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Sjögren’s Risk in Women with Low Estrogen Levels

Women who have primary Sjögren’s Syndrome also have decreased lifetime exposure to estrogen, a new study finds.

Women who have primary Sjögren’s Syndrome also have decreased lifetime exposure to estrogen, a new study finds.

In research published in a recent Arthritis Care & Research issue, investigators determined women who have lower estrogen levels and who have fewer years menstruating have a higher likelihood of developing primary Sjögren’s.

“Our findings suggest cumulative estrogen exposure may have a modulating effect on factors that predispose women to autoimmune disease,” said study author Sara McCoy, M.D., a rheumatologist with the University of Wisconsin School of Medicine and Public Health. “In the case of primary Sjögren’s Syndrome, lower cumulative estrogen exposure appears to augment the clinical expression of disease.”

To analyze the role that sex hormone exposure plays with the development of primary Sjögren’s, researchers examined reproductive and menstrual factors in 1,320 women with primary Sjögren’s Syndrome and 1,360 women who only experience the dryness associated with this condition but no other symptoms. Researchers included the age of first period and the age of menopause, as well as the number of full-term pregnancies and miscarriages. They also included any use of female hormones and hysterectomy history.

According to results, women with primary Sjögren’s Syndrome had a significantly reduced cumulative estrogen exposure when compared with women who only experienced dryness. Women with primary Sjögren’s who had the highest estrogen levels did have statistically-significantly reduced risk for abnormal cornea changes, increased immunoglobulin, rheumatoid factor, and anti-Sjögren’s antibodies when compared to women with lower estrogen levels. They did, however, have an increased arthritis risk.

Conversely, women with more cumulative years menstruating experienced an inverse association with inflammatory arthritis, but those cumulative years showed no association with anemia, increased immunoglobulin, rheumatoid factor, or anti-Sjögren’s antibodies. Researchers did determine, however, that fewer menstruating years could play a role in the development of dry eye or dry mouth symptoms, making it harder for clinicians to pinpoint women with primary Sjögren’s.


McCoyS, Sampene E, Baer A. "Sjögren’s Syndrome is Associated With Reduced Lifetime Sex Hormone Exposure: A Case-Control Study." Arthritis Care & Research (2019), doi: 10.1002/acr.24014.