The relationship between menopause and our immune system

Hormonal change and challenges

The impact of menopausal symptoms on women in the workplace should not be underestimated. In the UK, for example, it costs the economy around 14 million working days per year. More data are taken from the US National Health and Wellness and show that menopausal symptoms lead to real-world economic impacts. There was higher work impairment and presenteeism, where you might be physically at work, but mentally elsewhere.¹ Now, combine this with the fact that menopause impacts the immune system, and the barriers facing Canadian women are distressing.

What’s the impact?

Basically, the female immune system is better prepared against pathogens than the male immune system. Developmentally, this can probably be explained by the fact that pregnant women must protect themselves and their unborn child from infection. With the onset of menopause, this advantage fades - especially at the beginning of menopause when levels of female sex hormones fluctuate greatly.^2,3

• Increase in pro-inflammatory markers like interleukin-1, interleukin-6*, and TNF-α
• Decrease in the number of CD₄ T and B cells
• Decrease in the cytotoxic activity of natural killer cells

*IL-6 is also associated with cardiovascular disease, diabetes, and atherosclerosis.

It isn’t just early menopause, because as estrogen continues to decline, the female immune system no longer reacts as powerfully as in younger years. This whole process is more specifically called immunosenescence, the impacts of aging on our immune system.

This becomes a public health concern because menopausal symptoms can be a physical and mental challenge that affects the employees' job performance. The UK had published a Women’s Health Strategy for England in 2022 that would have piloted a ground-breaking “menopause leave policy” that acknowledged the impact of the symptoms. It was rejected by Members of Parliament in early 2023.

What are some other ways estrogen affects our immune system?

Estrogen can influence the function of immune cells in various tissues and organs, including the thymus, bone marrow, spleen, and lymph nodes. Estrogen has also been implicated in the pathogenesis of several autoimmune diseases, including systemic lupus erythematosus (SLE), multiple sclerosis (MS), and rheumatoid arthritis (RA).⁴

As a result of hormonal changes, the mucous membranes also become thinner and are often no longer as well supplied with blood as before.⁵ Mucosal cells lining the vaginal cavity also die and release compounds that are converted into glucose. The sugar breaks down into lactic acid, increasing the pH in the vagina and upsetting the carefully regulated environment.⁶ This adds to irritation and dryness in the cavity.

But it is precisely the mucous membranes in the nose, throat and vagina that are the first bastion to keep pathogens out (e.g. in colds, flu, COVID, UTIs). If the mucous membranes are weakened, it becomes far easier for germs to pass into the body.

That is why it is important to strengthen the mucous membranes as much as possible. This helps:

• Drinking plenty of fluids keeps the mucous membranes moist. It should be at least two litres a day and can include herbal teas to avoid the diuretic effect of caffeine. 
• Dry air should be avoided where possible and a humidifier can help with this.
• Perform regular nasal rinses, e.g. with isotonic saline solutions like Dry Nose Relief. This removes pathogens, lubricates the nasal passages, and reduces irritation due to the chamomile. 
• Sunflower oil can help if the nose is very dry and feels irritated. Application: Take a drop on a finger and dab the inner rim of the nostrils.

Menopausal sleep concerns

Sleep is something our bodies value above all else, the panacea to healing all tissues and woes…though maybe not. With the changes discussed so far, it’s also important to recognize the effect of hormonal changes on sleep. An international team of researchers reported that rates of sleep disturbances increase with menopause.⁷

• Pre-menopause: 16 – 42%
• Peri-menopause: 39 – 47%
• Post-menopause: 35 – 60%

Estrogen influences sleep-wake patterns known as the circadian rhythm through the hormone’s impact on neurotransmitters. These chemical messengers in the brain, like dopamine, serotonin and norepinephrine, affect mood, sleep and more.⁸ Decreased estrogen levels can lead to imbalances in these neurotransmitters, which can contribute to sleep disturbances, as well as mood changes and depression. It also helps to maintain a lower core body temperature, which increases the time spent in a deep, restful sleep.⁹ This partly explains why hot flashes and night sweats become more common, rousing even the deepest of sleepers from their slumber.

Without the proper amount of sleep, the risk of countless infections jumps. Patients with sleep disorders were 23% more likely to battle herpes zoster than those who sleep more.¹⁰ Even comparing those who slept six hours with those who slept seven saw the short sleep duration group at higher risk of cold, flu, gastroenteritis, and other diseases.¹¹ It also impacts how well the body can control tumour growth, especially those found in breast, colorectal or prostate tissue.¹²

Let’s go back to those mood changes for a second though.

It was already shown how estrogen levels influence neurotransmitters critical to a healthy mental state. During menopause, there is a higher risk of developing depression, anxiety, and episodes of emotional distress.¹³ Think about the well-established link between the stress hormone cortisol and risk of infection. When cortisol remains elevated over a period, it begins to suppress the activity of the immune system. Therefore, menopause makes it harder to cope with stress and stress disarms the immune system, a double whammy leading to more frequent infections. This is why access to mental health resources should be a discussion in every menopausal journey – it’s all connected!

Is hormone therapy the answer?

This is an individual conversation between every person and their primary care provider, but Health Canada notes some very important side effects to be wary of:

• Compared to non-use of HRT, the use of combined HRT increases breast density and was shown to compromise the interpretation of mammography results.
• In a subgroup of more than 4500 women aged 65 or older, an additional 23 cases of dementia in 10,000 women per year were reported among women on combined HRT, as compared to placebo
• As well, combined HRT did not prevent mild cognitive impairment among women who used it and there was a small increased risk of cognitive decline in the combined HRT group
• Eighteen more cases (34 vs 16) and a twofold greater rate of total blood clots in the lungs and legs

Their conclusion was, “In light of these results, combined estrogen and progestin are not recommended for long-term use in post-menopausal women, except in limited circumstances where other therapeutic choices are found inadequate. The risks of breast cancer, blood clots, stroke, coronary heart disease and dementia (in women aged 65 and over) are considered to outweigh the benefits of fracture reduction and the reduced risk of colorectal cancer, when long term use of HRT is considered.”¹⁴

What are my options?

It is important to have a balanced diet that is as varied as possible, with plenty of fresh fruit and vegetables. Broccoli, for example, is considered particularly good for immune defence, as well as cabbage, carrots, garlic, citrus fruits, all dark berries and nuts. The dietary fibres that are abundant in vegetables and wholemeal products also keep the intestines happy - after all, it houses a large part of the human immune system.

Depending on the situation, different medicinal plants can be used to support the menopausal transition. MenoSupport Complex is a combination of hibiscus, magnesium and organic, non-GMO soy isoflavones that support the spectrum of symptoms. These plants and minerals help lower blood pressure, maintain a healthy mood, and slow the decline of estrogen, helping to make the entire transition more manageable and increasing your protecting against infection. The clinically-proven Menoforce is also an option to reduce the frequency and severity of hot flashes and night sweats as two separate human clinical trials showed.^15,16,17

The beneficial effect of exercise on the immune system should not be forgotten. It is ideal to do moderate endurance sports such as jogging or cycling at least three times a week, preferably in the fresh air. However, you should not overexert yourself, because this weakens the defence.

Finally, consider reconnecting with nature as one study showed postmenopausal women who participated in a forest therapy program had fewer sleep troubles. The researchers concluded that, “…forest therapy could be a good alternative to nonpharmacological treatment for mitigating insomnia in postmenopausal women.”¹⁸

Summary

As you start out on your own menopausal transition, think carefully about how you want to spend the next five to 10 years. Do you want your symptoms running your life, or do you want to take control? Consider some of the tips and information provided in this article and know that you can age well.

References

1. Whiteley, Jennifer, et al. "The impact of menopausal symptoms on quality of life, productivity, and economic outcomes." Journal of women's health11 (2013): 983-990.
2. Gameiro, Cátia Morgado, Fatima Romão, and Camil Castelo-Branco. "Menopause and aging: changes in the immune system—a review." Maturitas4 (2010): 316-320.
3. Ghosh, Mimi, Marta Rodriguez-Garcia, and Charles R. Wira. "The immune system in menopause: pros and cons of hormone therapy." The Journal of steroid biochemistry and molecular biology142 (2014): 171-175.
4. Moulton, Vaishali R. "Sex hormones in acquired immunity and autoimmune disease." Frontiers in immunology9 (2018): 2279.
5. Semmens, James P., and Gorm Wagner. "Estrogen deprivation and vaginal function in postmenopausal women." Jama4 (1982): 445-448.
6. Mac Bride, Maire B., Deborah J. Rhodes, and Lynne T. Shuster. "Vulvovaginal atrophy." Mayo Clinic Proceedings. Vol. 85. No. 1. Elsevier, 2010.
7. Jehan, Shazia, et al. "Sleep disorders in postmenopausal women." Journal of sleep disorders & therapy5 (2015).
8. Hatcher, Katherine M., Sara E. Royston, and Megan M. Mahoney. "Modulation of circadian rhythms through estrogen receptor signaling." European Journal of Neuroscience1 (2020): 217-228.
9. Murphy, Patricia J., and Scott S. Campbell. "Sex hormones, sleep, and core body temperature in older postmenopausal women." Sleep12 (2007): 1788-1794.
10. Chung, Wei-Sheng, Hsuan-Hung Lin, and Nan-Cheng Cheng. "The incidence and risk of herpes zoster in patients with sleep disorders: a population-based cohort study." Medicine11 (2016).
11. Orzech, Kathryn M., et al. "Sleep patterns are associated with common illness in adolescents." Journal of Sleep Research2 (2014): 133-142.
12. Garbarino, Sergio, et al. "Role of sleep deprivation in immune-related disease risk and outcomes." Communications biology1 (2021): 1304.
13. Guérin, Eva, Gary Goldfield, and Denis Prud’homme. "Trajectories of mood and stress and relationships with protective factors during the transition to menopause: Results using latent class growth modeling in a Canadian cohort." Archives of Women's Mental Health6 (2017): 733-745.
14. Health Canada. (2004). Benefits and risks of hormone replacement therapy (Estrogen with or without progestin). https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/benefits-risks-hormone-replacement-therapy-estrogen-without-progestin.html
15. Bommer, S. A. G. E., P. Klein, and A. Suter. "First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes." Advances in therapy6 (2011): 490-500.
16. Bommer, S., P. Klein, and A. Suter. "A multicentre open clinical trial to assess the tolerability and efficacy of sage tablets in menopausal patients with hot flushes." Planta Medica09 (2009): PJ159.
17. Wilfried, Dimpfel, Chiegoua Dipah Gwladys Nina, and Bommer Silvia. "Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial." Heliyon 7.2 (2021): e05910.
18. Kim, Hyeyun, et al. "Effect of forest therapy for menopausal women with insomnia."International journal of environmental research and public health 18 (2020): 6548.