Medical professionals generally consider estrogens to be pro-inflammatory. With menopause and decreased estrogen, joint pain and mild arthritis may develop.
If a person chooses estrogen replacement therapy, the joint pain can decrease in some people. However, studies have not explicitly noted this in cases of ankylosing spondylitis.
The Axial Spondyloarthritis Support Program (ASSP) of Australia explains that when estrogen levels drop during menopause, inflammation may increase, resulting in greater disease activity and worsening arthritis symptoms.
However, the ASSP adds that there is insufficient research to properly determine the effect of menopause on ankylosing spondylitis.
A 2018 review suggests estrogen has an anti-inflammatory effect on ankylosing spondylitis. However, further research is necessary to understand the extent to which this hormone plays a role in the development or progression of the condition.