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Endometriosis and Lupus: What’s the Connection?

Posted on October 04, 2021
Medically reviewed by
Howard Goodman, M.D.
Article written by
Kristopher Bunting, M.D.

Recent studies have found that people with endometriosis have a higher risk of developing lupus, a type of autoimmune disease. Endometriosis is a chronic gynecological illness that affects approximately 10 percent of all women of reproductive (child-bearing) age. The condition occurs when endometrial tissue that normally lines the inside of the uterus grows in locations outside of the uterus, including the fallopian tubes, ovaries, and other organs in the pelvis and abdomen. The abnormal tissue growth leads to pain and other endometriosis symptoms.

Endometriosis has many common comorbidities (co-occurring conditions), including lupus. If you have endometriosis, here’s what to know about lupus, its connection to endometriosis, and the impact of having both conditions.

What Is Lupus?

Lupus is an autoimmune disease that typically affects the entire body. In an autoimmune disease, the body has an inflammatory immune response against itself. The body creates antibodies (autoantibodies) that mistakenly attack healthy parts of the body.

There are several types of lupus; the most common is systemic lupus erythematosus. The exact cause of lupus is not fully understood, but lupus is associated with inherited and environmental risk factors, including hormones and infection with certain viruses.

Signs and symptoms commonly seen with lupus include:

  • Skin rashes (circular rashes or a butterfly-shaped rash on the face)
  • Joint pain and swelling
  • Fatigue
  • Fever
  • Muscle pain
  • Chest pain
  • Painful breathing
  • Hair loss
  • Sensitivity to sunlight or ultraviolet light
  • Kidney disease (lupus nephritis)
  • Anemia
  • Brain fog or memory problems

Lupus can also cause many severe complications if it’s not properly managed, including kidney failure, heart disease, and dangerous blood clots. Treatment options for lupus include:

  • Over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Disease-modifying antirheumatic drugs, including antimalarial drugs such as hydroxychloroquine
  • Corticosteroids
  • Blood thinners (anticoagulants)
  • Blood pressure medication
  • Antidepressants
  • Anticonvulsants

How Are Endometriosis and Lupus Connected?

Researchers are still unsure of the exact mechanisms that increase the risk of lupus with endometriosis. However, there are some similarities that may contribute.

Signs of Autoimmunity

Endometriosis is not defined as an autoimmune disease. However, endometriosis frequently occurs alongside a range of autoimmune diseases, like lupus, and shares several characteristics.

For instance, autoantibodies against endometrial tissue are sometimes found in people with endometriosis. The immune system fails to recognize proteins in endometrial cells as part of the body and treats them as if they are foreign material.

What’s more, a specific variation of a gene called PTPN22 that’s linked to several autoimmune diseases — vitiligo, type 1 diabetes, rheumatoid arthritis, and lupus, to name a few — has also been linked to endometriosis. There is no evidence of cause and effect between autoimmune disease and endometriosis, but these conditions may have a shared underlying cause.

Effect of Hormones

Both endometriosis and lupus are affected by estrogen. Lupus flares and worsening endometriosis symptoms often coincide with elevated estrogen levels during the menstrual cycle. In addition, 90 percent of people with lupus are women, suggesting a hormonal connection.

Response to Antimalarials

Another connection between endometriosis and lupus is that they both respond to antimalarial drugs such as hydroxychloroquine. Antimalarials currently used to treat lupus also show promise in treating endometriosis, according to animal research. Furthermore, antimalarials may actually reduce the risk of endometriosis in people with lupus.

The Impact of Lupus on Endometriosis

Having lupus can complicate endometriosis in several ways. Lupus can cause pain in addition to the pain of endometriosis, which can make pain management more difficult. Both lupus and endometriosis are exacerbated by high estrogen levels, meaning that lupus flares and increased endometriosis symptoms may often occur together. Lupus also puts you at an increased risk of infection and slow healing due to immune dysfunction, which can make surgery for endometriosis more risky with a longer recovery time.

One very significant effect that lupus can have on endometriosis is limiting your choice of birth control methods. Certain types of hormonal contraception can worsen symptoms or are unsafe in certain people with lupus. The most effective forms of birth control that are safe for people with lupus are tubal ligation, intrauterine devices, and birth control implants.

On the positive side, treating lupus with antimalarial drugs can also help treat or prevent endometriosis. Treatments for lupus and endometriosis do not have much overlap, but care must be taken to check for interactions between medications when treating multiple medical conditions.

Managing Lupus and Endometriosis

Lupus and endometriosis are chronic diseases that can be difficult to diagnose and are often overlooked by health care providers. Endometriosis, lupus, and other autoimmune diseases often occur together — if you have one, make sure your doctor looks for others before settling on a single diagnosis. Early detection can prevent complications from lupus and improve quality of life. Together, you and your health care team can create the right management plan to keep pain, fatigue, and other symptoms of either condition under better control.

Talk With Others Who Understand

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 120,600 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

Are you living with endometriosis and lupus? Share your experience in the comments below, or start a conversation by posting on MyEndometriosisTeam.

References
  1. Endometriosis: Diagnosis and Treatment — Mayo Clinic
  2. Endometriosis — World Health Organization
  3. Causes of Lupus — Johns Hopkins Lupus Center
  4. What Causes Lupus? — Lupus Foundation of America
  5. PTPN22 Gene — MedlinePlus
  6. Lupus — Mayo Clinic
  7. Lupus Blood Tests — Johns Hopkins Lupus Center
  8. Finding the Treatment Approach for You — Lupus Foundation of America
  9. Autoimmune Diseases — National Institute of Arthritis and Musculoskeletal and Skin Diseases
  10. The Association Between Endometriosis and Autoimmune Diseases: A Systematic Review and Meta-Analysis — Human Reproduction Update
  11. High Rates of Autoimmune and Endocrine Disorders, Fibromyalgia, Chronic Fatigue Syndrome, and Atopic Diseases Among Women With Endometriosis: A Survey Analysis — Human Reproduction
  12. The Co-Occurrence of Endometriosis With Multiple Sclerosis, Systemic Lupus Erythematosus, and Sjögren Syndrome — Human Reproduction
  13. What Is a Lupus Flare? — Lupus Foundation of America
  14. Antinuclear Antibodies in Endometriosis and Systemic Lupus Erythematosus: Comparative Analysis and the Observation of a New Autoantibody Directed to a 78 kDa Protein — Fertility and Sterility
  15. Occurrence of Antinuclear Antibodies in Women With Endometriosis and Unexplained Infertility — Ginekologia Polska
  16. Effect of Hydroxychloroquine and Characterization of Autophagy in a Mouse Model of Endometriosis — Cell Death & Disease
  17. Hydroxychloroquine Might Reduce Risk of Incident Endometriosis in Patients With Systemic Lupus Erythematosus: A Retrospective Population-Based Cohort Study — Lupus
  18. Association Between Endometriosis and Risk of Systemic Lupus Erythematosus — Scientific Reports
  19. Endometriosis and Systemic Lupus Erythematosus: A Population-Based Case-Control Study — Lupus
  20. Lupus and the Joints, Muscles, and Bones — Lupus Foundation of America
  21. Lupus and Your Risk of Infections — Lupus Foundation of America
  22. How Lupus Affects the Kidneys — Johns Hopkins Lupus Center
  23. Drug Interactions: Understanding the Risk — U.S. Food and Drug Administration
  24. Birth Control for Women With Lupus — HOP-STEP
  25. Types of Lupus — John Hopkins Medicine
Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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