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 (IL10) production by TLR9-stimulated peripheral blood mononuclear cell 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
IL10 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 versus 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 predominately affect females.

Conditions % female Ratio (F:M) US prevalence NIH funding NIH funding per patient
Neurological diseases
Alzheimer's disease 65% 5,000,000
Empty sella syndrome 5:1[7]
Idiopathic intracranial hypertension
Myalgic Encephalomyelitis/Chronic fatigue syndrome 60-66%[9] 1.5:1 to 2:1[9] up to 4:1 (CDC)[10]
Multiple sclerosis 1.8:1 to 4:1[11][12][8]
Postural orthostatic tachycardia syndrome (POTS) 80-85%[13]
Endocrine diseases
Graves' disease 5:1[11]
Hashimoto's thyroditis 8:1[11]
Rheumatological diseases
Fibromyalgia 7:1 ACR 1990 Criteria and 2:1 ACR 2010 Criteria[14] and CDC[15]


4 million[15]
Rheumatoid arthritis 2.4:1[11]
Gastrointestinal diseases
Primary billary cirrhosis 4:1[11]
Celiac disease (IBD) 1.6:1[11]
Irritable bowel syndrome (IBS) 72%[17]
Musculoskeletal diseases and disorders
Systemic illnesses
Sjögren's syndrome 7.5:1[11]
Systemic lupus erythematosus 5.2:1[11] 4:1 to 12:1 (CDC)[18] 161,000 to 322,000[19]
Temporal arteritis (Giant cell arteritis) 2.3:1[11]
Connective tissue disorders
Ehler's Danlos Syndrome Type 3 (hypermobile type)
Systemic sclerosis 3.7:1[11]
Mental health disorders
Anxiety disorders[8] 1.2:1 to 3.2:1[20]
Major depressive disorder (depression)[8] 1.6:1 to 2.4:1[20]
Functional Neurological Disorder (FND) (Conversion disorder)
Post-traumatic stress disorder (PTSD) 1.3:1 to 6.4:1[20]
Other diagnoses
Asthma 3:2 (adults), 7:9 (children, less predominant in girls)[21] 24.8 million (current asthma)
Chronic lyme disease

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. Fairweather, DeLisa; Rose, Noel R. (November 2004). "Women and Autoimmune Diseases1". Emerging Infectious Diseases. 10 (11): 2005–2011. doi:10.3201/eid1011.040367. ISSN 1080-6040. PMC 3328995. PMID 15550215.
  2. Harbo, Hanne F.; Gold, Ralf; Tintoré, Mar (September 2013). "Sex and gender issues in multiple sclerosis". Therapeutic Advances in Neurological Disorders. 6 (4): 237–248. doi:10.1177/1756285613488434. ISSN 1756-2856. PMC 3707353. PMID 23858327.
  3. "Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". Centers for Disease Control and Prevention. January 18, 2019. Immune System Changes. Retrieved April 13, 2019.
  4. Klein, Sabra L.; Flanagan, Katie L. (October 2016). "Sex differences in immune responses". Nature Reviews. Immunology. 16 (10): 626–638. doi:10.1038/nri.2016.90. ISSN 1474-1741. PMID 27546235.
  5. 5.0 5.1 5.2 Zierau, Oliver; Zenclussen, Ana C.; Jensen, Federico (June 19, 2012). "Role of female sex hormones, estradiol and progesterone, in mast cell behavior". Frontiers in Immunology. 3: 169. doi:10.3389/fimmu.2012.00169. ISSN 1664-3224. PMC 3377947. PMID 22723800.
  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.; Sowjanya, B.; Reddy, P. Amaresh; Krishnamma, M.; Naidu, J. N. (April 2014). "Partial Empty Sella Syndrome: A Case Report and Review". Indian Journal of Clinical Biochemistry. 29 (2): 253–256. doi:10.1007/s12291-013-0369-1. ISSN 0970-1915. PMC 3990803. PMID 24757313.
  8. 8.0 8.1 8.2 8.3 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.
  9. 9.0 9.1 Lim, Eun-Jin; Ahn, Yo-Chan; Jang, Eun-Su; Lee, Si-Woo; Lee, Su-Hwa; Son, Chang-Gue (February 24, 2020). "Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)". Journal of Translational Medicine. 18 (1): 100. doi:10.1186/s12967-020-02269-0. ISSN 1479-5876. PMC 7038594. PMID 32093722.
  10. "Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". Centers for Disease Control and Prevention. January 21, 2022. Immune System Changes. Retrieved February 1, 2022.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 Jørgensen, Kristian Tore; Pedersen, Bo Vestergaard; Nielsen, Nete Munk; Jacobsen, Søren (May 2012). "Childbirths and risk of female predominant and other autoimmune diseases in a population-based Danish cohort" (PDF). Journal of Autoimmunity. 38 (2–3): J81–87. doi:10.1016/j.jaut.2011.06.004. ISSN 1095-9157. PMID 21813263.
  12. "Who Gets MS? (Epidemiology)". National Multiple Sclerosis Society.
  13. "10 Facts Doctors Should Know About POTS". Dysautonomia International. April 19, 2018.
  14. Boomershine, Chad S (September 14, 2021). Diamond, Herbert S (ed.). "Fibromyalgia: Practice Essentials, Background, Pathophysiology". Medscape.
  15. 15.0 15.1 "Fibromyalgia | Arthritis". Centers for Disease Control and Prevention. April 3, 2018. Retrieved February 1, 2022.
  16. 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.
  17. Eijsbouts, Chris; Zheng, Tenghao; Kennedy, Nicholas A.; Bonfiglio, Ferdinando; Anderson, Carl A.; Moutsianas, Loukas; Holliday, Joanne; Shi, Jingchunzi; Shringarpure, Suyash; Voda, Alexandru-Ioan; Farrugia, Gianrico (November 2021). "Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders". Nature Genetics. 53 (11): 1543–1552. doi:10.1038/s41588-021-00950-8. ISSN 1546-1718.
  18. "Systemic Lupus Erythematosus (SLE) | Lupus". Centers for Disease Control and Prevention. October 17, 2018. Retrieved February 1, 2022.
  19. "Lupus and women". Office on Women's Health. Retrieved February 1, 2022.
  20. 20.0 20.1 20.2 Seedat, Soraya; Scott, Kate Margaret; Angermeyer, Matthias C.; Berglund, Patricia; Bromet, Evelyn J.; Brugha, Traolach S.; Demyttenaere, Koen; de Girolamo, Giovanni; Haro, Josep Maria; Jin, Robert; Karam, Elie G. (July 1, 2009). "Cross-National Associations Between Gender and Mental Disorders in the World Health Organization World Mental Health Surveys". Archives of General Psychiatry. 66 (7): 785–795. doi:10.1001/archgenpsychiatry.2009.36. ISSN 0003-990X.
  21. "Asthma Surveillance — United States, 2006–2018 | MMWR Surveillance Summaries /70(5)". Centers for Disease Control and Prevention. September 17, 2021. Retrieved February 1, 2022.