Managing autoimmune disorders in female patients

Most autoimmune disorders are more prevalent in female patients, and their symptoms and impact on quality of life can vary widely across different conditions and throughout a woman’s lifespan.

Learn more about this topic in the HealthCert Professional Diploma program in Women's Health: fully CPD accredited online women's health training for GPs, quality-assured by Bond University.

Autoimmune disorders are a vast spectrum of conditions characterised by malfunctioning of the body’s immune system to produce an immune response against the body’s own tissue.

Some conditions, such as type 1 diabetes mellitus (T1DM), autoimmune thyroid disease, psoriasis, rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), affect one type of tissue or organ. Others can affect many aspects of the body’s physiology, for example, multiple sclerosis (MS) and systemic lupus erythematosus (SLE).

Some conditions may have relatively quiescent periods, and others may have frequent “flares” or a more progressive nature. 

Risk factors for autoimmune disorders, aside from female sex, include genetic, environmental, and hormonal factors. Women are thought to be disproportionately affected by autoimmune disorders due to the hormonal fluctuations which occur across the lifespan, including puberty, pregnancy and menopause.

Early diagnosis is crucial and poses a particular challenge to the primary care practitioner, as the spectrum of signs and symptoms of autoimmune disease is vast.

Symptoms of autoimmune disorders are often non-specific, such as fatigue and joint pains, and many women diagnosed with autoimmune disorders have experienced a delay in diagnosis. 

Management of autoimmune disorders typically involves a multi-disciplinary team, which may include rheumatology, immunology, endocrinology, and surgery.

Treatment methodologies aim to induce remission, relieve symptoms, improve quality of life, and prevent complications.

Common medications used to treat autoimmune conditions include painkillers (e.g., paracetamol and opiate-based painkillers), hormone replacement (e.g., insulin for T2DM and thyroxine for autoimmune hypothyroidism), anti-inflammatory drugs (e.g., ibuprofen), and corticosteroids. These medications are often commenced and managed in primary care, with input from experts.

In some cases, disease-modifying antirheumatic drugs (DMARDs) and immunomodulatory drugs may be required. An expert usually initiates these; however, ongoing management may be within the outpatient setting.

Patients may require regular examinations or blood tests, which are likely to occur within primary care. Many medications used to treat autoimmune conditions have the side effect of generalised immunosuppression, making patients more prone to infections that the primary care practitioner would manage. 

Female patients with autoimmune disorders pose a particular challenge around fertility and pregnancy. Careful preconception advice is needed as some autoimmune conditions (such as SLE and anti-phospholipid syndrome) affect fertility, and some medications used to treat autoimmune disorders are teratogenic and should not be taken when pregnant, trying to conceive or breastfeeding.

In many cases, optimal preconception management of any autoimmune diseases is crucial to a successful and healthy pregnancy. Many autoimmune conditions require close monitoring during pregnancy, such as T1DM, and women should be encouraged to involve their healthcare practitioners early in pregnancy.

All female patients with autoimmune disorders should be encouraged and empowered to adopt a healthy lifestyle, including stopping smoking, managing weight, regular exercise, and a well-balanced diet. Patients should be educated and supported in self-managing their autoimmune disorder, including recognising patterns of disease activity and triggers for any flares, medication management and when to seek medical assistance.

In conclusion, managing autoimmune disorders in female patients poses a unique challenge to the primary care practitioner. It involves a multi-disciplinary, patient-centred approach to achieve optimum quality of life and reduce the risk of complications.

- Dr Samantha Miller, MBChB

Learn more about this topic in the HealthCert Professional Diploma program in Women's Health: fully CPD accredited online women's health training for GPs, quality-assured by Bond University.

References

1.    US Department of Health and Human Services. Office on Women's Health. Autoimmune Diseases. https://www.womenshealth.gov/a-z-topics/autoimmune-diseases 

2.    Victoria State Government: Department of Health (2014). Autoimmune Disorders https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/autoimmune-disorders 

3.    Desai, M. K., & Brinton, R. D. (2019). Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Frontiers in endocrinology, 10, 265. https://doi.org/10.3389/fendo.2019.00265 

4.    American Autoimmune Association. Autoimmunity. https://autoimmune.org/resource-center/about-autoimmunity/ 

5.    Women’s Healthcare (2022). Current Primary Care Recommendations for Three Common Autoimmune Disorders https://www.npwomenshealthcare.com/current-primary-care-recommendations-for-three-common-autoimmune-disorders/ 

6.    Living Evidence for Diabetes Consortium (2020): Australian Evidence-Based Clinical Guidelines for Diabetes. https://www.diabetessociety.com.au/20211104%20Guideline-Australian-Evidence-Based-Clinical-Guidelines-for-Diabetes.pdf 

7.    Australian Family Physician (2012). Hypothyroidism: Investigation and Management.  https://www.racgp.org.au/afp/2012/august/hypothyroidism 

8.    Australian Prescriber (2019). Immunomodulatory drugs in pregnancy and lactation. https://www.nps.org.au/australian-prescriber/articles/immunomodulatory-drugs-in-pregnancy-and-lactation