Hormones & Hypermobility

Hypermobility Syndromes Association » Hormones & Hypermobility – By Alan Hakim, June 9, 2013

A hormone is sometimes described as a ‘chemical messenger’ that is secreted from a gland, circulates through the bloodstream and, finally, reaches the organ at which it is directed where it exerts its effect.  

Although there are many types of hormones, all of different structures, two main groups are relevant to hypermobility.

Firstly are the corticosteroids, which comprise three families: 

  1. the mineralo-corticoids, that alter minerals and fluids within the body and probably have no influence on hypermobility
  2. those sometimes referred to as metabolic steroids (for example, cortisol), that are secreted from the adrenal gland and control the diurnal (or 24-hourly) variation in body function, which allows organs to rest during sleep but ‘tones them up’ during the day.
  3. the sex hormones, which are divided into three types: androgens (mainly in males) and oestrogens and progestogens (mainly in females).
    The balance between oestrogens and progestogens, which is constantly changing, controls the 28-day menstrual cycle in the female in whom these hormones are almost absent prior to puberty and tail off after the menopause. The predominant sex hormones in males are androgens, and in particular testosterone.

A further group of hormones relevant to hypermobility have a specific function in pregnancy.  Relaxin relaxes the ligaments just prior to childbirth so the pelvis can open widely to allow the safe passage of the foetal head.

What affect can hormones have on hypermobility?

In both males and females the 24-hour changes in metabolic steroids may produce cyclical symptoms of pain and stiffness over a 24-hour period in joints but this is normally only a minor problem.

In males the predominant androgen hormones probably have very little effect on collagen though may increase muscle bulk around the joints.  In general this is likely to be helpful, the increased muscle power more than outweighing any effect on the collagen structure.

In females, it is quite a different story.  

Although estrogen tends to stabilise collagen,
progesterones loosen it.  

Many hypermobile patients, though not all, noticed a worsening in symptoms, more pain in the joints, clumsiness or a greater tendency to dislocate in the five days leading up to menstruation and in the few days after menstruation.  This is exactly the time when the progesterone compounds far exceed the stabilising oestrogen compounds.

Those females whose joints become worse at the time of menstruation often note that if the periods become irregular, for whatever reason, joints not only become worse but, are worse for longer.

This may be because in these patients progesterone is present in high concentrations at times when it would not normally be present.

Problems with Contraceptives

When careful gynaecological and rheumatological histories are taken together, it is surprising how frequently hypermobility, which was only slightly worse at the time of normal unmodified menstruation, becomes significantly worse with certain contraceptive pills, especially those containing progesterone alone or with progesterone depo contraception preparations or with mechanical devices impregnated with progesterone.

In general, however, patients with hypermobility are safer avoiding injectable progesterone and progesterone impregnated devices.  They might also be better avoiding contraceptive pills that contain progesterone derivatives alone.

If there are increased joint symptoms associated with menstrual irregularities in a patient not taking a contraceptive pill, it may also be worth trying an oestrogen-only preparation for a trial period in the first instance to see if this improves things

Hormone replacement therapy

Similar arguments to those above for contraception apply to hormone replacement therapy after the menopause.  

This normally involves a small amount of oestrogen to which a progestogen is added in women with an intact uterus.  

Since the oestrogen amount is very small (deliberately so in view of the slight increased risk of breast cancer when oestrogens are given to the elderly as well as the risk of thrombosis), the amount of oestrogen is often not enough to provide a protective effect for the joints.

Author: Professor Howard Bird   MA, MD, FRCP
Emeritus Professor of Pharmacological Rheumatology, University of Leeds

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