Reproductive transitions and autoimmunity: implications for women's health in rheumatology and gastroenterology

Women's reproductive life encompasses dynamic phases, including menarche, menstrual cycles, pregnancy, lactation, and menopause, as well as transitional periods of variable duration. These stages drive physiological changes that influence both physical and mental well-being and may modulate susceptibility to autoimmunity. The interplay between autoimmunity and reproductive milestones is bidirectional: reproductive stages can affect disease onset and progression, while autoimmune disorders influence fertility, pregnancy outcomes, and the timing of menopause. Persistent challenges in detecting autoimmune diseases, particularly within rheumatology and gastroenterology, underscore the need for targeted screening, multidisciplinary collaboration, and patient-centered strategies. Fertility preservation, preconception counseling, and individualized pregnancy management are essential to safeguard reproductive rights and optimize maternal and neonatal outcomes. Post-reproductive life, especially the menopause transition, represents a vulnerable period in which immune, hormonal, and metabolic changes converge. This manuscript highlights the importance of a comprehensive, lifespan-oriented approach to reproductive well-being in women with autoimmune diseases, integrating preventive, diagnostic, and therapeutic strategies across all stages of reproduction.