The Invisible Kingdom: Reimagining Chronic Illness

by Meghan O'Rourke

But the question remains: why do women make up approximately 80 percent of people with autoimmune diseases? An answer may lie in the replicated X chromosome (which allows for a genetic mutation to happen twice) or in the role estrogen plays in regulating the immune system. Women generally have a stronger immune response to infections and vaccines than men do. (Consider the fact that men are more likely to die from COVID than women.) Studies suggest that estrogen interacts with the adaptive immune system’s B and T cells in ways that predispose it to become more “autoreactive.” One review of the literature on autoimmunity noted that “many autoimmune disorders tend to affect women during periods of extensive stress, such as pregnancy, or during a great hormonal change.” Studies have identified links between endocrine transition states in women and the development of lupus, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, among others; the reproductive years, medical school teaches, put women at risk for autoimmune disease, perhaps due to the hormonal changes during and after pregnancy. During the decade surrounding menopause, studies show that women are at higher risk for developing some kinds of autoimmune diseases. Levels of anti-inflammatory cytokines decrease, and pro-inflammatory cytokines increase.