Menopause and Parkinson's

Dr Rebecca Lewis is a GP, with a special interest in menopause. Here, she explains what the menopause is, how symptoms can be similar to Parkinson’s, and how it can be treated.

What is menopause?

The menopause is defined as one year after your last period and happens when your ovaries no longer produce eggs, you stop having periods and your hormone levels fall, particularly oestrogen, progesterone and testosterone. 

Menopause is often a natural process but can occur because of surgery (if your ovaries are removed) or as a result of medical treatments, for example chemotherapy or medications that affect your hormones.

The average age of the menopause in the UK is 51. But 1 in 100 women will experience menopause in their 40s, and 1 in 1000 will be in their 30s.

What is perimenopause?

Perimenopause is the time leading up to the menopause, when hormones start to fluctuate and then decline. During this time, periods can become irregular and change to be lighter or heavier in flow, and symptoms may start to occur.

This can happen several years before periods stop altogether. The average age of someone starting perimenopause is 40-45 years.

What are the main symptoms of perimenopause and menopause?

Lots of people think the menopause is just hot flushes, but it can be so much more than that. Cells throughout the body contain oestrogen receptors. These receptors receive messages from hormones in the body and react by telling the cells what to do. When oestrogen levels reduce, the strength of these messages decrease and can affect every organ in the body.     

You may experience low mood - many women describe this as a loss of joy or feeling grey and flat all the time. Anxiety is very common too. It can be difficult to concentrate, and memory problems or ‘brain fog’ is common. You might not be able to think of a word, for example, or have mental ‘blanks’ which can be unnerving. 

Reduced oestrogen levels can lead to vaginal dryness and soreness. Some women find it uncomfortable just sitting down. Sex may be painful. Becoming less interested in sex altogether (libido) is also a common symptom of the menopause. 

During menopause, the bladder wall thins and can get more irritable, which means you may need to go to the toilet more frequently or have leaks of urine. This can lead to repeated urinary tract infections (UTIs).

Oestrogen is a natural anti-inflammatory, so as levels drop, you can get muscle and joint pains or stiffness. The stiffness is much worse after sitting for a long time or in the morning when getting out of bed. Sometimes it can make even turning over at night difficult. Low oestrogen levels can reduce your muscle mass and make your muscles weaker.

Many women also experience fatigue and sleep problems. Insomnia can be a symptom, but sleep can also be interrupted by night sweats, anxiety and needing to go to the toilet. You may feel more tired during the day though, even if you’ve had a good night’s sleep.  

There are many other changes that can occur during perimenopause and menopause. Your skin can become drier or itchy, your hair and nails more brittle, heart palpitations are common, your allergies may worsen, you might get bloating or stomach problems, or have tinnitus for example.

The severity and number of symptoms varies from individual to individual.

What can low oestrogen levels mean for your long-term health?

Reduced oestrogen levels can increase your risk of heart disease and stroke, cognitive problems and type 2 diabetes. 

Your risk of osteoporosis also increases. Osteoporosis is a condition that affects the bones, causing them to become weak and fragile and more likely to break. It is also often diagnosed in people with Parkinson's.

Treating menopause symptoms not only helps your immediate symptoms and improves your quality of life, it also helps to protect your future health.

Are your symptoms related to Parkinson’s or the menopause?

Many of the symptoms common in the menopause, including fatigue, sleep, anxiety, muscle pains and stiffness, are also symptoms of Parkinson’s. 

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. 

It’s important to understand the symptoms you’re experiencing, know what may be causing them and have accurate information so you know what might help them.

One way to do this is to track your symptoms and your periods and see if things change or get worse with your cycle. Apps such as Balance can help you do this. Once you have tracked your symptoms and periods for a month or two, the app can produce a health report for you, and you can discuss the results with your GP.   

If you’re over 45, your GP will usually be able to confirm whether you’re going through the menopause based on your symptoms. If you’re under 45, you may be sent for a blood test to measure your hormone levels.

If you are worried about your Parkinson's or menopause symptoms, speak to your GP, specialist or Parkinson's nurse.

Research into HRT and Parkinson’s is limited but there is no evidence that HRT and Parkinson’s medications can’t be taken alongside each other safely.

What treatments are available for the menopause?

Hormone Replacement Therapy (HRT) is the most effective treatment for managing menopause symptoms. It works by replacing the hormones your body has stopped producing.

The newest types of HRT are known as ‘body-identical’. This means the structure of the drug is the same as the oestrogen your body produces. HRT is available as a gel, a skin patch or a spray – through the skin is the safest way to receive oestrogen. 

You will also need to take a progesterone to keep your womb lining thin and healthy, and if you specifically struggle with poor concentration and memory, fatigue, brain fog and low libido, testosterone may be beneficial too.

HRT is very safe, and clinical guidelines say the benefits of taking HRT outweighs the risk for the majority of women. There may be risk factors for some women, depending on your age, family history and general health. You should discuss these with your GP. 

Research into HRT and Parkinson’s is limited but there is no evidence that HRT and Parkinson’s medications can’t be taken alongside each other safely. 

Can lifestyle changes help?

It’s an important time to do what you can to look after your physical health and mental health by staying active, managing stress, and eating healthily. Try and aim to: 

  • eat a healthy, balanced diet, containing lots of fruit and vegetables, wholegrains, omega 3 fats (for example, oily fish such as salmon or sardines), and foods containing prebiotics (such as cabbage, bananas and apples) and probiotics (such as live yoghurt). Try and reduce your amount of processed foods and those high in sugar and salt. Read more about diet and Parkinson's.
  • get enough vitamin D, which keeps your bones strong and healthy. Vitamin D comes from sunlight and some foods, including oily fish, some breakfast cereals, egg yolks and meat. It is also beneficial to take a vitamin D supplement. If you have Parkinson’s, your levels of calcium and vitamin D should be assessed in the early stages of your condition to prevent or lower the risk of poor bone health. 
  • exercise regularly, especially weight-bearing exercises and any that impacts through your joints, such as walking, as this can help maintain bone strength. Doing 2.5 hours of exercise a week can also slow the progression of your Parkinson’s symptoms. Read more about exercising when you have Parkinson’s.
  • reduce the amount of alcohol you drink as it can cause disturbed sleep and make hot flushes worse.
  • keep on top of your stress levels and make time to relax and unwind, enjoy time outside and connecting with family and friends.
Donna sat in her kitchen

Find out more

If you are worried about your Parkinson's or menopause symptoms, speak to your GP, specialist or Parkinson's nurse.

The Menopause Charity and Balance has a range of information and support for women going through the menopause.

Can you help?

‘My Neuro Survey’ is the largest survey of people with neurological conditions in the UK. By taking part you can help put an end to poor care and improve treatment and services for people with neurological conditions. 

The survey will take around 20 minutes to complete and is open until Friday 14 January 2022.

Anyone in the UK with a neurological condition can take part - make sure your voice is heard.