Menopause and Parkinson’s: what you need to know

If you have Parkinson’s, you may find it hard to determine if you are going through the menopause as many symptoms are similar

• Most people with Parkinson’s start to develop symptoms over the age of 50
• Fatigue, sleep issues, anxiety and muscle stiffness can occur in both Parkinson’s and during the menopause
• Women with Parkinson’s can make lifestyle changes and try HRT to help ease their menopausal symptoms

Parkinson’s disease is a neurological condition in which nerve cells are lost in the part of the brain called the substantia nigra. This leads to a reduction in dopamine, a neurotransmitter that regulates movement of the body.

The symptoms of Parkinson’s disease usually only start to develop when around 50% of the nerve cells have been lost, and most people only start to develop these symptoms when they’re over 50, although some people may experience it under the age of 40 [1]. Men are slightly more likely to get Parkinson’s than women.

It’s not known exactly what causes the loss of the nerve cells, but main symptoms include involuntary shaking of parts of the body, slow movement, and stiff and inflexible muscles. Other symptoms include depression and anxiety, memory issues, loss of sense of smell, sleep problems and balance difficulties.

In the early stages of Parkinson’s, you might not need any treatment if your symptoms are mild, otherwise you might receive physiotherapy or medication to help reduce symptoms.

How will I know if I become menopausal?

Many of the symptoms common in the menopause can also be symptoms of Parkinson’s. Dr Rebecca Lewis, GP, menopause specialist and co-founder of Newson Health, says: ‘If you’re going through the menopause and have Parkinson’s, it can be difficult to know whether your symptoms are because of the menopause or Parkinson’s. It’s also easy to think symptoms are related to your Parkinson’s when they might actually be because you’re going through the menopause. 

‘One way to understand the symptoms you’re experiencing is to track them and your periods to see if things change or get worse with your cycle. The balance app can help you do this and after a couple of months of tracking, the app can produce a health report that you can print out and discuss with your GP.  

‘If you’re under 45 years old, you may be offered a blood test to help make a diagnosis, but these can still be inaccurate. Your symptoms will help guide your healthcare professional.’

RELATED: what is the menopause?

Will the menopause exacerbate my Parkinson’s?

Oestradiol (the primary form of oestrogen during the reproductive years) has a protective role in women and when levels decrease during the menopause, it can lead to an increase in inflammation. Diseases associated with inflammation include osteoarthritis, rheumatoid arthritis, multiple sclerosis, Parkinson’s disease, leg ulcers, some types of cancer and infections, including COVID. One paper found that a later age at menopause was associated with a decreased risk of Parkinson’s disease in women, supporting the theory that sex hormones may be neuroprotective in Parkinson’s [2].

RELATED: menopause and brain health: what’s the link?

A review of three studies found that women with Parkinson’s generally experienced more anxiety, worse autonomic functioning (which regulates unconscious tasks such as heartbeat and breathing) and worse quality of life compared to men with Parkinson’s.

The decline of oestrogen levels during the menopause can affect mood, sleep and cognition, plus lead to symptoms such as hot flushes. These changes, and the worry of them, may affect your symptoms of Parkinson’s.

One survey carried out in The Netherlands found that two-thirds of women diagnosed with Parkinson’s disease reported an increase in severity of symptoms after menopause [3]. The symptoms that worsened most frequently were fatigue (45%) and urinary tract issues (42%). Increased Parkinson’s-specific symptoms included bradykinesia (slowness of movement) (23%) and tremor (19%). Many women also reported changes in the effectiveness of their medication.

How can I treat my menopause?

Because many menopausal symptoms are hard to distinguish from Parkinson’s disease, you may feel reluctant to speak to your healthcare professional but together you can look at ways to look after your physical and mental health.

‘Hormone replacement therapy is the most effective treatment for managing menopause symptoms,’ says Dr Rebecca. ‘It works by replacing the hormones your body has stopped producing. HRT is safe and clinical guidelines says the benefits of taking HRT outweighs the risk for the majority of women. There may be risk factors for some women and you can discuss these with your GP. Research into HRT and Parkinson’s is limited but regulated body identical HRT can be safely used with most medications.’

One retrospective study that looked at HRT and neurodegenerative diseases found HRT was associated with reduced risk of all neurodegenerative diseases, and the protective effective of long-term therapy (more than one year) on Parkinson’s was greater compared to short term therapy of less than one year [5].

RELATED: managing menopause beyond HRT

It’s also important to look at your lifestyle by staying active, eating a well-balanced, healthy diet and managing stress. Parkinson’s UK has resources for diet advice – while there is no specific diet for Parkinson’s, some simple changes may help you manage your symptoms effectively.

If you have Parkinson’s, you have a higher risk of getting osteoporosis [6]. Women are also more affected by a loss of bone strength during the perimenopause and before and after the menopause. You’ll need to ensure you get enough calcium and vitamin D, and it is worth checking your risk factor for having a bone fracture at The Royal Osteoporosis Society so you can see if you need to take further action. Complete the risk checker here.

Keeping physically active and including weight-bearing exercises into your weekly routine can help not just bone strength but mental health, as can reducing your alcohol intake, prioritising sleep and making time to de-stress.

Resources

Parkinson’s UK: menopause and Parkinson’s

Parkinson’s UK  

References

1. NHS: Parkinson’s disease
2. Kusters CDJ, Paul KC, Duarte Folle A, Keener AM, Bronstein JM, Bertram L, Hansen J, Horvath S, Sinsheimer JS, Lill CM, Ritz BR. Increased Menopausal Age Reduces the Risk of Parkinson’s Disease: A Mendelian Randomization Approach. Mov Disord. 2021 Oct;36(10):2264-2272. doi: 10.1002/mds.28760
3. CCJM: menopause linked to worsening of PD symptoms
4. Maas BR, Göttgens I, Tijsse Klasen HPS, Kapelle WM, Radder DLM, Bloem BR, Post B, de Vries NM, Darweesh SKL. Age and gender differences in non-motor symptoms in people with Parkinson’s disease. Front Neurol. 2024 Feb 1;15:1339716. doi: 10.3389/fneur.2024.1339716
5. Kim YJ, Soto M, Branigan GL, Rodgers K, Brinton RD. (2021), ‘Association between menopausal hormone therapy and risk of neurodegenerative diseases: Implications for precision hormone therapy’, Alzheimers Dement (N Y). 7(1):e12174. doi: 10.1002/trc2.12174
6. Parkinson’s UK: bone health and Parkinson’s