Who run the world? Girls. And some of us have psoriasis.

So let’s look at how our hormones impact the chronic skin condition.

For starters, let’s define psoriasis. Just in case you’re not really sure about it.

Psoriasis is a long-term (chronic) skin condition. It’s also an auto-immune disease. This is because infection-fighting cells attack healthy skin cells. By mistake.

And what happens to the skin?

New cells are produced quicker than they should be. Which leads to a build-up on the surface. And that’s how we can end up with dry, flaky, itchy patches.

Nobody’s really sure what causes psoriasis. But researchers say genetic and environmental factors are involved. Genetically, you could be pre-disposed to the chronic condition, and a certain environmental element could trigger it to start flaring up.

Triggers can be different for different people. Common examples include: skin infections, stress, certain medications, etc. And once it’s been triggered, it tends to be cyclical. You could get a flare-up for a couple of weeks or months, and then things can calm down for a while.

Speaking of triggers, another common one is hormonal changes. Which brings me to my main point.

The moments of hormonal change throughout a woman’s life can have a huge impact on the severity of her psoriasis. And on how she manages it.

Estrogen and progesterone. Sound familiar? They’re the two (main) female sex hormones. And they play a key role in the hormonal changes that occur in a woman’s body.

We’re talking about every menstrual cycle, pregnancy, postpartum period, and the menopause. Estrogen and progesterone are there, and they’re fluctuating.

Sounds like a lot, right?

Well that’s not all. They also play a part in the way the immune system works. You see, estrogen & progesterone are two hormones with very loud voices that the immune system must listen to. This means they have a significant say on the way psoriasis behaves in women.

Why?

Because when levels of estrogen and/or progesterone are high, it generally has an anti-inflammatory effect on the body.

Especially when it comes to autoimmune diseases. Like psoriasis.

This is because both estrogen and progesterone can lower the production rate of inflammatory ‘messengers’ that tell the immune system to respond. And by slowing them down, it reduces inflammation, which helps to calm psoriasis down. [-]

On the other side of the same immune-system-coin, progesterone can actually increase the production of the anti-inflammatory ‘messengers’ as well.

That means progesterone can work to balance the immune system by simultaneously hindering pro-inflammation, and encouraging anti-inflammation. [-]

With a calm immune system, psoriasis struggles. Woohoo.

The problem is, the immune system can’t really stay in that calm state for long. What with the (pretty much) constant state of hormonal changes going on in a woman’s body and all.

If we look at a menstrual cycle first, we’ll see how the levels of both estrogen and progesterone start low. With menstruation. The period.

Then comes the follicular phase. Where we have estrogen rising before peaking at ovulation.

The ovulation phase arrives, and estrogen stays high. So we have some anti-inflammation action.

Finally the luteal phase. Now progesterone joins estrogen. And they start this phase nice and high. Even more anti-inflammatory treats. But once they realise there’s no pregnancy, they drop. And they send us back to the menstruation phase to start all over again.

Or, maybe, there is a pregnancy. And both hormones can stay high. You know what that means? Nine whole months of anti-inflammation. “Psoriasis who?”

BAM. It’s already nine months later. Postpartum time. Estrogen and progesterone are on the floor. The flare-ups are back, and they might even be worse than pre-pregnancy.

Then after years and years of more menstrual cycles (and maybe pregnancies) it’s menopause time. Now the hormone drop is permanent. Which means the flare-ups are more frequent. And more severe. [-]

You know that episode of The Simpsons where Homer is in a hospital bed? And he’s using the controller to repeatedly adjust its position, saying “bed goes up, bed goes down, bed goes up, bed goes down…” That’s kinda what our hormones do.

So. Because of all the cycles and biological events in a woman’s life…and the hormonal changes they bring… and their influence on the immune system… and the immune system’s impact on the severity of psoriasis…….. it’s so important to take hormones into consideration when observing, managing, and treating it. [-]

What does this look like?

Tracking

A starting point could be combining the tracking of your period with the tracking of your flare ups.

If you notice that your psoriasis symptoms are getting worse, and you’re also in the luteal phase (estrogen + progesterone are down) then you know that the body is in a more inflammatory state. Which could be the reason for the flare up.

To help ease it, you could prioritise lifestyle choices that minimise inflammation.

Try avoiding alcohol and processed food (they’re guilty of promoting inflammation in the body). And eating more anti-inflammatory foods during this phase can help ease symptoms too (get your 5-a-day and swap white bread for wholegrain).

Stress Management

Another thing that could help is keeping stress under control. It’s been shown that managing stress can have a positive effect on immune function and hormone balance.

A chilled out immune system and balanced hormones? Yes please!

But stress is a big one, right? AND it's hard to just tell it “stop!” So, what’s to do?

You could try journaling. Get all your worries and ‘Greatest Hits of overthinking’ off your mind and onto the page. And leave them there. Or maybe meditation is more for you. Why not try a guided meditation for mindfulness video on Youtube?

Exercise is also a great way to keep stress levels down. It even helps to reduce those pesky pro-inflammatory ‘messengers’ we talked about before! [-]

If you need a bit of nudge into getting going with a workout routine, read this.

Combine your care

You’re talking to your dermatologist about a recent flare up. It was pretty bad. Worse than normal. Neither of you know what could’ve been the trigger.

Weeks and months go by. The flare up doesn’t look like it’s going anywhere. And you just don’t know what could’ve caused such a relentless round of flaky, cracking, itchiness.

Then your GP gets in touch. They want you to know they’ve talked with your derm. and think it’s a good idea for you to change contraception. It seems the hormones it contained were having a huge impact on your body’s ability to regulate inflammation and immune responses. They think that’s the reason your psoriasis was so bad recently.

So that means by making a connection between your skin health and your reproductive health, you were able to alleviate some of your psoriasis symptoms.

It’s vital for women with psoriasis to bring all their healthcare providers together. Your gynaecologist, mental health nurse, dermatologist, etc. should all be on the same page. Do you get different kinds of medical care across different departments? It’s a good idea to link them up. [-]

Psoriasis is a chronic autoimmune disease. It has no cure.

But there are many different management strategies and treatments available.

Women should factor their hormones into their treatment plans. It could result in them improving their quality of life, and reducing the severity of their symptoms. [-]

spec article inspired by Healthline (mockup I did for writing practise - not professionally for the company)