Can HRT help control psoriasis during menopause?

Question

Hello doctor,

My wife is 41 and her psoriasis has exploded since starting menopause transition 18 months ago. The plaques cover about 50 percent of her body now, including scalp, elbows, knees, lower back, and even the genital area, which makes intimacy impossible. Her dermatologist tried Methotrexate 20 mg weekly, but it made her nauseous and her liver enzymes went up to ALT 110 U/L, so they stopped it.

Then tried Adalimumab injections for eight months, but insurance stopped covering it after they changed formulary. Now she is back to just Betamethasone cream and Calcipotriene ointment, which barely help. The psoriasis plaques crack and bleed constantly, especially on her hands, where she works as a hairstylist, and clients have started avoiding her.

Her periods are irregular now, coming every two to eight months with terrible hot flashes that seem to trigger major flare-ups. She also developed psoriatic arthritis in her fingers, wrists, and knees, making it painful to stand all day at work. Her rheumatologist wants to try Ixekizumab, but insurance requires step therapy.

She tried UVB phototherapy twice weekly, but the time commitment with the work schedule is impossible. Her inflammatory markers are elevated with ESR 45 mm/hr and CRP 6.2 mg/L. The psoriasis is causing severe depression, and she is on Sertraline 100 mg. Can hormone replacement therapy help control psoriasis during menopause? What biologic works best for women with hormonal changes?

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your wife is suffering from severe psoriasis, menopause changes, and joint pain can be overwhelming both physically and emotionally. During menopause, estrogen levels drop sharply, and this hormonal change can make inflammation worse. That is why many women notice their psoriasis and arthritis flare up as their periods become irregular or stop. Hormone replacement therapy (HRT) can sometimes be beneficial in this stage, as it helps restore some estrogen and may alleviate inflammation in the skin and joints.

It is not a cure, but some women do see their psoriasis become less severe after starting it. If she also has strong menopausal symptoms like hot flashes, mood swings, or vaginal dryness, her gynecologist might consider starting her on a low-dose estrogen patch with progesterone. Using the patch form is gentler on the liver, which matters since she had liver enzyme problems with Methotrexate.

As for psoriasis treatment, newer biologic injections like Ixekizumab or Secukinumab are effective for both psoriasis and psoriatic arthritis. They also do not affect the liver like Methotrexate does. If her insurance is asking for step therapy, her dermatologist and rheumatologist can help by explaining that methotrexate caused side effects and Adalimumab failed, which often helps get approval.

I hope this information will help you.

Thanks.

Can HRT help control psoriasis during menopause?

Could HRT help your psoriasis during menopause?