Abstract Background/Aims Systemic autoimmune rheumatic diseases (SARDs) disproportionately affect women. Symptoms of the menopausal transition, including the vasomotor, urogenital, musculoskeletal, and neuropsychiatric, may exacerbate existing SARD symptoms, thus further reducing overall quality of life. Hormone replacement therapy (HRT/MHT) is a well-established treatment for menopause symptoms amongst the general population. However, among patients with SARDs, the effect of HRT on disease activity, quality of life and menopausal symptoms remains underexplored. It is important to reduce this gap in patient-centred research and understand patient experiences of the intersection of menopausal and disease symptoms, in order to improve decision-making and personalised care. Using patient-reported data, we aim to (1) quantify the self-reported impact of HRT on SARD and menopause symptoms; and (2) compare responses between those currently using/not using HRT including across disease subgroups. Methods An international, cross-sectional Menopause MATTERs study based on an online questionnaire distributed between Dec 2024 - Mar 2025. Patients with a confirmed SARD with age ≥ 18 across different stages of menopause were included in this study. A multivariate analysis of covariance (MANCOVA) was conducted to study self-reported differences in menopause-related (including using the menopause rating scale (MRS)) neuropsychiatric (including the PHQ-8 depression scale), and SARD symptoms over the last month between current and non-HRT users. Results The overall unadjusted effect of HRT status on neuropsychiatric and SARD symptoms was significant (F(16, 4608) = 4.37, p .001, partial η² = .015). Age had a strong effect across outcomes (p .001), whereas ethnicity was not significant (p = .75). After adjustment, HRT status continued to be a significant predictor of menopause symptom severity (MRS), fatigue, cognitive dysfunction, anxiety, depression, pain, and autoimmune disease activity (all p .05). Post-hoc tests (Bonferroni-adjusted) demonstrated that current HRT users (n = 404 had higher mean scores for all symptoms in the last month than those who had never used HRT (n = 1508). Women who had ever used HRT (N = 776) reported perceived effects on various health domains. The majority reported improvement in menopause symptoms (75%) and overall quality of life (76%), while most (66%) reported no change in autoimmune disease symptoms. Only 5% felt HRT worsened their menopause symptoms, compared with 12% for autoimmune symptoms. Conclusion Findings show that HRT is viewed by patients as improving menopausal symptoms and overall quality of life whilst largely having no adverse or positive effect on SARD symptoms. However, SARD patients who are currently using HRT have a higher burden of menopause-related, neuropsychiatric, and autoimmune symptoms than those not on HRT. A possible explanation is that women with more severe symptoms are more likely to use HRT. These data provide patient-reported evidence of risks and benefits, to assist patients and clinicians in making decisions about HRT use. Disclosure K. Naidu: Grants/research support; KKN is funded by The Lupus Trust. A. Kaul: None. D. D’Cruz: Consultancies; DD’C reports consultancy/speaker fees from GSK, Eli Lilly, and UCB; and a leadership role on the board of APS support UK.. Grants/research support; DD’C reports grants from MRC, NIHR, LUPUS UK, and The Lupus Trust. F. Naughton: None. L. Andreoli: Consultancies; LA has received consultancy fees from Pfizer, UCB and speaker fees from Abbott. Z. Mclaren: None. S. Taylor: Grants/research support; ST reports funding from The Lupus Trust, LUPUS UK and Vasculitis UK. M. Piper: Grants/research support; MP reports funding from The Lupus Trust. W. Diment: None. V. Talaulikar: None. T. Reilly: Grants/research support; TJR is supported by an MRC Clinical Research Training Fellowship, MR/W015943/1. L. Gallagher: None. L. Holloway: None. E. Tranah: None. M.A. Sloan: Consultancies; MS reports consultancy fees from SRUK and Otoimmune. Grants/research support; MS is funded by the NIHR, The Lupus Trust, LUPUS UK, Vasculitis UK.
Naidu et al. (2026) studied this question.