First of all — validated AND blindsided at 39? That's a lot to hold at once, and it makes complete sense to feel both relieved and not quite ready. You're not alone in that.
Your concern about estrogen-based HRT is worth taking seriously. Estrogen can potentially trigger lupus flares in some people, which is why it's so Show Full Answer
First of all — validated AND blindsided at 39? That's a lot to hold at once, and it makes complete sense to feel both relieved and not quite ready. You're not alone in that.
Your concern about estrogen-based HRT is worth taking seriously. Estrogen can potentially trigger lupus flares in some people, which is why it's so important that any hormonal treatment decisions are made carefully with your care team — not just a general PCP, but ideally someone who understands lupus specifically. It's also really worth knowing that lupus itself — not just perimenopause — can directly cause irregular cycles. Lupus-related inflammation can affect hormone production and absorption, leading to cycles that are long, short, heavy, or unpredictable. Some lupus medications can also play a role:
- Corticosteroids (like prednisone) can cause irregular or missed periods
- NSAIDs (like ibuprofen) can reduce or even eliminate menstrual bleeding
- Immunosuppressants like cyclophosphamide, methotrexate, or mycophenolate mofetil can cause skipped periods or stop menstruation altogether
This means the irregular cycles you've experienced since your hospitalization may have more than one contributing factor — and it sounds like that hasn't been fully explored yet. The extended PMS window you're describing — 12 to 15 days — is significant and lines up with what many MyLupusTeam members experience. One member shared that about a week before every period, their joints swell and they feel like they got hit by a truck. Hormonal shifts throughout the cycle can trigger lupus flares, which could be amplifying your PMS symptoms beyond what's typical for perimenopause alone. On the naturopath question — while there isn't specific research on naturopathic care for lupus patients going through perimenopause, seeing one isn't unreasonable as a way to explore non-hormonal options. That said, a few important cautions:
- Always loop in your rheumatologist before starting any supplements or herbal treatments, as some can interact with lupus medications or trigger flares
- Some herbal remedies used for hormonal balance (like certain phytoestrogens) may not be safe for lupus patients
- A naturopath works best *alongside* your medical team, not as a replacement
It may also be worth asking your PCP for a referral to a gynecologist who has experience with lupus patients, or pushing your rheumatologist a little harder for answers — a shrug isn't really good enough when your quality of life is being affected. Tracking your cycle carefully — including when PMS symptoms start, how long they last, and how they correlate with lupus symptoms — can give your care team genuinely useful data. It can also help make the case that waiting a full year without further investigation may not be the right call for you.
You deserve a care team that's curious about what's going on, not just waiting to see what happens. 💙
July 30
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