Ankylosing spondylitis (AS) is a form of arthritis that affects the spine. People with AS may experience hormonal or bone density changes that can affect their experience during menopause.

Research suggests that AS can affect hormones associated with ovarian function. These changes may affect menopause or menstruation in certain individuals.

This article will explore how AS affects menopause and menstruation, as well as what symptoms it may cause in females. Keep reading to learn more.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Individuals with AS may find that it affects their experience with menopause.

A 2020 review article cites an older study suggesting that AS may reduce sex hormone levels in people going through menopause. And a 2021 study suggests that levels of estrogen decrease in people with active AS. Because estrogen supports bone health, losing estrogen can lead to osteoporosis.

Estrogen levels also decrease during menopause. Therefore, individuals with AS who are going through menopause may be at a greater risk of developing osteoporosis. This condition can cause bone loss and increase the risk of bone fractures.

Researchers have also found that levels of vitamin D decrease in people with AS. Since menopause also causes vitamin D deficiencies, individuals with AS who are going through menopause may experience more negative effects of vitamin D deficiency.

Older studies suggest that people with active AS have lower estrogen levels during their menstrual cycle. Levels of progesterone also tend to be lower during menstruation among these individuals.

Estrogen deficiencies can lead to irregular menstrual cycles or cause menstruation to stop altogether. This can increase the risk of cardiovascular events and early menopause. Irregular menstruation can also cause or worsen anxiety and depression.

Progesterone is another hormone crucial for supporting menstruation. At healthy levels, progesterone helps thicken the lining of the uterus. This thickened lining increases the chance of a fertilized egg successfully implanting in the body.

When progesterone levels are low, it may negatively affect fertility. Progesterone deficiency can also increase the risk of:

Females with AS may experience a range of symptoms. Some of the more common AS symptoms include:

Learn more about AS symptoms.

In addition to common AS symptoms, females may experience less low back pain and more pain across the upper back and neck. Pain can also spread to other regions of the body.

Females with AS are also more likely to have the following complications than males with AS:

A 2018 study found that females with AS report a lower quality of life than males with this condition. They may experience more mental health symptoms as a result of their condition.

Healthcare professionals once believed that AS affected more males than females. Newer research suggests that non-radiographic axial spondyloarthritis (axSpA), a subtype of axial spondyloarthritis along with AS, affects men and women equally. However, three times as many males are diagnosed with AS as females.

Females are still more likely to receive a late AS diagnosis or a misdiagnosis. Researchers believe this may be due to how the disease presents differently in males and females.

Learn more about AS in females.

A healthcare professional may begin with a physical exam and a medical history. If they notice signs of AS, they may recommend imaging tests such as an X-ray or MRI.

If diagnostic tests confirm AS, healthcare professionals can refer females with this condition to other specialists for treatment.

Females with AS may have different symptoms than males and typically receive more misdiagnoses. They also tend to receive a later AS diagnosis, which can delay treatment and decrease quality of life.

X-ray images from women with AS generally show less damage than images from males with this condition. Blood tests from females with the condition may reveal fewer signs of AS.

Learn more about tests and diagnoses for AS.

Individuals living with AS and menopause may require a specialized treatment plan to address both conditions.

Medications for AS typically include:

Certain medications can also help reduce menopause symptoms. These may include:

Both menopause and AS can increase the risk of osteoporosis or bone loss. Calcium and vitamin D supplements may help promote bone health among these individuals.


Physical therapy and exercise can assist with menopause and AS. Physical therapy can improve the symptoms of AS and increase spinal mobility. Exercise can improve mental health and help promote bone health.

Other self-management approaches for preventing bone loss may include:

People living with menopause and AS should speak with a healthcare professional to learn more about ways to manage their symptoms.

Learn more about natural remedies for menopause.

People who have symptoms of AS, menopause, or changes in their menstrual cycle should speak with a healthcare professional. They can assess symptoms and suggest options for managing these conditions.

Similarly, people with existing AS and menopause should always speak with a healthcare professional if they develop any new or changing symptoms.

It can be helpful to keep a diary of any new or existing symptoms and note how long they have been occurring. Having a record of symptoms can help healthcare professionals make a diagnosis and determine the appropriate treatment.

Learn more about how to recognize AS symptoms.

Ankylosing spondylitis is a type of arthritis that causes inflammation in the spinal joints. This condition can also affect sex hormones and vitamin D levels, which may worsen menopause symptoms.

Medical treatment and self-management may improve the symptoms and quality of life for people with AS and menopause.

Self-advocacy during the diagnostic process is also helpful, as females are misdiagnosed more often than males or diagnosed with AS later.