Chronic urticaria, or hives, is more common in women than in men. It can suddenly appear in midlife and, at least in some cases, might be associated with hormonal changes, including those that occur during menopause. For some women going through menopause, the itching from hives outweighs the discomfort from other symptoms, such as hot flashes and night sweating.
While there aren't any definitive answers on the connection between menopause and chronic urticaria, there are some general theories:
Hormonal changes trigger an autoimmune response. Between 30 and 50 percent of cases of chronic urticaria are associated with autoimmune responses
Other symptoms of menopause, such as night sweats or hot flashes, trigger hives
Emotional or physical stress associated with menopause trigger hives
Changing estrogen levels increase histamine levels in the body, causing hives
Unfortunately, there is very little scientific research on the connection between menopause and chronic urticaria. A study in 2008 stated that “urticaria may be associated with some diseases and conditions characterized by hormonal changes,” and one completed in 2003 indicated that estrogen naturally helps to regulate the immune system. The decrease of estrogen during menopause might trigger an autoimmune response.
Traditional treatment for chronic urticaria includes oral antihistamines, antihistamine creams, and short-term corticosteroids. If these do not offer relief, a second-line of antihistamines can be added. Some medications are also prescribed off-label, such as a tricyclic antidepressant, which has been found to work when taken before bedtime.
Treatment for chronic hives during menopause can be difficult. The first step is to determine if it is caused by an autoimmune disorder; however, there is no definitive lab test that will indicate that it is an autoimmune response. You may need to talk with a specialist, such as a doctor specializing in endocrinology or immunology. Your doctor might start you with traditional treatments. If these treatments aren’t effective, your doctor might use off-label antihistamines, such as or immunosuppressant medications.
If your doctor rules out an autoimmune response, she might suggest traditional treatments. Because chronic urticaria during menopause isn’t caused by an allergy, you can’t avoid common triggers of other conditions, such as milk, eggs, or peanuts. And going to an allergist probably won’t help. You might want to discuss your estrogen levels with your gynecologist and talk about what types of treatments are available for low estrogen. But these treatments have downsides, and your doctor should explain the risks of estrogen treatments (and if your doctor doesn’t, please ask).
The bottom line? Don’t give up
According to a number of women who have posted questions or comments on HealthCentral, it takes time to find the right doctor to treat your chronic urticaria. You might want to point to the studies and links referenced here and share that information with your doctor, and point out that there may indeed be a link between chronic urticaria and menopause.
Chronic Idiopathic Urticaria: Medscape
Chronic Urticaria and Treatment Options: Indian Journal of Dermatology
Histamine-blocking drugs for hives: Cochrane Database of Systematic Reviews
Sex hormones and urticaria: Journal of Dermatological Science