Women and Autoimmune Disease: Why Are Our Rates Higher?
Approximately 24 to 50 million people in the U.S. currently have an autoimmune disease, which means their immune system is attacking their own healthy tissues and cannot correctly distinguish self from non-self. As a result of autoimmune attack, there is damage and dysfunction in the affected tissues.
Women are disproportionately affected by autoimmune disease. Why is it that four out of five are women?
I’ve pondered this question regularly over the past few decades of taking care of patients as a physician who practices precision and functional medicine. There’s a complex interplay of issues that lead to a greater risk in the tissues of women, and it can be difficult to disentangle sex (biological) differences and gender (socially constructed) differences between the sexes over the lifespan.
Further, 85 percent or more of patients with multiple autoimmune diseases—that is, three or more—are female.1 Multiple autoimmune disease is important to consider because while you may think of autoimmune disease as being separate conditions, they have a similar root cause.
Causes of Autoimmune Disease
When you consider autoimmune diseases, you might think of them as different processes because they affect different tissues—joints, skin, pancreas, liver, the nervous system. For example, while psoriasis involves the skin and Hashimoto’s thyroiditis concerns the thyroid, they have a similar triad at the root of illness. The triad is believed to be genetic predisposition, increased intestinal permeability, and a trigger.2 The trigger is where things get more interesting. A trigger can be a range of events, from dramatic hormonal change like pregnancy, postpartum, or perimenopause; an infection; and commonly, an overwhelmingly stressful event that registers in the body as trauma.
Autoimmune diseases are characterized by excessive and chronic immune activation and inflammation that can involve nearly all of the tissues in the body.3 Autoimmune disease and pre-autoimmune disease have been increasing dramatically in prevalence over the past thirty years.
Autoimmunity, the precursor to autoimmune disease, can be part of accelerated aging particularly of the immune system, known as immunosenescence.4 Importantly, one of the best ways to address the immune system is by modifying lifestyle factors such as the way you eat, move, feel, think, and react to stressful situations.
I’ve written about the lifestyle factors involved in the development of autoimmune diseases in all genders in my new book, The Autoimmune Cure (Harper Collins, New York, 2024). In the book, you will find the scientific support behind the potential causes of autoimmune disease and how to address them in a evidence-based protocol that I’ve used in my patients and myself for the past five years.
Women Are at Greater Risk
Among the 100 autoimmune diseases, the female-to-male ratios are higher for nearly every autoimmune disease except one, ankylosing spondylitis. Multiple sclerosis is twice as common in women compared to men. Rheumatoid arthritis is three times as common. Hashimoto’s thyroiditis affects 10 times as many women as men.5 The ratio for lupus is approximately 6- to 9-to-1 (6-9:1). For Sjogren’s, the ratio is 9- to 19:1. Psoriasis is about 1:1, and the ratio for type 1 diabetes is 1:1 to 1:2.
There are many reasons why rates of autoimmune disease are higher in women, including hormonal, genetic, environmental, lifestyle, and behavioral factors.
Women have higher rates of toxic stress and trauma. Recently, psychologist Dr. Nicole Lapera wrote, “I wish more people talked about how the ‘gifted and talented’ child endlessly trying to please is the adult with autoimmune disease.” Dr. Lapera continues, “We have to look at the role a lifetime of suppressing and pleasing does to our bodies.” Were you taught to be seen and not heard, or perhaps told not to speak unless spoken to? Gabor Mate MD is the first person that I heard prescribe the risk of autoimmune disease after trauma, though the link was established decades ago in studies of childhood adversity and autoimmune disease.
Conclusion
Autoimmune disease accelerates the aging process in people who are affected. Women have much higher rates than men, including for the most common one, Hashimoto’s thyroiditis. The triad at the root of autoimmune disease is genetic predisposition, increased intestinal permeability, and a trigger. Fortunately, lifestyle changes can significantly affect one’s immune function – to learn more, pick up your copy of my new science-based approach to autoimmune disease, called The Autoimmune Cure.
1. Desai MK, et al. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne). 2019 Apr 29;10:265. doi: 10.3389/fendo.2019.00265. PMID: 31110493; PMCID: PMC6501433. Pubmed
2. Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012 Feb;42(1):71-8. doi: 10.1007/s12016-011-8291-x. PMID: 22109896. Pubmed
3. Xiao ZX, et al. An updated advance of autoantibodies in autoimmune diseases. Autoimmun Rev. 2021 Feb;20(2):102743. doi: 10.1016/j.autrev.2020.102743. Epub 2020 Dec 14. PMID: 33333232. Pubmed
4. Calabrò A, et al. Sex and gender affect immune aging. Front Aging. 2023 Nov 28;4:1272118. doi: 10.3389/fragi.2023.1272118. PMID: 38088954; PMCID: PMC10715058. Pubmed
5. Mincer DL, Jialal I. Hashimoto Thyroiditis. 2023 Jul 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29083758. Pubmed