Doctors advise you to approach HRT with caution if you have lupus. HRT may increase the risk of flares or blood clots in some people. There are factors that you need to consider if you have lupus and are looking at HRT as a treatment option for hormonal imbalances or other conditions.

Hormone replacement therapy (HRT) can be a vital treatment option for managing various hormonal imbalances and conditions.

However, for individuals with lupus, HRT — particularly treatments that contain estrogen — may have specific risks, such as potential disease flares and blood clots.

Understanding whether HRT is safe for you or whether other options are better for your situation can help you make informed choices.

HRT may worsen lupus symptoms or trigger disease flares in some people.

Here’s how different hormones in HRT may affect lupus:

  • Estrogen: Estrogen can stimulate the immune system, worsen lupus symptoms, or trigger disease flares.
  • Progesterone: Progesterone generally has immunosuppressive and anti-inflammatory effects and may help balance the immune response. It may be safer for people with lupus. However, healthcare professionals often use progesterone in combination with estrogen in HRT.
  • Testosterone: There is no strong evidence that testosterone worsens lupus. Some studies in mice suggest a possible beneficial effect on lupus by reducing the activity of the immune system.

However, as each person is unique, the effect of hormones on symptoms will vary.

It’s important to monitor your symptoms closely and speak with a healthcare professional if you notice any new or worsening symptoms.

While some people with lupus tolerate HRT well, other people may experience flares or other side effects, particularly with estrogen-based HRT.

This is more common in certain instances, such as if you have active disease or antiphospholipid (aPL) antibodies.

People with lupus are more likely to have aPL antibodies, which target phospholipids. Phospholipids are an essential part of cell membranes. Having aPL antibodies can increase your risk of blood clots, pregnancy loss, and other health issues.

HRT for menopause in people with lupus

HRT may be safe for people with lupus in certain instances.

One 2022 review involving 16 studies found that HRT can help manage menopausal symptoms without the extra risk in most cases.

Most studies did not show worsening lupus or increased risk of thrombosis. However, one clinical trial found that HRT increased the number of blood clots.

If you are considering HRT and you have lupus, it’s best to discuss your options with a doctor.

You may be a more suitable candidate for HRT if the following factors apply:

  • You have stable lupus: HRT may be safer for you if you live with inactive or well-controlled lupus (no recent flares).
  • You do not have aPL antibodies: Around 30% of women with lupus have aPL antibodies which are related to a high risk of venous and arterial thrombosis. As HRT also increases the risk of blood clots, if you have aPL antibodies, HRT may not be suitable for you.
  • You have no history of thrombosis: HRT is related to a slight increase in the risk of thrombosis. So, if you have a history of blood clots, your doctor may not recommend HRT for you.

Speak with a healthcare professional about any concerns you have regarding HRT to make sure it’s suitable for your individual needs.

HRT for gender affirming care in people with lupus

Healthcare professionals can use HRT as a part of gender affirming care. Some case studies suggest that trans women may develop new autoimmune conditions following estrogen therapy.

However, long-term studies that explore how hormonal therapy affects the immune system in transgender individuals aren’t available.

It’s important to consult healthcare professionals who have experience in both transgender health and autoimmune diseases to tailor your treatment.

HRT, which contains estrogen, might concern people with lupus because it can increase immune system activity.

Alternatives to this type of HRT include:

  • Non-oral estrogen: Doctors usually recommend transdermal (patch or gel) or vaginal estrogen over oral forms. These methods may have a lower effect on coagulation and a lower risk of blood clots.
  • Progesterone or pregnane derivatives: Natural progesterone or its derivatives may be a better option for some people. These forms tend to have fewer side effects than synthetic options.
  • Lower doses: Using the lowest dose that is still effective can help reduce the risk of side effects.
  • Nonhormonal therapy: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be useful if you cannot take hormonal medications. Examples of SSRIs for hot flashes include paroxetine, citalopram, and escitalopram. SNRIs include venlafaxine and desvenlafaxine.

Speak with a healthcare professional about alternatives that may be suitable for you.

If you have lupus, you can still explore hormone replacement therapy (HRT), but it’s essential to work with your doctor to minimize potential risks.

Estrogen-based HRT carries the highest risk of flares, while alternatives like progesterone or testosterone may be safer.

With the right care plan and regular monitoring, HRT can still be a part of your treatment journey, helping you manage symptoms and improve your well-being.