include Advil and Motrin IB (ibuprofen) and Aleve (naproxen). Your doctor may prescribe stronger pain relievers if your pain is severe and cannot be relieved with over-the-counter options.

Steroids

Also known as corticosteroids, these drugs help relieve pain and inflammation during flares and reduce joint damage. One commonly prescribed steroid for RA flares is prednisone.

Disease-Modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs (DMARDs), which are designed to slow down RA and prevent the joints and other body tissues from permanent damage, can be used to help relieve active RA symptoms. DMARDs may include methotrexate, Arava (leflunomide), Plaquenil (hydroxychloroquine), and Azulfidine (sulfasalazine).

Newer forms of DMARDs, called biologic therapies (bDMARDs) or biologics, include Rituxan (rituximab), Humira (adalimumab), and Remicade (infliximab) — among many others. Another newer form of DMARDs called targeted synthetic DMARDs (tsDMARDs) includes Xeljanz (tofacitinib), Olumiant (baricitinib) , and Rinvoq (upadacitinib).

Physical and Occupational Therapy

Physical and occupational therapy can help reduce joint stiffness and improve RA symptoms during flares. A physical therapist can help you perform exercises to improve your joint flexibility. An occupational therapist can suggest new ways of performing everyday tasks to prevent joint pain and damage.

Home Remedies

The following tips can help you manage your RA flares at home.

Regular Exercise

Getting regular exercise can help keep your joints flexible by strengthening the muscles around them. Gentle physical activity can help you avoid the joint stiffness that comes with RA flares during menstruation. Always consult your doctor or rheumatologist before starting a new exercise routine for your RA.

Heat and Cold Therapy

Using a heating pad or hot water bottle on sore or stiff joints can help relieve pain and tension in the muscles. Cold therapy, such as an ice pack, helps improve symptoms by dulling the pain sensation and reducing swelling. Members of myRAteam have shared that soaking in a warm bath or sitting on a heating pad can help relieve period-related flares.

Taking It Easy

Take care not to overexert yourself, especially during your period if you experience RA flares during menstruation. Allowing your body to rest and taking the time you need to recover can help alleviate your symptoms or prevent them from worsening.

You Are Not Alone

If you are living with RA, you are not alone. On myRAteam, more than 144,000 people understand the challenges of life with rheumatic disease. Members often share their experiences with treatment options and offer support.

Do you experience changes in the intensity of your RA symptoms at different stages of your menstrual cycle? Share your experience in the comments below, or start a new conversation by posting on myRAteam.

All updates must be accompanied by text or a picture.
Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here.
Max Mugambi is a copywriter at MyHealthTeam with more than five years of experience writing about a diverse range of subjects. Learn more about him here.

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