Shingles and Menopause: Is There a Connection?

Shifting hormones, hot flashes, mood swings, sleep deprivation, and short-term memory loss are all normal and natural changes women experience and anticipate during menopause. However, many women may be unaware that they are also at an increased risk for developing shingles (herpes zoster) while transitioning through menopause.

Herpes zoster (HZ) is a reactivation of the varicella zoster virus that causes chickenpox and subsequently burrows into the host’s dorsal root ganglia, where it lays dormant until reactivating back to life decades later. Individuals at greatest risk for shingles are those 50 years of age and older; women account for more cases than men. Peak incidence for women coincides with the average age for menopause (51-54), while men tend to develop shingles later in life.

The menopause/shingles connection generally focuses on three factors: hormones, stress, and immunity.

According to the North American Menopause Society (NAMS), “Changes in our cellular immunity occur with age, stress, certain medications, and hormones, and make us more vulnerable to viruses, especially those in the herpes family (shingles, herpes simplex, cytomegalovirus).” NAMS also explained that “women, particularly during the menopause transition, have higher rates of shingles than men, most likely due to hormonal changes to their immune response.”

In her OBGYN practice in Ithaca, NY, Kathleen Gardner, MD, witnesses first-hand how hormones, stress, and immunity interact in her menopausal patients. “Herpes zoster is a reactivation of a virus that looks for opportunities of physiologic stress, and menopause is a time of both physiologic and emotional stress,” she said.

For example, hormonal disruptions associated with menopause affect sleep patterns. “Poor sleep patterns clearly play a role in overall health, but also play a role in immunologic health,” added Gardner.

NAMS Past President Marla Shapiro, CM, MDCM, points out that while there are gender differences when it comes to shingles, conclusive research data is lacking when it comes to shingles and women per se. “We often jump to the conclusion that these gender differences must be hormonal because it’s happening in 50 and 60 year olds, but we really don’t know if there are pathophysiological causes in gender differences,” she explains. “There are a number of theories that look at the fact that estrogen and progesterone may tamp down the inflammation, so in their absence during the onset of menopause we could lose that protection. But a lot of it is quite theoretical.”

NAMS advocates for the best protection against preventable diseases. The shingles vaccine is among the most valuable vaccinations for midlife women, according to NAMS.

Shapiro offered specific guidance to all women as well as men. “When you hit age 50, you really want to think about getting the shingles vaccine,” she said. “For those who had the attenuated live virus vaccine [Zostavax], we’re still recommending reimmunization with 2 doses of the recombinant vaccine [Shingrix].” She noted that Shingrix is not only highly effective in preventing shingles, but it also can help lessen the risk of complications like postherpetic neuralgia.

Effective July 2020, Merck announced that it would no longer sell Zostavax in the United States. The move leaves Shingrix as the lone shingles vaccine in distribution. Administered in 2 doses, it is FDA-approved for immunocompetent adults 50 years and older.