Parkinson's Disease in Women

Women are diagnosed with Parkinson’s disease (PD) at half the rate of men (Parkinson's Foundation, 2018). They also tend to experience different symptoms, medication side effects, and treatment outcomes.

Some of these differences may be due to biological factors, while others may have to do with lack of access to quality healthcare, or unconscious gender biases of healthcare professionals. Regardless, women make up a significant portion of the Parkinson’s community, and it is important to understand and develop treatment plans that specifically target their unique needs.

Symptoms and Disease Management

Healthcare professionals must take into consideration the many ways sex and gender may play a role in their female patient’s life in order to build a comprehensive care plan. Parkinson’s symptoms vary so widely between individuals that it is difficult to conclude whether women experience certain symptoms and side effects more often than men do. However, research suggests that certain trends may indeed be present.

Firstly, women tend to start presenting symptoms and getting diagnosed around two years later in life than men (Case-Lo, 2018). Tremors are most commonly the first reported symptoms in women, followed by the later onset of involuntary movement (dyskinesia), depression, and other mental health challenges; this is contrasted with men, who tend to present first with slow or rigid movement (bradykinesia), and develop more cognitive issues related to Parkinson’s (Case-Lo).

Levodopa, a drug commonly prescribed to treat Parkinson’s symptoms, is also more likely to build up in women’s bodies, as they generally weigh less than men. This often causes more side effects and fluctuations in the effectiveness of the medication.

Researchers and clinicians have also found differences between the sexes in regards to Parkinson’s care and treatment. Women face more barriers to accessing healthcare overall, and those seeking a medical diagnosis tend to experience discrimination, invalidation, and prejudice when self-reporting their symptoms.

It is important to note again that each individual experiences Parkinson’s in a vastly unique way. Try not to compare your experience against others, and focus on working with your healthcare team to pursue the best possible treatment options for your needs.

The Potential Role of Estrogen

One element thought to cause some of the differences in the way Parkinson’s is experienced amongst women is estrogen. Estrogen is one of the main sex hormones responsible for female physical features and reproduction. Studies have shown that estrogen may be preventative against Parkinson’s (Miller et al., 2010).

Though the effect is not yet fully understood, experts believe that estrogen may play a role in protecting the brain by exerting anti-inflammatory properties. Studies have shown a connection between number of children and later menopause – both markers of increased estrogen – with delayed onset of PD (Miller et al.). However, once the disease had developed, estrogen did not seem to make any difference on symptoms or the severity of PD. Further research is needed to discover more about estrogen’s neuroprotective effects, and its potential therapeutic benefit.

Effects on Pregnancy, Menstruation, and Menopause

As PD is more common among older populations, instances of pregnancy and PD are rare. However, so far there is no evidence to suggest that women with PD have a higher rate of birth or fetal complications (Odin, 2018). While certain symptoms of Parkinson’s may affect pregnancy and vice versa, such as balance concerns, slowness of movement, fatigue, and nausea, they have not been shown to be severe or life-threatening. Additionally, common PD medications such as levodopa and dopamine have been used in pregnancies without any adverse side effects (Odin) – however, to ensure the best possible care it is crucial to speak to your physician if you are, or wish to become, pregnant.

In terms of menstruation, research has shown that over 90% of women with Parkinson’s experience a worsening of symptoms before and during their period, and many report more pain and bleeding after developing Parkinson’s (Odin). In these cases, healthcare professionals will seek to treat PMS symptoms first, occasionally recommending additional PD medication doses, as these medications can be less effective during menstruation (Odin). If symptoms are drastically affecting an individual’s quality of life, options such as hormone therapy, surgery, or radiotherapy to induce menopause may be explored. It is important to note that common symptoms of menopause, such as fatigue, depression, sweating, and lack of sexual desire can sometimes be confused. Ensure you maintain communication with your doctor to determine the appropriate treatment for your concerns.

Effects on Self-confidence and Intimacy

For both men and women, Parkinson’s can affect self-confidence and body image. Women especially may experience a sense of loss around their changing body – these feelings can have wide reaching effects, such as a change in how they dress or less desire for sexual intimacy. It is important to remember that sexual problems are among the most common non-motor symptoms of PD – these are valid issues that can often be addressed. Staying open with your partner and seeking help from your doctor or a sex therapist are key ways to address these common concerns.

Sources

Case-Lo, C. (2018). Symptoms of Parkinson's: Men vs. Women. Healthline. https://www.healthline.com/health/parkinsons-symptoms-men-women

Miller, I., et al. (2010). Gender differences in Parkinson's disease. Movement Disorders, 25(16), 2695–2703. https://doi.org/10.1002/mds.23388

Odin, P. (2018). Women and Parkinson's. European Parkinson's Disease Association. https://www.epda.eu.com/living-well/wellbeing/personal-health/womenand-parkinsons

Parkinson's Foundation. (2018). Women and Parkinson's Disease. https://www.parkinson.org/pd-library/factsheets/Women-and-Parkinsons-Disease

This content was published in the Fall 2021 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.