Navigating rheumatoid arthritis through pregnancy and menopause with NRAS

The National Rheumatoid Arthritis Society (NRAS) is shining a light on the unique challenges women with rheumatoid arthritis (RA) face at key stages of life, particularly during pregnancy and menopause. Through initiatives such as the MAMA study, examining biologic treatments in pregnancy, and work highlighting gaps in menopause care, NRAS is advancing understanding of women’s experiences and helping to shape more informed, responsive care.

In this interview, we spoke with Donagh Stenson (Innovation & Service Delivery Director, NRAS) and Ailsa Bosworth (Founder, NRAS) about how RA affects women across hormonal life stages, with a focus on pregnancy and menopause. They discussed gaps in care, the aims of the MAMA study on biologic treatments in pregnancy, and how collaboration and new initiatives can drive meaningful improvements in clinical practice and patient support.

Q. How does rheumatoid arthritis uniquely affect women, particularly across hormonal life stages, such as pregnancy and menopause?

We know many women report changes in their RA symptoms around times of hormonal change, and many are diagnosed with RA around menopause age. Menopause and RA also share many of the same symptoms, including fatigue, brain fog and joint pain. In a study we were part of during early 2024, 93% of women with RA told us that no medical professional had discussed the menopause with them.¹ While research remains limited, emerging evidence suggests that women with RA may experience menopause earlier than those without the condition.

To produce our Menopause & RA patient booklet, we held a focus group of women experiencing RA and menopause; many told us that they were managing their RA well until menopause, but then found it difficult to bounce back from a flare.² Some also told us that menopause made working with RA unmanageable, leading them to leave or change jobs.

During pregnancy, around 75% of women experience some sort of symptom relief.³ Unfortunately, many women experience a flare up within weeks of giving birth. Managing a new born alongside an RA flare can be incredibly challenging; parenthood is difficult enough, and even more so when living with a lifelong condition that affects the whole body. This situation often means mothers will need to restart their medication, and may no longer be able to breastfeed. The British Society of Rheumatology is about to revise its guidelines on pregnancy.⁴

Q. What prompted your focus on improving RA care for people going through menopause, and what are the biggest gaps you’ve identified?

NRAS was part of a study group in early 2024 where we surveyed women with RA and menopause.¹ We were shocked at the lack of guidance, information and support available for women experiencing RA and menopause. We set out to produce a booklet that would provide information and support, enabling women experiencing RA and menopause to start a conversation with medical professionals, whether that be their GP or rheumatology team. Being a women’s health advocate, I am passionate about improving care, information and support for women, particularly when the ratio of women to men with RA is approximately 3:1. I was also moved by the limited opportunities for women to share experiences of RA and menopause, and receive peer support.

The first thing we do when creating new materials is convene a diverse group of service users for a focus group. Many of the women who attended our first focus group told us not only had they never spoken to a medical professional about RA and menopause, but they also had not spoken to ANYONE about their challenges and difficulties. During the group several expressed how they felt less alone now they had the opportunity to talk to others going through the same experience. Initially, we had only planned to create the patient resource, but this need to share experiences inspired us to set up one of our JoinTogether Online peer support groups dedicated to menopause and RA. Our volunteer group leader held the first group on the 29^th January, with more than 100 women registering to attend. We hosted menopause specialist Dr Olivia Hum who presented educational information.

When creating new information materials, we look to collaborate with experts in their specialist fields. Here we sought a collaboration with the British Menopause Society (BMS) to ensure that the information was evidence-based and credible. The collaboration has been brilliant and we thank Sarah Moger and Dr Olivia Hum for working with us to create this valuable resource.

We held a patient webinar in November 2025 with menopause expert, Vikram Talaulikar talking all things menopause, which can still be accessed via our website and YouTube channel. I met Vikram at the European rheumatology congress in June 2025. Vikram was presenting to rheumatology specialists on menopause, encouraging them to consider hormone replacement therapy (HRT) for women with RA to see whether it improves their symptoms. His last point of the presentation really hit home with me, he said “women now live 30–40 years past menopause age and that’s a long time to live in ill health.” We were already working on the menopause program by then, but this fact really spurred me on.

Last November, the BMS invited us to attend their women’s health symposium, and one of our medical advisors, Dr Elena Nikiphorou, presented to menopause clinicians about all things rheumatology. It was brilliant to see these clinicians eager to learn more about the cross overs and the experiences of women. Our intention for this work is to educate both patients and clinicians, so women receive improved care and support. The booklet was launched on International Women’s Day – 8^th March 2026.²

Q. What practical changes or resources do you hope your menopause initiative will bring to both clinicians and patients?

In addition to previous items and activities, we have a healthcare professional webinar planned in October 2026, which we will start to promote at this year’s BSR Annual Congress in Glasgow. By arming patients and healthcare professionals with information and education, we hope to empower women experiencing RA and menopause to discuss the option of HRT in addition to their medication. We want to prevent women from experiencing decades of poor health because of the intersection of RA and menopause.

Q. What are the biggest unanswered questions or unmet needs around treating inflammatory arthritis during pregnancy?

Women with RA who are of child bearing age and want to start a family require a great deal of support and information from their rheumatology team. At the end of 2022, the BSR released NICE-accredited guidelines on prescribing immunomodulatory anti-rheumatic drugs and corticosteroids in pregnancy and breastfeeding.⁵ That’s when we decided, in 2023, to schedule an NRAS Live webinar on this topic, which aired in autumn 2024 and is available on our YouTube channel.

Our expert panel included the guideline author Professor Ian Giles (University College London, UK), Specialist Nurse Louise Moore who was on the guideline development group (Our Lady’s Hospice and Care Service, Ireland), Dr Kate Duhig (Academic & Obstetrician, University of Manchester, UK), Professor Kimme Hyrich (Principal Investigator on the British Society for Rheumatology Biologics Registers in Rheumatoid Arthritis [BSRBR-RA], University of Manchester, UK) and patient Katy Pieris. We ran a second NRAS Live featuring Louise Moore’s contribution from a nursing perspective, as she had a complete power outage on the night of the first webinar and was unable to present.

Before embarking on having children, it is important that women receive advice from their rheumatologist and that plans are made to manage their disease before and during pregnancy and after giving birth. For many women, their RA may be fine during pregnancy, but not for all. RA can often flare badly after giving birth, but with careful planning with a rheumatology team, particularly around medicines management, post partem flares can be minimized. It is important that RA is as well controlled as possible 3–6 months before and during pregnancy; badly controlled disease at this time is not good for the mother or baby, and the aim is to prevent poor outcomes like preterm birth or low birth weight. Active, uncontrolled inflammation is more harmful to a pregnancy than many medications, making planning with a rheumatologist essential for switching to pregnancy-safe treatments.

We are currently supporting the MAMA trial – Monoclonal Antibody Medications in inflammatory Arthritis: stopping or continuing in pregnancy study.⁶ The MAMA Study is for pregnant women with inflammatory arthritis who are being treated with a biologic, and is looking to provide an answer on whether it is better to stop or continue biologic/biosimilar treatments. We have a landing page on our website to support recruitment to this trial which you can find here.

Q. What key questions about biologic treatment in pregnancy is the MAMA study aiming to answer?

NRAS is delighted to support the MAMA trial which is addressing the question of stopping or continuing a biologic treatment during pregnancy, which will hopefully give prospective parents some much needed reassurance. We are aware that pregnancy and parenthood can bring a lot of stress and challenges, and this is even more challenging for women living with complex diseases, such as RA. One of the more common enquiries we receive about pregnancy is whether it is better to stop or continue biologic/biosimilar treatment while trying to conceive and during pregnancy.

Q. How will NRAS ensure that insights from these projects translate into real changes in everyday clinical practice?

Our role at NRAS is to support and inform RA and juvenile idiopathic arthritis communities, whether that be people with RA or the professionals that support and care for them. We undertake a multi-channel approach to making positive change through advocacy and policy at national and local levels, or by being involved with best practice guideline development at national and European levels. We work with clinical and research experts to provide insight and input from a patient perspective and we also raise awareness of the condition with the general public with the intention of creating understanding about all aspects of living with and managing these diseases. For menopause specifically, we have already undertaken some healthcare professional education in both rheumatology and menopause, and we have more planned for the rest of 2026. We will be promoting our information and support at national and international congresses this year. For our service users, we will use all the usual communication channels to highlight these resources.

Q. How can rheumatology teams, GPs, and patient organizations work together to close the gaps highlighted in your menopause and pregnancy initiatives?

Working with rheumatology and menopause experts and people living with RA has enabled us to collectively produce information that will hopefully make a positive impact on the lives of women. Arming people with the information needed to start a conversation at the patient and clinician level, and even at a guideline development and national policy level, can only improve the situation. These collaborations have been a real joy for us to work on.

With limited research about RA and menopause available, we created a Menopause & RA coalition as part of the programme, bringing together professionals from research to clinical practice, alongside women living with RA. The intention of the coalition is to seek new opportunities for research, service development and education, in order to continue improving the lives of people experiencing poor health.

One of the things that we always promote when presenting to multi-disciplinary teams about our services and resources is broadening their understanding of the value that partnering with patient organizations can bring. We often find that healthcare professionals are unaware of the breadth and depth of our resources and the work we undertake at a national level to ensure the patient voice is included in guideline and quality standards development; disseminating these messages is a priority for NRAS.

References

1. Petford S, Robinson S, Matthews S, et al. Menopause Matters: Results of a National Survey of Rheumatoid Arthritis Patients in the UK. Musculoskeletal Care. 2024;22:e70007.
2. National Rheumatoid Arthritis Society (NRAS). Rheumatoid arthritis & menopause. Available at: https://nras.org.uk/product/menopause-rheumatoid-arthritis/ (accessed 24 March 2026).
3. National Rheumatoid Arthritis Society (NRAS). Rheumatoid arthritis & pregnancy. Available at: https://nras.org.uk/resource/rheumatoid-arthritis-pregnancy/ (accessed 24 March 2026).
4. British Society for Rheumatology. Guidelines | British Society for Rheumatology. Available at: https://www.rheumatology.org.uk/guidelines/ (accessed 24 March 2026).
5. Russell MD, Dey M, Flint J, et al; BSR Standards, Audit and Guidelines Working Group. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology. 2023;62:e48–e88.
6. National Rheumatoid Arthritis Society (NRAS). MAMA Study: pregnant women with inflammatory arthritis being treated with a biologic. Available at: https://nras.org.uk/2026/01/08/mama/ (accessed 24 March 2026).