Objective: To explore how reproductive health factors, such as menstruation and pregnancy, impact motor fluctuations in premenopausal women with young-onset idiopathic Parkinson’s disease (PD).

Background: Women with PD have unique disease trajectories influenced by reproductive factors like menopause, hormonal therapies, and pregnancy history. Young-onset PD exhibit more motor fluctuations, and case reports suggest that premenopausal women with genetic PD may experience additionnal significant fluctuations around menstruation or pregnancy. 

Preliminary findings from two small cohorts of premenopausal women (N = 19; N = 12) suggest similar findings in idiopathic cases, but the depiction of the disease in this population remains incomplete. Existing studies (1986, 2002) are outdated and fail to adress disease burden, symptom timing, or medical strategies. Understanding these factors is crucial for developing tailored treatment strategies taking into account hormonal status.

Method: Medical files of 10 women diagnosed with young-onset idiopathic PD in their premenopausal years were reviewed. They were followed by a movement disorder specialist in a tertiary center.

Results: Symptoms began between ages 26 and 50. Three (30%) patients presented with bradykinesia, five (50%) with tremor and the remaining two (20%) with both. 40% experienced motor fluctuations within three years. They were prescribed between two to five different medications. Four (40%) are being evaluated for surgical or perfusion therapies.  

Five (50%) women reported an increase in fluctuations around menstruations, two to three days before and after. Notably, two patients experienced early, self-limited symptoms during pregnancy, with improvement after delivery, and worsening during subsequent pregnancy. Fluctuation severity varied : one patient described a 25% loss of medication efficacy, one increased her regular medication by half a tablet every morning during menstruations, while another started on continuous hormonal therapy and saw improvement in her fluctuations.

Conclusion: This preliminary series highlights the specific needs of premenopausal women with PD. Since diagnosis occurs during their active professional and personal lives, inadequate control of symptoms severely impact quality of life. Further studies are needed to better describe this phenomenon on a bigger population and investigate the potential benefit of hormonal therapies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-tailored-approach-to-parkinsons-disease-the-influence-of-hormonal-status-in-women/