Table 1.

Autoimmune diseases and transition states.

	Puberty	Pregnancy	Menopause
T1DM	•Peak incidence between 5 and 7 years and at puberty. •Greater risk of complications in girls.	•Worsens pregnancy outcome vs. T2DM. •Thyroid antibodies associated with Gestational DM but lack predictive value. •High TSH and thyroid autoimmunity increase GDM risk.	•Females with T1Dm have higher mortality than men. •Microvascular complications in T1DM result in pre-mature menopause. •Women bear unequal burden of sequelae of T1DM vs. men.
SLE	•Increase incidence in girls post-puberty. •ANA titer higher in female children. •Effect on height higher in males. •Menarche pushed to higher age.	•Lower E2 levels in pregnant lupus patients vs. pregnant controls. •Prolactin levels positively associated with severity. •Flares more common with increase in estrogen.	•Decreased frequency of flares after menopause but more damage from each flare. •Sexually dimorphic immune response in the gut mucosa of males and females.
RA	•Earlier age at menarche increases risk.	•Pregnancy and breast feeding is protective.	•Irregular menstrual cycle increases risk. •Early age at menopause significantly associated with RA. •More joint destruction in post-menopausal women. •HRT protective.
MS	•Sex ratio rises to 2.2:1 post-puberty. •Late menarche decreases risk (females-only). •Pre-pubertal ovariectomy decreases risk. •Spike in relapse during peri-menarche and incidence peak post-menarche. •Higher leptin in females may increase risk.	•Relapse rate reduced during pregnancy but worsens after delivery. •Breast-feeding reduces relapse.	•Peak incidence in perimenopausal age group. •Post-menopausal women have worse symptoms and higher severity. •More frequently primary progressive MS than relapsing-remitting MS in post-menopausal age group.
Psoriasis	•Perimenarchal increase in incidence.	•Decreased severity during pregnancy. •Higher estrogen and higher E2 to progesterone ratio results in improvement.	•Post-menopausal exacerbation of psoriasis. •Late onset psoriasis is more common in women than in men.