Patients with systemic lupus erythematosus (SLE) face a daunting journey accompanied by severe morbidity, a poor quality of life and potential damage to major organs including the kidneys, eyes, cardiovascular and cerebrovascular systems. Disease prevalence is highly skewed towards females of childbearing age - polarizing statistics pointing to a role for estrogen in disease origin and/or progression. Female patients of certain races/ethnicities are more predisposed to SLE while also presenting with more severe and aggressive disease. Unfortunately, this cohort also experiences the most delays in disease diagnosis. Herein we discuss SLE and its outcomes in the backdrop of estrogen and delays in diagnosis.