Key takeaways:
Systemic lupus erythematosus (lupus) is a complex autoimmune disease that can affect anyone, although it mainly affects women.
Scientists aren’t exactly sure what causes lupus or why lupus affects women more than men. Genes, hormones, and the environment all likely play a role.
All people with lupus experience similar symptoms, but they may be more severe in men.
Systemic lupus erythematosus (SLE) is an autoimmune condition that causes a wide range of symptoms and can affect any part of your body. Lupus is much more common in women than men. In fact, many autoimmune conditions, including rheumatoid arthritis and multiple sclerosis, are more common in women than men.
How much more common is lupus in women than men?
Lupus is much more common in women than men. In fact, rates of lupus are nine times higher in women than in men. But lupus doesn’t equally affect all women. White women, for example, are less affected than women who are:
African American
Hispanic and Latino
Native American
Asian
Lupus can also affect children, though women of reproductive age have the highest risk of developing lupus.
Why is lupus more common in women?
Many autoimmune diseases tend to affect women more than men. But scientists don’t yet know why lupus is more common in women.
There’s no single identifiable cause of lupus. But there are a few possible reasons it more commonly affects women, including genetic and hormonal differences.
Genes
Chromosomes are packages of DNA in your cells. Women are usually born with two X chromosomes, and men usually have one X chromosome. Within a chromosome, there are several genes. Your parents pass down this genetic information to you. And the genes you inherit determine many things about you, like the color of your hair, height, and chances of developing certain health conditions.
Because women have two X chromosomes, they have the potential to have two sets of genes. A complex process called “X chromosome inactivation” occurs in women’s bodies to prevent these two X chromosomes from doubling the proteins they make. While this process is helpful, it may lead to the development of autoantibodies. These antibodies attack your body’s own tissues. And this may play a part in autoimmune diseases like lupus.
Differences in chromosomes may explain why some men are more prone to developing lupus. In fact, men with multiple X chromosomes (Klinefelter syndrome) are 14 times more likely to develop lupus when compared to men who don’t have additional X chromosomes.
Hormones
Scientists are also studying how hormones like estrogen may play a role in lupus. The more X chromosomes you have, the more estrogen your body can make. Women typically have higher levels of estrogen than men. And the symptoms of lupus tend to peak when estrogen levels are particularly high — during pregnancy and before menstruation.
Research has found that estrogen may abnormally activate the immune system in people with lupus. Once activated, the immune system may mistakenly attack healthy cells throughout the body.
The relationship between the immune system, genes, and hormones is very complex. More research is needed to better understand the different factors at play in the development of lupus.
Do oral contraceptives or menopausal hormone therapy increase the risk of lupus?
Some research suggests there may be a link between oral contraceptives (“the pill”) and menopausal hormone therapy and an increased risk of lupus. But not all research has found this link. Also, studies haven’t shown an increased risk of lupus flares from birth control pills or hormone therapy for menopause.
To be clear, the exact cause of lupus is unknown. And multiple factors are likely at play, including genetics, hormones, and the environment. 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.
If you have lupus and have questions about whether oral contraceptives with estrogen or menopausal hormone therapy are right for you, be sure to speak with your healthcare team.
Does lupus affect the menstrual cycle?
Yes, lupus may affect your menstrual cycle. And your menstrual cycle can affect lupus symptoms. Some people experience lupus flares in the premenstrual part of their menstrual cycle.
Menstrual changes caused by lupus can range from irregular periods and fewer cycles (oligomenorrhea) to the complete absence of a menstrual cycle (amenorrhea). Research shows 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 cyclophosphamide, a lupus medication that works by suppressing the immune system.
Can lupus affect a woman’s fertility?
There’s no direct link between lupus and infertility (difficulty getting pregnant). But treatment with cyclophosphamide can affect your ability to get pregnant. This medication can lower how many eggs are available for fertilization.
Good to know: Lupus raises the risk of complications during pregnancy. But there are ways to make your pregnancy as safe as possible. If you’re living with lupus and interested in becoming pregnant, work closely with your healthcare team to understand your options.
Are women with lupus likely to pass it down to their children?
Lupus has been found in families, but genes aren’t the only cause. Children of parents with lupus are more likely to get it, but that doesn’t mean they will definitely get it.
Frequently asked questions
Lupus can be challenging to diagnose in women and men alike. It can cause a very wide range of symptoms, and these symptoms can be hard to tell apart from other autoimmune conditions.
So if a healthcare professional suspects lupus, they’ll consider your symptoms and medical history as well as your family history. There’s no specific test that can diagnose lupus, but there are a few lab tests that can provide important clues. A blood test to look for antinuclear antibodies (ANA) is particularly helpful. Almost all people with lupus have ANA in their blood.
Lupus symptoms are typically the same in men and women. Treatment can also be similar.
But lupus is much less common in men, which means it can get overlooked until the condition is in a later stage. 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.
Lupus isn’t contagious, so you won’t contract it by coming into contact with someone with the condition.
Lupus can be challenging to diagnose in women and men alike. It can cause a very wide range of symptoms, and these symptoms can be hard to tell apart from other autoimmune conditions.
So if a healthcare professional suspects lupus, they’ll consider your symptoms and medical history as well as your family history. There’s no specific test that can diagnose lupus, but there are a few lab tests that can provide important clues. A blood test to look for antinuclear antibodies (ANA) is particularly helpful. Almost all people with lupus have ANA in their blood.
Lupus symptoms are typically the same in men and women. Treatment can also be similar.
But lupus is much less common in men, which means it can get overlooked until the condition is in a later stage. 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.
Lupus isn’t contagious, so you won’t contract it by coming into contact with someone with the condition.
The bottom line
Lupus can affect anyone, including children. But it’s much more common in women. There’s no single cause of lupus, and it can take time to make the diagnosis. Researchers continue to study how genes, hormones, and environmental factors play a role in autoimmune conditions like lupus.
Living with lupus can be challenging. A healthcare professional can work with you to find treatments and resources to manage your symptoms and prevent flares.
Why trust our experts?
References
Andrade, R. M., et al. (2007). Accelerated damage accrual among men with systemic lupus erythematosus: XLIV. Results from a multiethnic US cohort. Arthritis & Rheumatology.
Ceccarelli, F., et al. (2020). Premature ovarian failure in patients affected by systemic lupus erythematosus: A cross-sectional study. Clinical and Experimental Rheumatology.
Centers for Disease Control and Prevention. (2024). People with lupus.
Costenbader, K. H., et al. (2007). Reproductive and menopausal factors and risk of systemic lupus erythematosus in women. Arthritis & Rheumatology.
do Socorro Teixeira Moreira Almeida, M., et al. (2011). Male systemic lupus erythematosus, an overlooked diagnosis. Clinics and Practice.
Elbakry, S. A., et al. (2020). Impact of cyclophosphamide on gonadotropins in menopausal systemic lupus erythematosus patients: Relation to disease activity and damage. The Egyptian Rheumatologist.
Goldman, B. (2024). Stanford Medicine-led study shows why women are at greater risk of autoimmune disease. Stanford Medicine.
Izmirly, P. M., et al. (2021). Prevalence of systemic lupus erythematosus in the United States: Estimates from a meta-analysis of the Centers for Disease Control and Prevention National Lupus Registries. Arthritis & Rheumatology.
Lupus Foundation of America. (2024). What causes lupus?
Moulton, V. R. (2018). Sex hormones in acquired immunity and autoimmune disease. Frontiers in Immunology.
National Human Genome Research Institute. (2020). Chromosomes fact sheet.
Petri, M., et al. (2005). Combined oral contraceptives in women with systemic lupus erythematosus. The New England Journal of Medicine.
Pons-Estel, G. J., et al. (2010). Understanding the epidemiology and progression of systemic lupus erythematosus. Seminars in Arthritis and Rheumatism.
Rojas-Villarraga, A., et al. (2014). Safety of hormonal replacement therapy and oral contraceptives in systemic lupus erythematosus: A systematic review and meta-analysis. PLOS One.
Sánchez-Guerrero, J., et al. (2007). Menopause hormonal therapy in women with systemic lupus erythematosus. Arthritis & Rheumatology.
Scofield, R. H., et al. (2008). Klinefelter’s syndrome (47,XXY) in male systemic lupus erythematosus patients: Support for the notion of a gene-dose effect from the X chromosome. Arthritis & Rheumatology.
Shabanova, S. S., et al. (2008). Ovarian function and disease activity in patients with systemic lupus erythematosus. Clinical and Experimental Rheumatology.
Schwartzman-Morris, J., et al. (2012). Gender differences in the pathogenesis and outcome of lupus and of lupus nephritis. Journal of Immunology Research.
