Health issues specific to women may influence Parkinson’s severity

Exploratory study suggests pregnancy to menopause weigh on symptoms

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

Share this article:

Share article via email
A woman in the later stages of a pregnancy is shown in this illustration.

Certain experiences particular to women, from a natural childbirth or pregnancy-related depression to a hysterectomy, could cause their Parkinson’s disease symptoms to be more severe, an exploratory U.S. study suggests.

As noted by it authors, the study “sets the groundwork for acknowledging the role [women specific health factors] … may play in [Parkinson’s] and the potential benefit the scientific community can gain for therapeutics and clinical guidance if we further investigate the role sex-specific factors have.”

The study, “Association of women-specific health factors in the severity of Parkinson’s disease,” was published in npj Parkinson’s disease.

Recommended Reading
Bolts of lightning shoot out from the bottom of a brain in this illustration.

Women with Parkinson’s less likely to be referred for DBS than men

Differences by sex in Parkinson’s course are emerging in research

Research in recent decades has revealed a number of sex differences in Parkinson’s risk, presentation, and progression.

While men are about 1.5 times more likely to be diagnosed with Parkinson’s than women, some studies indicate that women experience faster disease progression and have a greater burden of certain symptoms than do men with this disease.

Exactly how these differences emerge is not fully understood. In general, the contributions of women-specific health factors, dubbed WSHFs by the authors, — such as menstruation, birth control, family planning, and menopause — have not been comprehensively studied in this context.

These issues also aren’t addressed in clinical trials, which often place requirements for contraception use or sterility on female participants, usually for safety reasons.

“Without incorporating these WSHFs, the scientific community ignores the basic biology of women and continues to inaccurately represent the clinical manifestations and treatment outcomes for 50% of the population,” the researchers wrote.

A team led by scientists at the Cleveland Clinic conducted an exploratory study to examine the role of WSHFs in Parkinson’s severity.

The researchers previously developed a questionnaire regarding women’s health issues in Parkinson’s, with questions relating to menstruation, pregnancy, birth control, and menopause.

This questionnaire was sent to women enrolled in the Parkinson’s Foundation PD GENEration study (NCT04994015), which collects clinical and genetic information from patients in the U.S.

Overall, 304 women with a mean age of 64.7 responded to the survey. They had been living with Parkinson’s for an average of 6.2 years.

Most respondents (73.7%) reported that their Parkinson’s onset was during menopause, meaning at least one year after their last menstrual cycle.

A majority had children (74.3%), but rates of infertility (32.2%) and pregnancy complications (31.2%) were higher than what is reported in women without Parkinson’s in the U.S., where infertility rates range from about 15% to 19%.

Parkinson’s can be severe in women with perinatal depression, total hysterectomy

Researchers then looked for associations between women’s health factors and a person’s disease severity, as determined by scores on components of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS).

Participants were classified as having either mild or moderate-to-severe symptoms for each of these components.

In final statistical analyses, a number of women’s health factors were associated with a higher risk of more severe Parkinson’s.

Specifically, giving natural (vaginal) birth linked to a nearly five times greater risk of moderate-to-severe symptoms on the MDS-UPDRS part 1, which measures the effects of Parkinson’s nonmotor symptoms on daily life.

With MDS-UPDRS part 2, assessing how disease motor symptoms affect everyday life, pregnancy-related (perinatal) depression was linked to more severe symptoms.

A total hysterectomy, or surgery removing the uterus, cervix, and ovaries/fallopian tubes, also associated with a risk of more severe motor symptoms, as assessed by MDS-UPDRS part 3.

Some clinical but not sex-specific factors associated with more severe symptoms on components of the MDS-UPDRS, including depression, disease duration, LRRK2 gene mutations, and vitamin B12 deficiency.

Findings, overall, suggest that women’s health-specific factors can influence Parkinson’s outcomes.

Due to the exploratory nature of the study, however, “a causal relationship between sex-specific factors and [Parkinson’s] cannot be established,” the researchers wrote.

Larger and more comprehensive studies are needed to understand the role of perinatal depression, type of childbirth delivery, hysterectomy, or other health factors on Parkinson’s severity.

The scientists are currently working to expand their findings by surveying more patients in the U.S. as well as patients in Latin America.

“This international effort will help better understand WSHF differences between regions and sociocultural norms, overcoming the lack of generalizability this study currently faces,” they wrote.