Women are more likely than men to suffer with certain chronic illnesses. Many of these are the things that we treat daily in practice—anxiety and depression, chronic fatigue, headaches, gallbladder disease, arthritis, osteoporosis, and auto-immune diseases just to give a few examples. Epidemiological and clinical studies have determined that in almost all cases of “gender gap” in various conditions, the gap is connected to a mix of biological and social factors.

Worsmer and Shapiro found that “patients with chronic Lyme disease differ with regard to gender from those with either B. burgdorferi infection or post-Lyme disease syndrome. This finding suggests that illnesses with a female preponderance, such as fibromyalgia, chronic fatigue syndrome, or depression, may be misdiagnosed as chronic Lyme disease.”

The goal of this article is to explore treating women with chronic illness, namely those that have been diagnosed with Lyme disease, by pulsing therapeutic strategies depending on the phase of their menstrual cycle. In some cases, we also consider treatments in accordance with a woman’s phase of life. For example, perimenopausal and menopausal women are in a different hormonal rhythm than those that are still menstruating on a monthly basis.

A woman’s physiology is deeply connected and impacted by the fluctuation of hormones throughout the monthly rhythm of their menstrual cycle. Women who are in the midst of perimenopause or who have entered menopause experience a shift in their hormonal rhythm that also impacts their physiology.

We have observed clinically that many women who struggle with Lyme disease and its common co-infections experience symptoms that include insomnia, depression, anxiety, brain fog, fatigue, chronic digestive issues, dysautonomia, mast cell activation syndrome, POTs, air hunger, interstitial cystitis, and more.

Women with chronic illness, including those namely who struggle with Lyme disease, often experience signs and symptoms related to estrogen dominance. This may include ovarian cysts, fibroids, menorrhagia, PMS, and painful periods. Another observation is that these women often experience a flare of symptoms one week prior to menstruation. We have called this phenomenon, luteal phase flare (LPF).

The severity of the LPF is variable and dependent on a number of hormonal imbalances, but primarily lower progesterone and higher estrogenic activity. We know this can be related to anovulatory cycles, the estrogenizing effects of our environment, overall body burden of toxicants, and in some cases trauma. We also note that many women with chronic pathogen problems may have an earlier start to the perimenopausal transition. The entire hypothalamic- pituitary-ovarian (HPO) axis is sensitive to the effects of pathogen exposure.

Our approach in the treatment of chronic illness is to address the patient’s terrain, remove toxicants and improve eliminations via the gut, liver, and kidneys. We focus on the extracellular matrix and address the lymphatic system as well since it is essential for removal of many toxicants and permeates the whole body, including the central nervous system and brain.

We know from basic physiology that a woman’s immune system shifts throughout her monthly menstrual cycle. During the follicular phase, when estrogen is rising, there are higher levels of circulating antibodies and a heightened inflammatory response. Prior to ovulation and potential pregnancy, a woman’s body is ready to fight foreign invaders so she can be healthy to conceive.

After ovulation, women enter the luteal phase when estrogen drops off and progesterone begins to rise. A women’s immune system is downregulated by progesterone in order to prevent immune cells from attacking a fertilized egg and thereby prevent implantation. Immune suppression during this time can make women more susceptible to infection. Ovulating females are more prone to infections from yeast, bacteria, and viruses. On the other hand, immune suppression may play a role in other conditions so that women are less likely to suffer with things like asthma symptoms during this time.

The late luteal phase, typically one week prior to menstruation, women with chronic illness may experience negative or worsening of symptoms due to the rise of prostaglandins as the uterine lining prepares to shed. The complexity of immune recognition means that certain susceptibilities are present in the late luteal phase and the reactivity of certain inflammatory pathways are occurring at the same time.

This is especially concerning for women with chronic pain and those women suspected of having endometriosis. There is a lack of coordinated immune response that leads to unchecked inflammation and a heightened sensitivity to pain. In some women, there is also a susceptibility to autoimmune processes. The same underlying issues are involved in an ongoing immune response to a past infection, like Borrelia or many other pathogens. We know there is an overlap with the symptom picture in women diagnosed with Lyme—chronic pain, fatigue, digestive issues, brain fog, and mood challenges. Root causes such as inflammation, stress, gut microbiome dysbiosis, and nutrient deficiencies must be addressed in both scenarios to help women heal.

As noted, women with Lyme tend to have an increase in symptoms the week before their menstrual cycle. Dr. Marylynn Barkley studied the relationship of female hormones on the rise and fall of Lyme disease symptoms.

She observed (data recorded over a two-year period) an intensification of night sweats in a cyclical pattern coinciding with the decline of ovarian hormones and onset of menses with women with Lyme. She also found that during this phase of the cycle, the immune recognition of Borrelia antigen in the urine (LUAT) was at a peak and that cytokines were found to be above normal. Night sweats are often correlated with immune activation.

Dr. Barkley identified this interval of increased immune activity several days before the onset of menses. She speculated that the increase in immune response leads to an increased die off of spirochetes during this period, which leads to the intensified symptomatology and the increased shedding of antigen.

Of note, the timing a woman gets a tick bite (or other route of exposure) may also affect likelihood of an infection or resistance to infection. Also, timing of Lyme test may be best three to four days prior to the period.

With this in mind, we propose adjusting support for various conditions dependent upon the time of the menstrual cycle or the life-stage of the woman: i.e. puberty, perimenopause, post-menopause.

For women that are still cycling monthly, we recommend various support for both halves of the roughly 28-day cycle. For example, supporting healthy estrogen metabolism by working with liver and gallbladder health is key in the follicular phase. In the luteal phase we shift focus to supporting healthy levels of progesterone and the delivery and sensitivity of tissues to progesterone. Some of this is accomplished by making sure a woman’s lymphatic system is optimized, and there are many aspects of our work that intersect with lymph and the clarification of the extracellular matrix.

In addition, luteal phase flare support may include increased antimicrobial strategies to pair with the noted increased immune activity against spirochetes, addressing biofilm, immune modulation therapies, and enhanced elimination remedies, such as binders, to support a woman’s immune system during this time.

Perimenopausal and menopausal women with chronic illness have different needs and different symptomatology. These women often experience anxiety, insomnia, brain fog, low libido, vaginal dryness, and weight gain in more dramatic fashion than simply transitioning through menopause alone. Recommended therapies may focus more on tonifying or nutrifying tissues and organ systems based on the individual’s history, including past exposure to viral, bacterial, or fungal pathogens and how they responded to those events. This is where our understanding of miasm is very helpful.

Shifting treatment strategies each month also allows women to connect more deeply to their inner rhythms while further connecting to the outer rhythms in nature.