Autoimmune disease symptoms in women: the signals to know

Autoimmune conditions affect around eight percent of the population. Of that group, 78 percent are women (PMID 18688037). That is not a small difference at the margin, it is a skew that changes your whole risk profile.

And still the average woman spends years with vague complaints before anyone looks that way. The nature of the symptoms is to blame: tired, stiff, fluctuating, never one thing at a time. Exactly the complaints that get pinned on stress or menopause.

What is an autoimmune disease?

In an autoimmune disease your immune system turns on your own tissue. The system that should clear bacteria mistakes your thyroid, your joints or your gut lining for an intruder. The result is inflammation that never settles, because the "enemy" never leaves.

More than eighty such conditions exist. In the Netherlands the best known are Hashimoto and Graves (thyroid) and rheumatoid arthritis (joints). Coeliac disease, type 1 diabetes and lupus belong here too. They differ enormously, but share one mechanism.

Which symptoms show up most often?

The symptoms autoimmune diseases share are precisely the ones that are specific to nothing. That is the heart of the problem. Fatigue, joint pain, skin complaints and a slightly raised temperature fit dozens of things, and usually it is indeed something else.

Even so, there is a pattern worth noticing:

• Fatigue that sleep does not fix and that does not match your activity.
• Joint pain or stiffness, often left and right at once.
• Complaints that come and go over weeks, with genuinely good spells in between.
• Skin that reacts: rashes, hair loss, extremely dry eyes or mouth.
• Gut complaints that do not settle, or unexplained weight loss.
• A sedimentation rate that stays raised while your CRP is normal.

That last one is the most concrete. A chronically raised ESR with a normal CRP fits slow-running inflammation, and that is exactly the profile of an autoimmune process.

Why do women get autoimmune disease more often?

The honest answer is that we do not fully know. For a long time hormones took the blame. Oestrogen certainly plays a part, but it does not explain the skew completely. In recent years attention has moved to the X chromosome itself.

Women have two X chromosomes and switch one off using an RNA molecule called XIST. That molecule forms a complex with proteins, and the immune system can start making antibodies against that complex. Researchers see a possible explanation there for the female over-representation in diseases such as lupus (PMID 39375734).

It is not a closed case. But it does explain why the skew already begins before puberty, which is hard to square with hormones alone.

Which antibody matches which suspicion?

There is no general autoimmune test. What exists are antibodies that match a specific suspicion, and they only mean something when a clinical story sits underneath. Testing everything blindly mostly produces confusion.

Imagine two women of 39, both tired, both with an ESR of 34 mm/hour. One also has an underactive thyroid and positive anti-TPO. The other has gut complaints and a positive anti-TTG. Same fatigue, same sedimentation, two completely different diseases.

That is why the question "which test should I do" can never be answered apart from your symptoms.

Is coeliac disease also more common in women?

Yes. In a global meta-analysis, coeliac prevalence sat at 1.4 percent on blood testing, and women came out clearly more often than men: 0.6 versus 0.4 percent (PMID 29551598). Coeliac disease is an autoimmune condition, not an allergy, and that distinction decides how you test.

There is one large trap in that test, and it costs people years. Start eating gluten-free before your blood is drawn and your antibodies fall, making the result falsely negative. How that works is covered in the article on the gluten intolerance test for coeliac disease.

What can you test?

Two autoimmune profiles you can measure yourself at Lunara. For your thyroid there is Thyroid Complete, which alongside TSH and free T4 includes anti-TPO. For coeliac disease there is the coeliac panel with anti-TTG and endomysial IgA.

For a first impression, you can pick CRP and ESR individually through building your own blood test. Those two show whether inflammation is measurable at all. ANA, anti-CCP and rheumatoid factor run through your GP, because they only gain meaning after a physical examination.

My advice stays simple: do not go and draw a shopping list of antibodies on your own. Pick what matches your symptoms, and take the result to your GP. Thuisarts and the NHG always look at the whole picture with autoimmune complaints, and in practice that works better than one isolated positive number.

References

1. Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008;173(3):600-609. PMID 18688037.
2. Vieira AA, et al. Female-bias in systemic lupus erythematosus: how much is the X chromosome to blame? Biol Sex Differ. 2024. PMID 39375734.
3. Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836. PMID 29551598.
4. NHG and Thuisarts. Information on autoimmune conditions and blood testing. Available via thuisarts.nl.

Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.