Why do women face a higher autoimmune risk?

When you think of joint pain, fatigue, and wrist stiffness, you might picture an elderly person. However, what if you were told that these symptoms could affect you even in your 30s? And what if you learned that your risk is even higher if you’re a woman?

Dr Anna Farazilah Mohd Salleh, a rheumatologist and internal medicine consultant in Malaysia, emphasises that arthritis can occur at any age. “Someone once told me that, as a rheumatologist, the elderly would be my closest patients. But we see so many young individuals suffering from inflammatory arthritis. Unfortunately, awareness is low, symptoms are often ignored, and diagnosis is delayed,” she explains. Alarmingly, nearly 80% of individuals with autoimmune diseases are women.

Charishma Cohen, who grew up in Bengaluru and moved to the US at 20, never imagined facing a major health challenge so early in life. In 2011, she was diagnosed with rheumatoid arthritis, an autoimmune disease.

Autoimmune diseases occur when the body’s immune system mistakenly attacks its own healthy tissues, cells, and organs. These conditions can present with varying degrees of severity, and symptoms may come and go. Examples include psoriasis, lupus, rheumatoid arthritis, type 1 diabetes, celiac disease, and multiple sclerosis. While there is no cure, symptoms can be managed with proper treatment.

“It was important for me to take a holistic approach to managing my rheumatoid arthritis rather than solely relying on immunosuppressants, which can significantly impact quality of life. With my rheumatologist’s approval, I explored Ayurvedic medicine alongside lifestyle changes. During flare-ups, I followed an anti-inflammatory diet, eliminating gluten and dairy. I also took supplements to support gut health, practised mindfulness, improved my sleep, and reduced stress,” Cohen shares.

Fiza Taj Samadh, a physiotherapist in Bengaluru, has been helping patients with autoimmune disorders. “Most of our patients come in with symptoms such as muscle fatigue, joint pain, postural imbalances, and coordination difficulties. We focus on pain management and reducing inflammation using techniques like dry needling and cupping. Rehabilitation Pilates, and strength training also play a crucial role in restoring independence in daily activities,” she explains.

Unfortunately, autoimmune diseases disproportionately affect women. The reasons for this disparity include hormonal differences, X chromosomes, genetic predispositions, environmental factors, and variations in immune system function. Samadh elaborates, “Women generally have a stronger immune response than men, which helps them fight infections. However, this heightened response can also make them more susceptible to autoimmune conditions. An overactive immune system may mistakenly attack the body’s own tissues, leading to these disorders.”

Experts also highlight the role of stress. In The Mel Robbins Podcast, trauma expert Dr Gabor Maté explains that women often prioritise the emotional needs of others over their own. They tend to equate their self-worth with duty and responsibility, feeling accountable for the emotions of those around them. This societal expectation, rather than biological differences alone, may contribute to higher rates of autoimmune diseases among women.

Having lived with the condition for over a decade, Cohen sees a connection. “I’ve read a lot about how high stress levels can trigger flare-ups,” she notes. Cohen, who holds a PhD in electrical engineering, left her corporate job two years ago. Now, she is a full-time content creator, sharing her experiences and learning from other women affected by autoimmune diseases. Through her work, she strives to raise awareness about these conditions.

Understanding the risks and triggers is crucial. Dr Salleh points out, “Rheumatology is often overlooked. Patients with rheumatic diseases present with vague symptoms that are frequently dismissed. Joint pain and swelling are ignored because patients are perceived as too young or too old to be taken seriously. Symptoms like hair loss and skin rashes are mistaken for cosmetic issues rather than being recognised as signs of autoimmune disease.” She emphasises that autoimmune diseases deserve the same level of attention and urgency as cancer, heart disease, and stroke.

Samadh underscores the importance of education and self-awareness in managing autoimmune conditions. “Recognising early symptoms and adopting a holistic, proactive approach with a positive mindset can make a significant difference,” she advises.

While women are up to four times more likely to develop autoimmune diseases due to factors beyond their control, early diagnosis and awareness can be the first step towards better health and an improved quality of life.