Why Lupus (SLE) Affects Women More Than 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). 

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. 

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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