Women and Parkinson's: An Intersectional Look

Parkinson’s disease (PD) affects both men and women, but the experiences of women have been underrepresented in research and care practices. Women with PD often face unique challenges, such as delays in diagnosis, differences in symptom progression, and being more likely to take on caregiving roles, which can impact their health and quality of life. Despite these disparities, research on the experiences of women with PD remains limited, and even less attention is given to how other aspects of identity, such as race or sexual orientation, intersect with these challenges.

Biases in Research

Despite women being a large portion of the PD population, studies examining sex differences in Parkinson’s have been overwhelmingly sparse (Cerri et al., 2019). However, scientists have finally started to recognize that biological sex plays a large role in how severe Parkinson’s disease can be. In 2015, the National Institutes of Health (NIH) stated that sex should be treated as a key factor in research, yet many studies continue to overlook or fail to prioritize these differences (Ferreira et al., 2022).

Development and Diagnosis of PD

Biological sex, alongside other factors like environment, genetics, and age, influences the development of Parkinson’s. Men are twice as likely to develop PD than woman, for a variety of reasons that are not fully understood yet (Cerri et al., 2019). However, one explanation for this might be the role of estrogen: some studies have shown that this hormone seems to protect the part of the brain affected by Parkinson’s disease. In animal studies, estrogen affects how dopamine is made, used, and processed, and may also influence how dopamine receptors work (Shulman, 2002). In fact, PD rates in women go up a lot after menopause, which is characterized by a large drop in estrogen production. This further suggests a potentially protective role for estrogen, though more human studies are needed to fully understand this relationship (Makav & Eroğlu, 2021).

When it comes to receiving a Parkinson’s disease diagnosis, women unsurprisingly face challenges (Parkinson’s Foundation, n.d.). Because the stereotype of Parkinson’s as an ‘old white man’ disease is so pervasive, it seems that physicians have internalized it, leading to delays in women getting diagnosed. However, some contributing factors may also stem from women themselves, such as a reduced likelihood of disclosing or emphasizing bothersome symptoms during medical appointments (Subramanian et al., 2022).

Symptoms of PD

Research shows that symptoms and treatment responses can differ significantly between women and men. The chart below highlights some of the key differences (Cerri et al., 2019 & Subramanian et al., 2022):

Furthermore, symptoms will change during the menstrual, pregnancy, and perimenopausal/postmenopausal stages of a woman’s life:

Menstrual:

Women experience worsening of PD symptoms before their monthly menstrual period (Parkinson’s Foundation, 2022)
Parkinson’s medication may be less effective, resulting in more ‘off’ periods (Davis Phinney Foundation, 2022)

Pregnancy:

The good news is that women with Parkinson’s do not have a higher risk of complications during pregnancy or childbirth
While some PD symptoms, like balance issues, fatigue, slowness, and nausea, can impact pregnancy and be affected by it in return, these issues typically are not serious or life-threatening
Commonly used PD medications, like levodopa, have been taken during pregnancy without reports of harmful side effects (Odin, 2018)

Perimenopause/postmenopause:

Many women report an increase in Parkinson’s symptoms after menopause, specifically worsening of fatigue, urinary tract problems, bradykinesia (slowness of movement), and tremor
Menopause can also change the effectiveness of PD medications
Fortunately, hormone replacement therapy (HRT) is safe, effective, and appropriate for women with PD, even if PD-specific research is limited on the topic (Lewis, 2024)
Pelvic floor problems, such as incontinence, can also worsen in the perimenopausal and postmenopausal period, especially for women with Parkinson’s, so it is important to speak with a pelvic floor physiotherapist for guidance and education (Subramanian et al., 2022)

Treatment

Unfortunately, studies have shown that when compared to their male counterparts, women with PD are more likely to receive lower-quality healthcare. Following on this disparity, research has also found that women are less likely to be referred for advanced treatments, such as Deep Brain Stimulation (DBS), even when they meet the clinical criteria (Parkinson’s Foundation, n.d.). In fact, women only make up 25% of those referred for DBS. This is particularly concerning, because women report greater increases in quality of life, including improvements in mobility and cognition, from treatments like DBS when compared to men (Subramanian et al., 2022).

Building on this, research also shows that even when women are identified as suitable candidates for advanced therapies, they are still less likely to undergo the procedure. This appears to be driven not only by systemic factors, such as physician biases, but also by personal and psychological considerations, including a greater fear of surgery, higher rates of depression, and a more hesitant, socially influenced decision-making process among women compared to men (Maccarrone et al., 2024).

While it might seem reasonable to assume that fewer women are referred for advanced therapies simply because Parkinson’s is more prevalent in men, research shows that the gender gap in access persists even after accounting for that difference. Studies have found that women still receive less care, despite no significant differences in clinical variables like age, disease duration, symptom severity, or medication levels (Maccarrone et al., 2024).

Care: Giving and Receiving

Women, more commonly than men, assume caregiver roles especially in midlife, and often experience more distress when they fall short of fulfilling their responsibilities. These roles span from family to career, and can be very demanding. Though the sample was small and region-specific, a study in Brazil looked at women with PD and found that despite their disease, women continued their occupational and domestic caregiving roles. In contrast, men appeared to struggle more with adapting to the limitations brought on by their disease (Subramanian et al., 2022).

Sadly, women with Parkinson’s usually have less social support, leading to psychological distress and reduced quality of life. Additionally, women who see themselves as caregivers in any capacity are more likely to experience poorer health outcomes, face barriers to accessing necessary medical care, and report higher levels of depression. And because of the gender divide of giving and receiving care, women with Parkinson’s disease are twice as likely to report paying for care compared to men (Subramanian et al., 2022). Women’s longer life expectancy and their tendency to prioritize giving care over receiving it – even when support is present – may help explain this discrepancy (Cerri et al., 2019).

Intersectional Barriers in Parkinson’s Care

The experience of Parkinson’s disease is not just shaped by biological sex; it is also deeply influenced by an individual’s intersecting identities, such as sexual orientation and race, which can impact everything from access to care to the social and emotional toll of the disease.

Most of the research on differences between men and women relating to PD has focused on biology, with not enough emphasis on the psychosocial context (the influence of psychological and social factors on someone’s wellbeing), which is known to affect care and quality of life (Subramanian et al., 2022).

While little is known about women in the LGBTQIA+ community in the context of Parkinson’s, studies do show that older LGBTQIA+ individuals report significant stigma from healthcare providers, with 33% stating they have mistrust of the medical system because of discrimination (Subramanian et al., 2022).

Furthermore, racial differences exist in the diagnosis, treatment, and research of Parkinson’s disease. In particular, limited research participation and representation results in a limited understanding of the disease, which hinders the development of evidence-based treatments for diverse populations (Aamodt et al., 2023).

Diagnoses of PD may also be delayed or missed in those from minority groups due to a variety of reasons, including biases, mistrust of the medical system, and other barriers that prevent those individuals from seeking care (Aamodt et al., 2023).

When it comes to treatment, biases continue to influence the care patients receive. Black individuals with Parkinson’s are less likely to receive DBS than their white counterparts, with women from non-white racial backgrounds being even less likely to undergo the procedure compared to men from the same racial groups (Cramer, 2022).

There’s a clear need to bring intersectionality into public health and research, so we can better understand and support women with Parkinson’s who also face other forms of marginalization, and make sure they receive the inclusive, high-quality care they deserve.

How Parkinson Society BC Can Help

Parkinson Society BC (PSBC) is proud to serve a diverse community of women with Parkinson’s by challenging stigma, advocating for more inclusive care, and providing support.

Here are some of the ways women with PD can count on us:

Comprehensive awareness campaigns: We are working to dispel the myth that Parkinson’s only affects older men through our many awareness campaigns, which have featured women front and centre. By educating the public and amplifying the voices of women living with PD, we aim to dismantle outdated stereotypes.
Healthcare professional outreach: We also engage directly with physicians and healthcare professionals to improve their understanding of how Parkinson’s presents in women, and how to recognize and respond to their unique needs.
Professional and peer support for women: Additionally, PSBC offers counseling services tailored specifically for women with Parkinson’s, providing them with a safe space to navigate the emotional and psychological challenges of their disease. To learn more, please visit www.parkinson.bc.ca/counselling. We are also pleased to offer a Women Living with PD support group that meets online every month. For more information, see www.parkinson.bc.ca/supportgroups.

Sources

Aamodt, W. W., Willis, A. W., & Dahodwala, N. (2023). Racial and ethnic disparities in Parkinson disease: A call to action. Neurology: Clinical Practice, 13(2), e200138. https://doi.org/10.1212/CPJ.0000000000200138

Cerri, S., Mus, L., & Blandini, F. (2019). Parkinson’s disease in women and men: What’s the difference? Journal of Parkinson’s Disease, 9(3), 501–515. https://doi.org/10.3233/JPD-191683

Cramer, S. W., Do, T. H., Palzer, E. F., Naik, A., Rice, A. L., Novy, S. G., Hanson, J. T., Piazza, A. N., Howard, M. A., Huling, J. D., Chen, C. C., & McGovern, R. A. (2022). Persistent racial disparities in deep brain stimulation for Parkinson's disease. Annals of Neurology, 92(2), 246–254. https://doi.org/10.1002/ana.26378

Davis Phinney Foundation (2022). YOPD and Menstruation. https://davisphinneyfoundation.org/yopd-women-and-menstruation/

Ferreira, L. P. de S., da Silva, R. A., da Costa, M. M. M., Roda, V. M. de P., Vizcaino, S., Janisset, N. R. L. L., Vieira, R. R., Sanches, J. M., Soares Junior, J. M., & Simões, M. de J. (2022). Sex differences in Parkinson's disease: An emerging health question. Clinics (São Paulo), 77, 100121. https://doi.org/10.1016/j.clinsp.2022.100121

Lewis (2024). Menopause and Parkinson’s: what you need to know. https://www.balance-menopause.com/menopause-library/menopause-and-parkinsons-what-you-need-to-know/

Maccarrone, G., Saporito, G., Sucapane, P., Rizi, C., Bruno, F., Catalucci, A., Pistoia, M. L., Splendiani, A., Ricci, A., Di Cesare, E., Rizzo, M., Totaro, R., & Pistoia, F. (2024). Gender disparity in access to advanced therapies for patients with Parkinson’s disease: A retrospective real-world study. Frontiers in Neurology, 15, 1429251. https://doi.org/10.3389/fneur.2024.1429251

Makav, M., & Eroğlu, H. A. (2021). Recuperative effect of estrogen on rotenone-induced experimental model of Parkinson’s disease in rats. Environmental Science and Pollution Research, 28, 21266–21275. https://doi.org/10.1007/s11356-020-11975-z

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 (n.d). Women & Parkinson’s. https://www.parkinson.org/living-with-parkinsons/finding-care/women

Parkinson’s Foundation (2022). The Unmet Needs of Women with Parkinson’s. https://www.parkinson.org/blog/science-news/women

Shulman, L. M. (2002). Is there a connection between estrogen and Parkinson's disease? Parkinsonism & Related Disorders, 8(5), 289–295. https://doi.org/10.1016/s1353-8020(02)00014-7

Subramanian, I., Mathur, S., Oosterbaan, A., Flanagan, R., Keener, A. M., & Moro, E. (2022). Unmet needs of women living with Parkinson's disease: Gaps and controversies. Movement Disorders, 37(3), 444–455. https://doi.org/10.1002/mds.28921

This content was published in the Summer 2025 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.

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