Why are women’s bodies under attack from autoimmune diseases?

Almost 80 per cent of people affected by autoimmune disorders are women, with the sex difference varying depending on specific conditions.

This astonishing percentage is a result of a distinction between sex chromosomes, hormones and different gut microbes which play a part in why women’s bodies are under attack.

Your immune system is made up of organs and cells meant to protect your body. An autoimmune disease is the result of the immune system accidentally attacking your body instead of protecting it. The causes for the prevalence of autoimmune disorders in women have long been a mystery, with researchers only beginning to understand why women are affected more than men with an insight into the various mix of risk factors, causes and symptoms. With more than 80 different types of disorders that affect varying parts of the body, the aches and pains women experience are often put down to the stresses of life, when in fact they may be connected to an underlying autoimmune disease.

Dr Diane Bennis, a GP with Webdoctor.ie, says that “many autoimmune disorders tend to affect women during periods of stress, such as pregnancy or when there are hormonal changes. Normally, the immune system will attack foreign antigens only and produce a response to the antigens. In the case of autoimmune disorders, the immune system is unable to differentiate between foreign antigens and its own host cells. When this happens, the body makes autoantibodies that attack normal cells. At the same time, special cells called regulatory T-cells fail to do their job of keeping the immune system in check. The result is an attack on your own body. This causes the damage we know as autoimmune disease.”

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Dr Bennis further explains that “it is now also thought that molecular mimicry plays a part in the process. Molecular mimicry is a mechanism in which a foreign antigen holds structural similarities to self-antigens. The research around its association with autoimmune conditions is ongoing, but molecular mimicry remains a key mechanism that might be involved in the initiation of autoimmunity.”

Women are advised to be aware of the potential for the onset of autoimmune diseases as a leading cause of death and the symptoms attributable. The most common autoimmune diseases in women include alopecia areata, autoimmune hepatitis, coeliac disease, overactive thyroid, underactive thyroid, inflammatory bowel disease, multiple sclerosis (MS), psoriasis, lupus, and rheumatoid arthritis.

“Autoimmune disease can affect almost any part of the body and often affects multiple systems at the same time,” says Dr Bennis. “Therefore, the symptoms can be very varied. Although each disease is unique, many share typical symptoms.”

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These symptoms include but are not limited to fatigue, joint pain and swelling, skin problems, abdominal bloating and pain or digestive issues, recurring fever and swollen glands, weight loss or weight gain, irritability, heat sensitivity, weakness, muscle aches and stiff joints, and swollen glands.

Autoimmune diseases hold many risk factors with gender being one. “Overall, 78 per cent of people affected by autoimmune disease are female,” says Dr Bennis. “In some conditions it is even higher. For example, in systemic lupus erythematosus, a disease that can damage the joints, skin, kidneys, heart, lungs, and other parts of the body, also called SLE or lupus, up to 95 per cent are women.”

In addition to the difficulty in diagnosing these conditions, women are at danger of being ignored or silenced when presenting with conditions that describe unexplained fatigue, pain, or digestive issues

Genetics play a further risk with autoimmune conditions running in families. Hormonal changes, obesity, smoking, and infections are additional risk factors. Dr Bennis also reiterates that already having an autoimmune disease may mean you are more at risk of developing another autoimmune disease, with it not uncommon for women to be diagnosed with more than one condition.

“Many individuals are predisposed to autoimmune disorders, and the disease is then thought to be activated by triggers such as diet and lifestyle,” says Dr Bennis. “Stress and poor sleep are also thought to be triggers. Other triggers, such as hormonal changes during puberty, pregnancy and menopause, cannot be changed. Women predisposed to autoimmune conditions may be able to lessen the severity or prevent the condition from arising altogether by not smoking, avoiding excessive alcohol, having a healthy diet and lifestyle, reducing stress factors, and developing a good sleep routine. Because autoimmune disorders are often hereditary it is also important to know your full family history.”

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Diagnosing an autoimmune disease can be challenging as the varied and non-specific symptoms can be attributed to more than one condition and there is no single test available to diagnose. Considering there is also a risk of developing further autoimmune conditions if one is already present, the waters are significantly muddied.

“Many of the symptoms also occur in other illnesses,” says Dr Bennis. “The symptoms typically come and go, and the patient can have periods of remission and flare-ups. Symptoms can be mild or severe and they can be confusing for the patient.”

In addition to the difficulty in diagnosing these conditions, women are at danger of being ignored or silenced when presenting with conditions that describe unexplained fatigue, pain or digestive issues. The gender gap in medicine creates a significant negative effect on the quality of healthcare women receive. This can and has led to substantial delays in diagnosis or misdiagnosis. In the worst cases, it has led to death.

Patients, doctors and researchers can all hold biased views regarding gender which can have a significant impact on an individual’s health outcome. A patient may unconsciously lean towards the bias and brush their own symptoms aside with a predisposed belief that women hold their pain and carry on. Doctors and researchers can work off associated generalisations leading to women’s health being underresearched or inaccurately diagnosed.

“The gender bias plays a role in the difficulty in the diagnosis of autoimmune diseases,” says Dr Bennis. “Gender bias in health can affect diagnosis, treatment and outcomes. Both patients and doctors can hold biased views about gender and these views can have a serious impact on health outcomes and can add to the difficulty in diagnosing autoimmune diseases.”