Female predominant diseases

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Many immunological and neurological diseases disproportionately affect women.

Epidemiology[edit | edit source]

Roughly 80% of patients with autoimmune disease are women.[1] Over the last decades, the ratio of women to men with MS has increased markedly, representing a true increase in MS among women but not men.[2]

ME/CFS and most autoimmune diseases are more common in women and both are characterized by increased inflammation.[3]

Mechanisms[edit | edit source]

Immune system[edit | edit source]

Summary of sex differences in innate and adaptive immune responses[4]

Immune component Characteristic In Females (relative to males)
Innate immune system
Toll-like receptor (TLR) pathways TLR pathway gene expression Higher
TLR7 expression Higher
Interleukin 10 (IL-10) production by TLR9-stimulated [[peripheral blood mononuclear cells]] Lower
antigen-presenting cells (APCs) APC efficiency Higher
Dendritic cells TLR7 activity Higher
Macrophages TLR4 expression Lower
Activation Higher
Phagocytic capacity Higher
Pro-inflammatory cytokine production Lower
IL-10 production Higher
Neutrophils Phagocytic capacity Higher
TLR expression Lower
Natural killer cells NK cell numbers Lower
Adaptive immune system
Thymus Size of thymus Smaller
T cells CD4 T cell counts Higher
CD4/CD8 T cell ratio Higher
CD8 T cell counts Lower
Number of activated T cells Higher
T cell proliferation Higher
Cytotoxic T cell Increased activity
Th1 v Th2 cell bias Th2 cell bias in females, Th1 cell bias in males
Regulatory T cell numbers Lower
B cell B cell numbers Increased
Immunoglobulins Antibody production Higher

Hormones[edit | edit source]

Women with these diseases may experiencing a worsening of symptoms at specific points in their menstrual cycle, particularly just before or around their periods.[5] Estradiol and progesterone induce mast cell maturation and degranulation,[5] which may contribute to the symptoms of a wide range of allergic and mast cell-mediated diseases.

Genetics[edit | edit source]

Diseases[edit | edit source]

Asthma[edit | edit source]

In humans, a much higher asthma prevalence was found in women at reproductive age as compared to men. Serum levels of estradiol and progesterone have been directly correlated with the clinical and functional features of asthma. Around 30–40% of women with asthma experience a worsening of symptoms near their period. Postmenopausal women receiving hormone replacement therapy have an increased risk of new onset of asthma.[5]

Social impact[edit | edit source]

Treatment options[edit | edit source]

Research funding[edit | edit source]

Stigma[edit | edit source]

Men and women with these diseases are at risk of stigmatization, dismissal, minimization and psychologization of their symptoms.[6]

List of diseases[edit | edit source]

Below, a list of diseases that disproportionately affect women.

Conditions % female Ratio (F:M) US prevalence NIH funding NIH funding per patient
Neurological
Alzheimer's Disease 65% 5,000,000
Empty sella syndrome 5:1[7]
Idiopathic intracranial hypertension
Postural orthostatic tachychardia 80-85%[8]
Chronic fatigue syndrome 75-85%
Multiple sclerosis 2:1 to 4:1[9][10]
Endocrine
Grave's disease
Hashimoto's thyroditis
Rheumatological diseases
Rheumatoid arthritis
Gastrointestinal diseases
Primary Billary Cirrhosis
Celiac disease
Irritable Bowel Syndrome (IBS) 65%
Systemic
Sjögren's syndrome
Systemic lupus erythematosus
Connective tissue disorders
Ehler's Danlos Syndrome Type 3
Systemic Sclerosis
Other diagnoses
Fibromyalgia 7:1 ACR 1990 Criteria and 2:1 ACR 2010 Criteria[11]

1.5:1[12]

See: Fibromyalgia > Prevalence

Chronic lyme disease
Conversion disorder (FND)
Osteoporosis

[13]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. Fairweather, DeLisa (November 2004). "Women and Autoimmune Diseases". Emerging Infectious Disease.
  2. Harbo, Hanne (July 2013). "Sex and gender issues in multiple sclerosis". Ther Adv Neurol Disord.
  3. "Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC". www.cdc.gov. January 18, 2019. Immune System Changes. Retrieved April 13, 2019. Cite has empty unknown parameter: |dead-url= (help)
  4. Klein, SL (October 2016). "Sex differences in immune responses". Nat Rev Immunol.
  5. 5.0 5.1 5.2 Zierau, Oliver (2012). "Role of female sex hormones, estradiol and progesterone, in mast cell behavior". Front Immunol.
  6. Goudsmit, Ellen M (1993). "All in her mind! Stereotypic views and the psychologisation of women's illness". Health Psychology Update. 12: 28–32.
  7. Aruna, P (April 2014). "Partial Empty Sella Syndrome: A Case Report and Review". Indian Journal of Biochemistry.
  8. "10 Facts Doctors Should Know About POTS". Dysautonomia International. April 19, 2018. Cite has empty unknown parameter: |dead-url= (help)
  9. "Who Gets MS? (Epidemiology)". National Multiple Sclerosis Society. Cite has empty unknown parameter: |dead-url= (help)
  10. Vos, Theo; Feigin, Valery; Degenhardt, Louisa; Ferrari, Alize J.; Whiteford, Harvey A. (February 6, 2015). "The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010". PLOS ONE. 10 (2): e0116820. doi:10.1371/journal.pone.0116820. ISSN 1932-6203. PMC 4320057. PMID 25658103.
  11. "Fibromyalgia: Practice Essentials, Background, Pathophysiology". February 3, 2019. Cite journal requires |journal= (help)
  12. Häuser, Winfried; Rasker, Johannes J.; Perrot, Serge; Walitt, Brian; Wolfe, Frederick (September 13, 2018). "Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias". PLOS ONE. 13 (9): e0203755. doi:10.1371/journal.pone.0203755. ISSN 1932-6203. PMID 30212526.
  13. Vos, Theo; Feigin, Valery; Degenhardt, Louisa; Ferrari, Alize J.; Whiteford, Harvey A. (February 6, 2015). "The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010". PLOS ONE. 10 (2): e0116820. doi:10.1371/journal.pone.0116820. ISSN 1932-6203. PMC 4320057. PMID 25658103.