Hormones, menopause and Parkinson's
After being diagnosed with Parkinson's, Richelle Flanagan was surprised how much her symptoms varied in each stage of her menstrual cycle. Now she’s leading a project to uncover the link between female hormones and Parkinson’s, and potentially improve treatment for everyone.
“While I was pregnant with my second child, I noticed that my handwriting was getting smaller,” Richelle remembers.
“I knew from my work as a dietitian that it could be a symptom of Parkinson’s.” Sure enough, Richelle was diagnosed with young-onset Parkinson’s shortly after her daughter was born.
But within a few months of her menstrual cycle getting back to normal, she noticed that her Parkinson’s symptoms got worse the week before her bleed.
At the World Parkinson’s Congress in Kyoto, Richelle found that she wasn’t the only one to have seen this: “I met a lot of younger women, and a number of them said they had the same problem. So we put together a survey to find out how common this was.”
4 in 10 women reported that their medication was less effective at particular times in their menstrual cycle.
Over 290 women across the world completed the survey. More than 8 in 10 (86%) said that their Parkinson’s symptoms were worse the week before their menstrual bleed. There is evidence that changes in hormone levels, especially falling levels of oestrogen, can make the symptoms of Parkinson’s worse.
Menopause or Parkinson's?
The situation gets more complicated for women as they approach menopause.
Richelle says: “Many menopause symptoms are hard to distinguish from the non-motor symptoms of Parkinson’s: things like anxiety, depression, brain fog, sweating, difficulty multitasking, pain and fatigue.”
2 in 3 women said their symptoms were more severe after menopause.
This means it can be difficult for women approaching menopausal age, or their GPs, to recognise the early signs of Parkinson’s. This might at least partly explain why women are more likely to experience a delay in getting an accurate Parkinson’s diagnosis compared to men, Richelle believes.
More data
Although Richelle and her team’s survey results were compelling, they weren’t enough to change the clinical guidelines about how Parkinson’s is treated. These set out the type of treatment and advice that someone should be offered - and at the moment they don’t mention hormones at all.
“We wanted a way for women to share their experience with neurologists,” she says. “So I developed an app called My Moves Matter to enable women to track their Parkinson’s symptoms across their menstrual cycle and through menopause.”
9 in 10 women said that neurologists did not discuss the potential impact of hormones on their Parkinson’s.
The app isn’t only a way for individuals to track their symptoms change over time, Richelle says - it could provide the evidence needed to change clinical guidance: “We collaborated with Professor Aideen Sullivan of University College Cork to run a pilot study in women with Parkinson’s.
"This is a prospective real world evidence pilot study to validate the survey research. We want to validate women’s experience across the different hormonal stages of life - so not just the menstrual cycle but also in pregnancy, and as you go through the perimenopause, into menopause and postmenopause.”
Better treatment for everyone
Although the main aim of the study is to improve treatment for women, Richelle and her team hope to make a difference much more widely. “There’s an awful lot that we can learn about the impact of hormones on women that actually potentially could help men as well.”
- Read what our expert Tech Guide reviewers thought of My Moves Matter
- Richelle discussed the study at ParCon 2024. Watch her full talk here, and read our plans for ParCon 2025