Can Your Menstrual Cycle Affect Ankylosing Spondylitis Flares?

Medically reviewed by David Ozeri, MD

Ankylosing spondylitis (AS) is an inflammatory condition that may be affected by the menstrual cycle due to changing hormone levels. Though the condition is diagnosed more often in males, It also affects females.

This article will provide an overview of how the menstrual cycle affects ankylosing spondylitis and how to treat a flare in symptoms.

Ankylosing Spondylitis and Menstrual Cycles

Ankylosing spondylitis is a type of autoimmune inflammatory arthritis that affects the spine. The immune system mistakenly targets the body's own tissues and causes inflammation between the bones of the spine (vertebrae). It also affects the joints in the spine.

People with ankylosing spondylitis often experience back pain and stiffness. Symptoms can begin in late adolescence or early adulthood.

In people who menstruate, hormone levels fluctuate throughout the month. These fluctuations may affect their ankylosing spondylitis symptoms and even lead to a flare (an increase in symptoms).

Some people with ankylosing spondylitis have pain and stiffness all of the time. For others, their symptoms tend to come and go.

Verywell Health prefers to use inclusive terminology for sex and gender. This article, when citing research or a health authority, uses the terms for sex or gender from the sources cited.

Hormone Fluctuations

During a menstrual period, estrogen levels in the body decrease. This may lead to a change in ankylosing spondylitis symptoms.

Estrogen may have an anti-inflammatory effect on the body. When estrogen levels fall, inflammation can worsen. For a person with ankylosing spondylitis, inflammation is already an issue, so any increase can lead to pain and stiffness.

A 2022 study found that women with rheumatic diseases (such as ankylosing spondylitis) reported higher levels of cramping, pain, and menstrual bleeding during their periods than those without a rheumatic disease.  

Taking hormonal birth control may affect a person’s ankylosing spondylitis disease. A 2014 review found that women who took daily birth control pills were significantly younger at the time of their ankylosing spondylitis diagnoses than those who did not use hormonal birth control. There were no significant differences in disease severity or medication usage between the two groups.

Sensitivity to Pain

Our hormone levels affect how our bodies perceive pain, so it is not uncommon to feel more pain during your period. Having low levels of estrogen (as is common during the menstrual period) is known to increase pain sensitivity in the body. Estrogen also influences the immune system.

Sex Disparities in Diagnosis and Research

More research on the relationship between ankylosing spondylitis and menstrual cycles is necessary. Because this disease has been more commonly diagnosed in men, women have been underrepresented in clinical research studies.

Though ankylosing spondylitis diagnoses in men are widely understood to outnumber those in women three to one, a Swiss study reported that with increased recognition of the condition in women, the ratio had dropped to 1.2 to one.

Menstrual Cycles and Inflammation

Ankylosing spondylitis is an inflammatory disease. During certain phases of the menstrual cycle, there is more inflammation in the body. This can lead to increased disease severity and pain.

Progesterone is a hormone with anti-inflammatory properties. Its levels rapidly fall with the menstrual period, and this decline in progesterone may lead to increased inflammation.

Impact of Ankylosing Spondylitis on Fertility and Pregnancy

There is no evidence to suggest that ankylosing spondylitis affects your fertility or ability to conceive. People with ankylosing spondylitis are able to use any type of birth control they choose.

It is safest to talk with your healthcare provider if you are thinking of becoming pregnant. It is possible to experience increased back pain and stiffness during pregnancy.

Some medications that treat ankylosing spondylitis are not safe to take during pregnancy. There may also be a genetic component to ankylosing spondylitis, so your healthcare provider may recommend genetic counseling before trying to become pregnant.

Managing AS Flares During Your Period

An ankylosing spondylitis flare can involve increased pain, fatigue, and emotional upset. If you notice that your disease symptoms tend to flare before or during your period, make a plan for how you will manage them. Talking with your healthcare provider about treatment options during flares may help.

To ease pain during an AS flare, consider the following treatment options:

• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) can treat both AS pain and period cramping.

• Hot bath or shower: The heat from the water may ease back pain and stiffness.

• Heating pad or hot water bottle: Try using a heating pad to relieve muscle soreness.

• Medication change: Ask your healthcare provider if there are additional medications you can take to address the pain from a flare.

• Journal: Keep a symptom journal of when your flares tend to occur so that you can better prepare for them.

In addition to these management strategies for flares, common treatments for ankylosing spondylitis include:

• Biologics aimed at reducing inflammation

• Janus kinase (JAK) inhibitors such as Xeljanz (tofacitinib) and Rinvoq (upadacitinib)

• Corticosteroids (usually injected into a joint) to reduce inflammation and pain

• Physical therapy

• Surgery

Some treatments for ankylosing spondylitis, such as biologic medications, can raise the risk of serious infections. If you experience any of the following symptoms during a flare, seek medical care right away:

• Severe neck pain

• Fever

• Chills

• Malaise (or a general feeling of being unwell)
  

Summary

Ankylosing spondylitis is a type of arthritis that affects the bones and joints in the spine. The menstrual cycle may affect ankylosing spondylitis because of changing hormone levels. Decreasing levels of estrogen can lead to increased pain sensitivity, and decreasing levels of progesterone can lead to increased inflammation.

To treat an AS flare, try using over-the-counter NSAIDs, taking a hot bath or shower, and talking with your healthcare provider about additional options.

Ankylosing spondylitis is a serious disease that can be challenging to manage. Some people experience constant pain and stiffness, while others have intermittent symptoms that come and go.

If you have noticed that your symptoms tend to flare during your menstrual period, talk with your healthcare provider. There may be more you can do to get your pain under control.

Frequently Asked Questions

How does ankylosing spondylitis differ in women and men?

Ankylosing spondylitis affects men and women differently. Men tend to experience more serious disease progression than women. They also report more severe sexual function declines. Women tend to report more pain from ankylosing spondylitis than men do.

Can oral contraceptive pills help ease AS flares?

There is no evidence to suggest that oral contraceptive pills have an effect on AS flares. A 2014 study found that taking oral contraception does not impact AS disease onset or severity.

Do any ankylosing spondylitis medications affect menstrual cycles or fertility?

Though ankylosing spondylitis medications are not known to affect fertility, they can affect a person’s sexual health. Corticosteroids may cause mood changes, headaches, fatigue, and decreased sexual desire. Methotrexate has been linked with decreased libido, erectile dysfunction, and impotence. Biologics have been associated with pain and headaches, which may affect sexual desire.