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Female predominant diseases

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Many immunological and neurological diseases disproportionately affect women.

Epidemiology[edit | edit source]

Autoimmune Disease[edit | edit source]

Roughly 80% of patients with autoimmune disease are women.[1] In other words, women have four times the risk of developing an autoimmune disease than men.[2]

(The terms "woman" and "man" refer to assigned sex at birth. Research shows gender-affirming hormone therapy does not affect an individual's risk of developing autoimmune disease. So trans women have similar risks as cisgender men, and trans men have similar risks as cisgender women.[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
Neurological diseases
Alzheimer's disease 66% 2:1 6.2 million[7]
Empty sella syndrome 5:1[8]
Idiopathic intracranial hypertension
Migraine[9] 3:1 to 4:1[10] 37 million[11]
Myalgic Encephalomyelitis/Chronic fatigue syndrome 60-66%[12] 1.5:1 to 2:1[12] up to 4:1 (CDC)[13] 3.3 million[14]
Multiple sclerosis 1.8:1 to 4:1[15][16][9] 852,000 - 914,000[17]
Postural orthostatic tachycardia syndrome (POTS) 80-85%[18] 4:1 1-3 million (prior to COVID-19)[19]
Endocrine diseases
Graves' disease 5:1[15]
Hashimoto's thyroditis 8:1[15]
Rheumatological diseases
Fibromyalgia 7:1 ACR 1990 Criteria and 2:1 ACR 2010 Criteria[20] and CDC[21]

1.5:1[22]

4 million[21]
Rheumatoid arthritis 2.4:1[15] 1.3 million[23]
Gastrointestinal diseases
Primary billary cirrhosis 4:1[15]
Celiac disease (IBD) 1.6:1[15] 3 million[24]
Irritable bowel syndrome (IBS) 72%[25]
Musculoskeletal diseases and disorders
Osteoporosis
Systemic illnesses
Sjögren's syndrome 7.5:1[15]
Systemic lupus erythematosus 5.2:1[15] 4:1 to 12:1 (CDC)[26] 161,000 to 322,000[27]
Temporal arteritis (Giant cell arteritis) 2.3:1[15]
Connective tissue disorders
Ehler's Danlos Syndrome Type 3 (hypermobile type) 2:1[28] American prevalence rates

are unavailable. Thought to affect up to

1 in 3,100 people worldwide.[29]

Systemic sclerosis 3.7:1[15]
Mental health disorders
Anxiety disorders[9] 1.2:1 to 3.2:1[30] 40 million[31]
Major depressive disorder (depression)[9] 1.6:1 to 2.4:1[30] 21 million[32]
Functional Neurological Disorder (FND) (Conversion disorder)
Post-traumatic stress disorder (PTSD) 1.3:1 to 6.4:1[30] 13 million[33]
Other diagnoses
Asthma 3:2 (adults), 7:9 (children, less predominant in girls)[34] 24.8 million (current asthma)

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. ↑ Kronzer, Vanessa L.; Bridges, Stanley Louis; Davis, John M. (2020-12). "Why women have more autoimmune diseases than men: An evolutionary perspective". Evolutionary Applications. 14 (3): 629–633. doi:10.1111/eva.13167. ISSN 1752-4571. Check date values in: |date= (help)
  3. ↑ Wiepjes, Chantal; Heijer, Martin Den (2023-10). "SAT416 The Incidence Of Autoimmune Disease In Transgender People After Initiation Of Gender-Affirming Hormone Therapy". Journal of the Endocrine Society. 7 (Supplement_1). doi:10.1210/jendso/bvad114.2087. ISSN 2472-1972. Check date values in: |date= (help)
  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. ↑ Jump up to: 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. ↑ "Why are women more likely to develop Alzheimer's disease? - Harvard Health". www.health.harvard.edu. Retrieved May 22, 2025.
  8. ↑ 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.
  9. ↑ Jump up to: 9.0 9.1 9.2 9.3 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.
  10. ↑ Cohen, Fred; Brooks, Caroline V.; Sun, Daniel; Buse, Dawn C.; Reed, Michael L.; Fanning, Kristina M.; Lipton, Richard B. (2024-05). "Prevalence and burden of migraine in the United States: A systematic review". Headache: The Journal of Head and Face Pain. 64 (5): 516–532. doi:10.1111/head.14709. ISSN 0017-8748. Check date values in: |date= (help)
  11. ↑ "The Facts About Migraine | American Migraine Foundation". americanmigrainefoundation.org. Retrieved May 22, 2025.
  12. ↑ Jump up to: 12.0 12.1 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.
  13. ↑ "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.
  14. ↑ "ME/CFS Basics". Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. September 18, 2024. Retrieved May 22, 2025.
  15. ↑ Jump up to: 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 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.
  16. ↑ "Who Gets MS? (Epidemiology)". National Multiple Sclerosis Society.
  17. ↑ www.nationalmssociety.org https://www.nationalmssociety.org/understanding-ms/what-is-ms/who-gets-ms/how-many-people. Retrieved May 22, 2025. Missing or empty |title= (help)
  18. ↑ "10 Facts Doctors Should Know About POTS". Dysautonomia International. April 19, 2018.
  19. ↑ Harris, Cheryl Iny (2022-09). "COVID-19 Increases the Prevalence of Postural Orthostatic Tachycardia Syndrome: What Nutrition and Dietetics Practitioners Need to Know". Journal of the Academy of Nutrition and Dietetics. 122 (9): 1600–1605. doi:10.1016/j.jand.2022.06.002. ISSN 2212-2672. Check date values in: |date= (help)
  20. ↑ Boomershine, Chad S (September 14, 2021). Diamond, Herbert S (ed.). "Fibromyalgia: Practice Essentials, Background, Pathophysiology". Medscape.
  21. ↑ Jump up to: 21.0 21.1 "Fibromyalgia | Arthritis". Centers for Disease Control and Prevention. April 3, 2018. Retrieved February 1, 2022.
  22. ↑ 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.
  23. ↑ Xu, Yingke; Wu, Qing (July 26, 2021). "Prevalence Trend and Disparities in Rheumatoid Arthritis among US Adults, 2005–2018". Journal of Clinical Medicine. 10 (15): 3289. doi:10.3390/jcm10153289. ISSN 2077-0383.
  24. ↑ "20 Things You Might Not Know About Celiac Disease | Celiac Disease Foundation". Celiac Disease Foundation. August 19, 2016. Retrieved May 28, 2025.
  25. ↑ 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.
  26. ↑ "Systemic Lupus Erythematosus (SLE) | Lupus". Centers for Disease Control and Prevention. October 17, 2018. Retrieved February 1, 2022.
  27. ↑ "Lupus and women". Office on Women's Health. Retrieved February 1, 2022.
  28. ↑ Pezaro, Sally; Pearce, Gemma; Reinhold, Emma (2020). "Understanding hypermobile Ehlers-Danlos syndrome and Hypermobility Spectrum Disorders in the context of childbearing: An international qualitative study". Midwifery. 88.
  29. ↑ "What is EDS? - The Ehlers Danlos Society". The Ehlers Danlos Society. Retrieved May 22, 2025.
  30. ↑ Jump up to: 30.0 30.1 30.2 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.
  31. ↑ "Anxiety Disorders - Facts & Statistics". Anxiety & Depression Association of America. October 28, 2022.
  32. ↑ "Depression | Mental Health America". Mental Health America. Retrieved May 28, 2025.
  33. ↑ "How Common is PTSD in Adults? - PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved May 28, 2025.
  34. ↑ "Asthma Surveillance — United States, 2006–2018 | MMWR Surveillance Summaries /70(5)". Centers for Disease Control and Prevention. September 17, 2021. Retrieved February 1, 2022.

T cell A type of white blood cell which is mostly produced or matured in the thymus gland (hence T-cell) and is involved in the adaptive immune response on a cellular level. Also known as a T lymphocyte. (Learn more: www.youtube.com)

Bias in research is "a systematic deviation of an observation from the true clinical state".[1] (Learn more: me-pedia.org)

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

B cell B lymphocyte, or a type of white blood cell, which is involved in the immune response by secreting antibodies to ward off infections. In mammals, they are mostly matured in the bone marrow.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

serum The clear yellowish fluid that remains from blood plasma after clotting factors have been removed by clot formation. (Blood plasma is simply blood that has had its blood cells removed.)

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

See Centers for Disease Control and Prevention.

See postural orthostatic tachycardia syndrome.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

dysautonomia disorders of the autonomic nervous system that cause disturbances in all or some autonomic functions, may cause problems regulating autonomic functions, including heart rate, blood pressure, body temperature, and digestion. Can cause symptoms including lightheadedness, fainting, unstable blood pressure, and orthostatic intolerance.

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