Why is the prevalence of autoimmune diseases in women higher than among men?

In India, vague illnesses are often met with even more vague explanations. “Viral.” “Stress.” “Some infection.” Yet the symptoms keep cycling through. Persistent fatigue. Unmapped pain. Test reports that say little. Autoimmune diseases in women often take root in this ambiguity, long before a diagnosis comes to light.

Women are four times more likely to develop autoimmune diseases. The gap persists across regions and age groups. Data tells the same story. The Indian Rheumatology Association revealed that women make up for 70 per cent of autoimmune patients in India. 

This isn’t coincidental, but a collision of biology, hormones, stress, and social conditioning that places women at higher risk. 

What is an autoimmune disease? 

“Autoimmune diseases occur when the body’s immune system, which normally defends against infections, mistakenly attacks its own healthy tissues and organs,” explains Dr Ruby Taparia, consultant rheumatologist at KIMS Hospitals, Mumbai. “This self-directed immune response leads to chronic inflammation, pain, and damage to specific organs or systems.” 

More than a hundred recognised autoimmune diseases exist today, some idiopathic (having no definite identified cause), and some without a definitive cure. These conditions vary widely in presentation, severity, and progression. 

“Rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, spondyloarthritides, and idiopathic inflammatory myopathies are some of the common autoimmune diseases,” says Dr Pranav R Chickermane, consultant rheumatologist at Zynova Shalby Hospital, Mumbai. “The characteristic symptoms depend on the type of the disease and can include joint pain, swelling, and early morning stiffness, muscle pain and weakness, photosensitivity, rashes, oral ulcers, dryness of eyes and mouth, unexplained fever and weight changes.” Hashimoto’s thyroiditis and psoriasis are other common autoimmune conditions, adds Taparia. “Many patients experience flare-ups—periods when symptoms worsen—followed by remissions where they improve.”

Why autoimmune diseases become silent red flags  

Autoimmune conditions rarely begin with clarity. Early symptoms can be misleading, appearing mild, inconsistent or easily attributed to unrelated causes—a rash resembles an allergy, exhaustion appears like burnout, joint stiffness that might be a result of overworking. This ambiguity contributes to delays in identifying autoimmune diseases, especially when the earliest signs appear indistinguishable from everyday fluctuations in health. 

A study by Bio Med Central reveals that autoimmune diseases are the fourth leading cause of disability in women. This is because autoimmune diseases are chronic, progressive, and can adversely affect multiple organs, informs Taparia. “In the short term, they cause fatigue, pain, and reduced mobility. In the long run, if uncontrolled, they can lead to irreversible organ or joint damage, disability, and increased risk of infections due to long-term immune suppression from treatments.” 

This can lead to disability, reduce productivity, and negatively impact the quality of life, adds Chickermane. There is no singular, straightforward approach to diagnose what causes autoimmune conditions. This uncertainty often allows inflammation to progress unchecked. An article by John Hopkins Medicine corroborates that there is no single marker or blood work that helps conclude the presence of an autoimmune condition at once. 

“RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS, SJÖGREN SYNDROME, SPONDYLOARTHRITIDES, AND IDIOPATHIC INFLAMMATORY MYOPATHIES ARE SOME OF THE COMMON AUTOIMMUNE DISEASES” –– Dr Pranav R Chickermane

Autoimmune diseases demand differential diagnoses, spanning genetic markers, immune profiles, and symptom clusters. As a result, autoimmune diseases can be misdiagnosed, or even left undiagnosed, particular in women, where symptoms often overlap with stress or hormonal functions. 

Why are women more vulnerable to autoimmune diseases?

The gender disparity in autoimmune diseases is not accidental. It is rooted in hormonal rhythms, genetic architecture, and immunological differences. In India, one in every 10 women have thyroid concerns, with a higher prevalence in women (11.4 per cent) than men (6.2 per cent). A study by  Global Burden of Disease found that Rheumatoid Arthritis (RA) affected over 2 million Indian women, whereas it barely surpassed the 7.5 lakhs marker among men.

Hormonal fluctuations: 

The first and most biological distinction is hormonal rhythm. Women experience far more frequent and pronounced hormonal shifts as  compared to men, notes Dr Pranav Ghody, an endocrinologist at Wockhardt Hospitals, Mumbai. “The female endocrine system undergoes cyclical changes every month during the menstrual cycle, in addition to major hormonal shifts during puberty, pregnancy, postpartum, and menopause. In contrast, men have relatively stable hormone levels, with gradual changes over time rather than cyclic variations. These fluctuations in estrogen, progesterone, and other hormones influence not only reproductive health but also metabolism, immunity, and mood regulation.”

“DYNAMIC HORMONAL CHANGES IN WOMEN CAN SOMETIMES TRIGGER OR EXACERBATE AUTOIMMUNE CONDITIONS, ESPECIALLY DURING LIFE STAGES LIKE PUBERTY, PREGNANCY, OR MENOPAUSE” –– Dr Pranav Ghody

These hormonal shifts are a central factor in explaining why autoimmune diseases in women appear more frequently and often more aggressively. “Estrogen tends to enhance immune activity, which helps the body fight infections—but it can also increase the likelihood of the immune system attacking its own tissues. In contrast, androgens like testosterone tend to suppress immune responses. Therefore, the dynamic hormonal changes in women can sometimes trigger or exacerbate autoimmune conditions, especially during life stages like puberty, pregnancy, or menopause, when hormone levels shift dramatically,” says Ghody.

Immune reactivity:

“The female-to-male ratio varies by condition—for example, systemic lupus erythematosus (about 9:1), Hashimoto’s thyroiditis (about 5–10:1), multiple sclerosis (about 3:1), and rheumatoid arthritis (about 2–3:1),” says Dr Phulrenu Chauhan, an endocrinologist at PD Hinduja Hospital, Mumbai. The higher predisposition stems from a stronger baseline immune reactivity and hormonal effects that enhance immune signaling, cites the doctor.

Genetic influence:

Genetic factors linked to the ‘X’ chromosome also augment a woman’s susceptibility to immune system imbalances, informs Dr Sneha Kothari, an endocrinologist at Gleneagles Hospital, Mumbai. The male cell comprises one ‘X’ chromosome and one ‘Y’ chromosome—the latter being largely inactive when it comes to cell activity. The female cell, on the other hand, contains two ‘X’ chromosomes. This amplified genetic activity can strengthen immunity but also increase risk of immune misfires. “The presence of two ‘X’ chromosomes, which contain immune-related genes, provides women with a stronger immune response—but also increases the likelihood of immune dysregulation,” explains Ghody. In some cases, X-inactivation is incomplete, increasing susceptibility to what causes autoimmune diseases.

Higher antibody production:

Women also have a higher reserve of antibodies than men. Although this might appear protective, it increases the likelihood of antibody-driven autoimmune diseases. As a PubMed Central study states, “an enhanced B‐cell activation and production of higher levels of antibodies results in increased incidences of antibody‐driven autoimmune diseases.” 

Nutrient deficiencies:

Nutrient gaps common among Indian women add yet another layer of risk. “Nutrient gaps in vitamin D, omega-3s, zinc, and selenium are common; but, they are important to address as they regulate immune function, lower oxidative stress, and reduce inflammation,”  says nutritionist Sophia Kohli. Iron deficiency, frequently due to menstrual losses, further weakens immune cell production. “Iron is vital for immune cell production and low levels can increase vulnerability to infections. Some studies even link iron deficiency to increased risk of thyroid autoimmunity,” she adds. 

Stress, emotional labour and psychological triggers: 

Higher levels of stress among women significantly increase vulnerability to autoimmune diseases. While the biological factors associated with autoimmune diseases in women are extensively researched, the psychological and emotional triggers receive far less attention. Multiple studies suggest a strong link between chronic stress and autoimmune diseases. 

The Global Autoimmune Institute notes that up to 80 per cent of autoimmune patients have reported uncommon emotional stress before the onset of their conditions. Another large-scale study, examining more than 1,00,000 people with stress-related disorders, found that “as compared to 1,26,000 of their siblings and another million without stress-related disorders, those individuals were more likely to be diagnosed with an autoimmune disease or develop multiple autoimmune diseases.” 

Now, studies confirm what is already known: nearly three-quarters, or 72.2 per cent, of Indian women reported high stress levels. In contrast, 53.64 per cent of Indian men confessed to experiencing high stress levels. 

A sizable chunk of Indian women are severely stressed, due to reasons including gender role biases, societal and familial expectations, professional and personal life imbalances and the guilt that comes along with rest, higher sleep deprivation, and a working cycle that goes beyond the 24-hour clock that has left women chronically stressed. 

According to psychologist Sanam Devidasani, women are perpetually shouldering emotional labour. “Remembering everyone’s needs, managing moods, keeping peace in relationships, making sure nothing falls apart—in therapy, I see women who feel constantly ‘switched on.’ They’re not just doing a lot, they’re feeling a lot for everyone around them. Even when they want to rest, their minds keep running. That stress doesn’t always look dramatic, but it sits deep in the body.” 

Taparia adds, “Chronic stress disrupts immune balance by increasing inflammatory markers and reducing the body’s ability to regulate immune responses. Over time, this can trigger or worsen autoimmune activity.”

“REMEMBERING EVERYONE’S NEEDS, MANAGING MOODS, KEEPING PEACE IN RELATIONSHIPS, MAKING SURE NOTHING FALLS APART—IN THERAPY, I SEE WOMEN WHO FEEL CONSTANTLY ‘SWITCHED ON.’” –– Sanam Devidasani

Social conditioning further complicates this. “Women are taught to be accommodating—to take care of others, to avoid conflict,” says Devidasani. “So instead of expressing frustration or pain outwardly, they turn it inward.” This internalisation creates a sustained physiological burden that heightens susceptibility to immune dysregulation. 

How can women lower the risk of autoimmune diseases?

Autoimmune diseases carry long-term impact, but early intervention and consistent management can reduce severity and progression. “While not all autoimmune diseases can be prevented, women can lower their risk by maintaining a healthy lifestyle—eating an anti-inflammatory diet, managing stress, exercising regularly, getting enough sleep, and avoiding smoking. Regular medical check-ups and early attention to symptoms like unexplained fatigue, rashes, or joint pain can help with early detection and better management,” suggests Taparia. “[Treatment] depends on the specific disease but generally includes medications to reduce inflammation and suppress the overactive immune system, such as corticosteroids, disease-modifying antirheumatic drugs (DMARDs), or biologics.”

Ghody highlights the importance of managing conditions like polycystic ovary syndrome (PCOS) or thyroid imbalance in their early stages. “In some cases, hormonal therapies or supplements under medical guidance can help stabilise fluctuations that may contribute to immune dysregulation. Routine check-ups with an endocrinologist can ensure early detection and prevention strategies.”

Chronic emotional strain also shapes immune function, making recovery practices essential. Psychologist Dr Prerna Kohli recommends beginning with recalibrating stress. “Small daily breaks, mindfulness, movement, and therapy, if needed—these things matter more than we think.”

Nutritionist Karishmma Chawla emphasises dietary support. “Include foods containing antioxidants like vitaminsC and E and essential minerals such as magnesium, zinc, calciumto keep your cells active. Feed your gut flora with prebiotic foods, and top it off with a good probiotic supplement to nurture your microbiome from within. If need be, get on an anti-inflammatory, autoimmune disease diet—drop the irritants, and rebuild your gut from the inside out.”

Genetic predisposition forms one part of the equation, and modifiable factors such as diet, sleep, movement, and stress regulation form the other. Early diagnosis, treatment, and lifestyle intervention remain central to reducing the long-term impact of autoimmune diseases in women. The more these patterns are understood, the easier it becomes for women to move from delayed recognition to informed control.