The link between hormones & psoriasis
Psoriasis is a chronic, inflammatory autoimmune skin condition. While both genders are susceptible, there is a profound hormonal influence on the severity and burden in women, which can intensify the challenges of psoriasis: persistent itching, pain and skin tightening, disruptions in sleep, and the psychological stresses associated with having a visible skin condition.
Hormones such as estrogen, progesterone, prolactin and cortisol play a significant role in modulating the immune system and altering inflammatory pathways central to psoriasis development. Estrogen typically exhibits anti-inflammatory properties, while progesterone fosters immune tolerance. Together, these hormones can have a protective effect against autoimmune-driven inflammation. However, fluctuations in hormones can significantly impact the severity of psoriasis, particularly during key life stages like puberty, pregnancy, and menopause.
Menstrual Cycle
Shift in hormones across a cycle can have differing impacts on psoriasis severity.
While hormonal effects on psoriasis can vary between individuals, higher oestrogen levels generally have anti-inflammatory effects influencing the immune system and potentially dampening inflammation in several ways:
Suppression of pro-inflammatory molecules and enhancing anti-inflammatory cytokines
Switches the balance of the immune system to a more anti-inflammatory profile (from Th1 and Th17, which is pro-inflammatory to a less inflammatory Th2 profile)
Enhances regulatory cells which are involved in immune tolerance and important for dampening down autoimmunity (T-regs)
Progesterone also plays a role in managing psoriasis, promoting immune balance by dampening down immune over-activity, reducing pro-inflammatory cytokines and promoting anti-inflammatory cytokines. This effect can reduce keratinocyte hyperproliferation, plaques and skin scaling.
However, hormonal effects aren’t always clear cut. It is important to keep in mind that different effects can be seen during different stages of the menstrual cycle and depend on a woman’s individual hormonal fluctuations.
Menstrual Cycle
The luteal stage (post-ovulation), when progesterone levels rise, may be associated with reduced inflammation in some women. In others, lower levels of oestrogen during the luteal phase comes with a greater risk of immune dysregulation, inflammation and psoriasis flares. Flares are also more common during menstruation due to lower estrogen levels or when there is an imbalance between estrogen and progesterone (either high oestrogen levels or low rises in progesterone).
Recognising cyclical patterns can help to more effectively manage psoriasis. Strategies to help modulate hormonal balance and skin impacts such as herbal medicine, dietary approaches and stress management can all help to reduce cyclical flares.
Tip: tracking symptoms across your menstrual cycle can help to determine if psoriasis is impacted by hormonal shifts. Hormone testing may also help to establish any effects, but a good clinical assessment may be enough to establish hormonal patterns of exacerbation or remission in psoriasis.
Pregnancy & Postpartum
During pregnancy, higher levels of progesterone and oestrogen can create an anti-inflammatory state and lead to relief of symptoms. However, there is a window of vulnerability postpartum, when oestrogen and progesterone levels drop rapidly creating a rebound effect in inflammation. Coupled with elevated prolactin at this time, a hormone associated with exacerbations due to keratinocyte proliferation, these changes in hormones are linked with increased inflammation and flares in psoriasis symptoms – itching, redness and scaling. It is important that any therapeutic approaches in the post-partum stage consider breastfeeding (if applicable) along with the other stressors that come with the demands of motherhood such as sleep deprivation, postpartum mood changes and nutritional status.
Menopause
Many women also report worse symptoms and sustained flares when oestrogen levels decline during menopause. Generally, menopause is characterised by elevated inflammation levels so treatment approaches will often focus on restoring immune system balance and reducing inflammation rather than influencing hormone levels.
Stress
When it comes to the stress hormone cortisol, acute increases in cortisol during acute stress typically results in an immunosuppressive effect dampening down inflammation. Chronic stress is associated with chronic cortisol dysregulation and a net pro-inflammatory state, which can contribute to psoriasis development and severity.
Recognising how hormonal changes influence psoriasis can help in tailoring treatments and lifestyle adjustments for better management. If you're experiencing hormonally triggered psoriasis flares, consider booking a session with Ananda for a personalized approach.
Reference:
Cassalia F, Lunardon A, Frattin G, Danese A, Caroppo F, Fortina AB. How Hormonal Balance Changes Lives in Women with Psoriasis. Journal of Clinical Medicine. 2025; 14(2):582. https://doi.org/10.3390/jcm14020582