Why Lupus (SLE) Affects Women More Than Men
Key takeaways:
Lupus is a complex autoimmune disease that primarily affects people assigned female gender at birth, but it can occur in all people.
Research suggests the higher prevalence in people assigned female gender at birth is due to the effect of estrogen on the immune system.
All people with lupus experience similar lupus-related symptoms, but symptoms may be more severe in men.
Lupus is an autoimmune condition, a disease caused by a dysfunction of the immune system. The full medical name for lupus is systemic erythematous lupus, or SLE. Lupus can affect all people, but it is significantly more common in people assigned female gender at birth. In places, we refer to “women” as compared to “men” in this post, because the research and data we quote use these binary terms. But all readers are welcome here.
The fact that lupus shows up in more than half of the population is not unique to lupus: Many autoimmune diseases are more common in women than men. Why is this? Keep reading to learn about the latest research and findings.
How much more common is lupus in women than men?
Lupus is up to 15 times more likely to affect women than men in their 20s and 30s. That difference is less — but still exists — in children (3 times more likely) and in older adults (8 times more likely).
Looking to save on BENLYSTA (belimumab)?
BENLYSTA is for people 5+ with active SLE (lupus) or active lupus nephritis on other lupus medicines. Not for people with severe active central nervous system lupus.
Do not use BENLYSTA if you are allergic to belimumab or any ingredients in BENLYSTA.
The most important information about BENLYSTA
Immunosuppressive agents, including BENLYSTA, can cause serious side effects. Some of these may cause death.
• Infections:
fever, chills, pain or burning with urination, urinating often, coughing up mucus, or warm, red, or painful skin or sores on your body. Infections could be serious, leading to hospitalization or death.
• Allergic (hypersensitivity) reactions:
itching, swelling of the face, lips, mouth, tongue, or throat, trouble breathing, anxiousness, low blood pressure, dizziness or fainting, headache, nausea, or skin rash. Serious allergic reactions can happen the day of, or in days after, receiving BENLYSTA and may cause death.
• Mental health problems and suicide:
thoughts of suicide or dying, attempt to commit suicide, trouble sleeping (insomnia), new or worse anxiety or depression, acting on dangerous impulses, other unusual changes in your behavior or mood, or thoughts of hurting yourself or others.
Before receiving BENLYSTA, discuss with your healthcare provider if you:
• think you have an infection or have infections that keep coming back. Do not use BENLYSTA if you have an infection unless your healthcare provider tells you to.
• have or have had mental health problems such as depression or thoughts of suicide.
• have recently received or may need a vaccination. If you are receiving BENLYSTA, you should not receive live vaccines.
• are taking any medicines, including prescription, over-the-counter, vitamins, and herbal supplements.
• are allergic to other medicines.
• are receiving other biologic medicines.
• have or have had any type of cancer.
• have any other medical conditions.
• are pregnant or plan to become pregnant. It is unknown if BENLYSTA will harm your unborn baby. Talk to your healthcare provider about whether to prevent pregnancy while on BENLYSTA. If you choose to prevent pregnancy, you should use an effective method of birth control for at least 4 months after the final dose of BENLYSTA.
• become pregnant while receiving BENLYSTA, talk to your healthcare provider about enrolling in the BENLYSTA Pregnancy Registry. You can enroll in this registry by calling 1-877-311-8972 or go to https://mothertobaby.org/ongoing-study/benlysta-belimumab/
• are breastfeeding or plan to breastfeed. It is unknown if BENLYSTA passes into your breast milk.
Possible side effects of BENLYSTA
• Progressive multifocal leukoencephalopathy (PML). PML is a serious and life-threatening brain infection. PML can result in death or severe disability. Tell your healthcare provider right away if you notice any new or worsening medical problems: memory loss, trouble thinking, dizziness or loss of balance, difficulty talking or walking, or loss of vision.
• Cancer. Medicines that affect the immune system, including BENLYSTA, may increase your risk of certain cancers.
The most common side effects of BENLYSTA are nausea, diarrhea, fever, stuffy or runny nose and sore throat, persistent cough, trouble sleeping, leg or arm pain, depression, headache, and pain, redness, itching, or swelling at the site of injection (when given subcutaneously). These are not all the possible side effects of BENLYSTA. Call your doctor for medical advice about side effects.
Please see Prescribing Information and Medication Guide for BENLYSTA.
What is BENLYSTA?
BENLYSTA is a prescription medicine used to treat people 5 years of age and older with active systemic lupus erythematosus (SLE or lupus) or active lupus nephritis (LN) (lupus-related kidney inflammation) who are receiving other lupus medicines. It is not known if BENLYSTA is safe/effective in people with severe active central nervous system lupus.
It is not known if BENLYSTA, given under the skin, is safe/effective in:
• children with SLE under 5 years of age or weighing less than 33 lbs
• children with LN under 18 years of age
It is not known if BENLYSTA, given in a vein (intravenously), is safe and effective in children less than 5 years of age.
BENLYSTA IV is available as 120 mg in a 5-mL single-dose vial and 400 mg in a 20-mL single-dose vial. BENLYSTA SC is available as a 200 mg/mL single-dose autoinjector and prefilled syringe.
Trademarks owned by or licensed to the GSK group of companies.
©2024 GSK or licensor.
PMUS-BELWCNT240036 October 2024
Produced in USA.
Also, not all women are affected equally: White women, for example are less affected than women who are:
African American
Hispanic
Native American
Asian
Have researchers figured out why lupus affects more women than men?
Many autoimmune diseases tend to affect people assigned female gender at birth more. Why? One theory suggests this is due to chromosomal differences between people of different sex. It’s pretty complex, but we’ll try to simplify here.
Chromosomes are packages of DNA in our cells. Women are usually born with two X chromosomes, and men usually have one X chromosome. Within a chromosome, there are several genes. Think about it this way: A chromosome is like a cookbook, and the genes are the recipes. They give instructions on how the body should look and work. Together they determine the color of a person’s hair, how tall you should be, and everything else that makes you who you are.
Because women have two X chromosomes, they have the potential to have two sets of genes. The more X chromosomes a person has, the more estrogen their body can make. Research has found that in lupus, the immune system may be abnormally activated by estrogen. Once activated, the immune system may mistakenly begin attacking healthy cells throughout the body. This process is known as autoimmunity.
This theory may also explain why some men are more prone to developing lupus. In fact, men with multiple X chromosomes (Klinefelter’s syndrome) are 14 times more likely to develop lupus when compared to men who do not have additional X chromosomes.
More research is still needed to completely understand this process. The relationship between the immune system and all hormones, including estrogen, is incredibly complex.
Do oral contraceptives or hormone replacement therapy increase the risk of lupus?
As we mentioned, the link between estrogen and autoimmunity is complex. Some research suggests there may be a link between oral contraceptives (“the pill”) and post-menopausal hormone replacement therapy and an increased risk of lupus. However, other research has not. Also, studies have not shown an increased risk of lupus flares from oral contraceptives or hormone replacement therapy.
To be clear, the exact cause of lupus is unknown. It appears to be related to an interaction between a person’s genetics, environment, and hormones. Experts think that some people are more likely to get lupus for genetic reasons. Certain hormones and triggers in their environment make it even more likely to develop.
Clearly, more research is needed to explain how hormones like estrogen affect a person’s risk for autoimmune disease. If you have lupus and have questions about whether oral contraceptives or hormone replacement therapy are right for you, be sure to speak with your healthcare provider.
Are symptoms and treatment methods different for men with lupus?
No, lupus is lupus, no matter your sex or gender. For the most part, symptoms are typically the same and so is the treatment.
However, it is commonly believed that men cannot develop lupus. This may lead to them receiving their diagnosis much later and potentially when their disease is more severe. In fact, lupus has been linked to more severe organ damage in men and faster disease progression. This often means men require treatments with more powerful medications.
Does lupus affect the menstrual cycle?
Yes, lupus may affect the menstrual cycle and the menstrual cycle can affect lupus. In fact, for some people, lupus can flare in the premenstrual part of the menstrual cycle.
The menstrual irregularities caused by lupus can range from irregular and fewer cycles (called oligomenorrhea) to the complete absence of a menstrual cycle (called amenorrhea). Research indicates that irregular menstrual cycles may be more likely in people with more severe lupus symptoms.
If you have lupus, you may also experience menopause at an earlier age. Menopause is when your cycle completely stops. Early menopause can be caused by lupus itself, but it can also happen after treatment with a medication called cyclophosphamide, which works by suppressing the immune system.
Can lupus affect a woman’s fertility?
There is no direct link between lupus and infertility (difficulty getting pregnant). However, your fertility may be affected if you were treated with cyclophosphamide. This medication can decrease the number of eggs available for fertilization.
Are women with lupus likely to pass it down to their children?
Lupus has been found in families, but genes are not the only cause. Children of parents with lupus are more likely to get it, but that does not mean they will absolutely get it. As discussed, there are other factors that go into the development of autoimmune disorders like lupus.
The bottom line
All people can develop lupus, although it is much more common in people assigned female gender at birth. Research suggests this is due to an interaction between estrogen and the immune system. Lupus symptoms and treatments are usually the same in all people, but men are usually diagnosed much later in their disease and therefore may have more advanced lupus.
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