By: Tori Lee Cartwright, DO
Editor’s Note: The article featured this week is titled, “The Prevalence of Autoimmune Disorders in Women: A Narrative Review.” [1] It was published in 2020 by Angum et al. Dr. Tori Lee Cartwright summarized highlights from the article while on the FACTS online elective for medical students. Although the authors did not address the role of fertility awareness-based methods (FABMs) in autoimmune diseases, Dr. Cartwright identified potential benefits of charting and using FABMs as these patients manage their symptoms.
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Introduction
Autoimmune diseases, conditions in which the immune system attacks itself, show a greater predilection for women; 80% of individuals affected by these conditions are women. For many of these conditions, such as systemic lupus erythematosus (SLE), the age of onset is around the time when many couples are attempting to conceive. The article, “The Prevalence of Autoimmune Disorders in Women: A Narrative Review,” [1] dives into some of the hypotheses for this disparity as well as common triggers for these conditions.
“Autoimmune diseases, conditions in which the immune system attacks itself, show a greater predilection for women; 80% of individuals affected by these conditions are women.”
Cellular Factors and X Inactivation
Molecular mimicry, or the ability of a foreign antigen to display a similar structure to a self-antigen, is a common explanation for why the body may mistakenly attack itself in autoimmune diseases. The authors also discuss other theories for these autoimmune responses, especially in women. One possibility is that the presence of two X chromosomes in women’s genetic make-up predisposes them to these conditions. Having two X chromosomes means they must undergo a process called X inactivation, which randomly selects genes to express from one of the two X chromosomes in each cell. Thus, a woman’s genetic expression varies from cell to cell and is a combination of genes from both parents. This could cause cells to not recognize each other, viewing one another as foreign, and triggering an autoimmune attack.
The process of X inactivation is essential in preventing overexpression of genes, especially those with roles in the immune system. The authors cite a study that discovered a deficiency in X inactivation in T cells from the thymus of female human and mouse cells. This deficiency leads to an overexpression of immune genes which will, in turn, create autoantibodies. This is one of the leading theories for SLE.
The Role of FABMs in Autoimmune Diseases
The article also mentions triggers for many autoimmune diseases, such as psoriasis; triggers include increased levels of stress, inadequate sleep, and changes in hormone levels. This is pivotal information to approach patient care with a holistic mindset. Fertility awareness-based methods (FABMs) such as the Creighton Model could be extremely useful for these patients. The charting that is central to this method is not only helpful to achieve or avoid pregnancy but can also be used to gather clues into a woman’s hormone levels.
“Triggers for many autoimmune diseases, such as psoriasis, … include increased levels of stress, inadequate sleep, and changes in hormone levels.”
The authors discuss the theory that some autoimmune diseases, such as rheumatoid arthritis and Sjogren’s syndrome, are linked to a decrease in estrogen levels. This means pregnancy could be considered protective against development of these conditions; on the other hand, chronic low estrogen levels could act as a trigger.
Charting May Signal Triggers and Root Causes
Medical professionals trained in the Creighton Model may notice chart patterns that could indicate abnormal hormone levels that warrant further investigation and give insight into another way to manage symptoms caused by an autoimmune disease. As patients learn more about their triggers, such as hormone changes, they may prefer a non-hormonal way to prevent pregnancy, and FABMs can be a valuable tool for them. After meeting with a clinician and learning how to chart with the method she chooses, a woman can avoid pregnancy effectively without exogenous hormones.
“As patients learn more about their triggers, such as hormone changes, they may prefer a non-hormonal way to prevent pregnancy, and FABMs can be a valuable tool for them.”
Learning this connection between stress and autoimmune symptoms is also pertinent for people who are trying to conceive or navigating infertility. This process can be stressful and cause anxiety for many couples, and the stress can induce an autoimmune response in some women. The stress of having such a reaction could, in turn, affect their ability to conceive.
As we learned in the FACTS elective, periods of stress may delay ovulation and decrease cervical mucus, both of which could make trying to get pregnant more difficult and stressful for the couple. By charting with FABMs, a woman can feel more in control and understand what is happening in her body. These methods will also enhance a couple’s likelihood of finding answers as to possible causes for their difficulty getting pregnant.
Future studies in women with autoimmune diseases who use FABMs could assess whether understanding and managing their cycles through charting does indeed help them manage some of their autoimmune disease symptoms. After reading this article by Angum et al and making the connections with what we learned in the FACTS elective, I am even more excited to know about these methods to be able to help patients clinically, beyond achieving or avoiding pregnancy.
Editor’s Note: Learn more about autoimmune diseases and benefits of FABMs in women’s health in this interesting research review: “The Link Between Endometriosis and Chronic Diseases: Empowering Clinicians to Screen More Effectively.”
References
[1] Angum F, Khan T, Kaler J, et al. (May 13, 2020) The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus 12(5): e8094.
ABOUT THE AUTHOR
Tori Cartwright, DO
Tori Cartwright, DO is a graduate of Ohio University Heritage College of Osteopathic Medicine and is currently a family medicine resident at OhioHealth O’Bleness in Athens, OH. She completed her undergraduate education at Ohio State University and earned a master’s degree from the University of Toledo. Dr. Cartwright is a new mom who plans to practice family medicine with an emphasis on women’s health, pediatrics and adolescent care, and osteopathic manipulation. She enrolled in the FACTS elective to gain a better understanding of fertility awareness-based methods, as she has heard many patients in Athens use them, and to gain another resource to help her patients.
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