Objective: To characterize the prevalence of menstrual cycle–related symptom fluctuations in women with early-onset Parkinson’s disease (EOPD).

Background: Hormonal fluctuations during the menstrual cycle may modulate dopaminergic neurotransmission and influence motor and non-motor symptoms in reproductive-age women with PD. Despite prior studies describing perimenstrual worsening, systematic registry-based data remain limited, particularly in EOPD cohorts where women comprise the majority of reproductive-age patients.

Method: Cross-sectional analysis of 93 women from an EOPD registry (mean motor onset age 41.3±6.9 years). Menopause status at disease onset was ascertained retrospectively. Women with premenopausal onset (n=82) were queried about menstrual cycle influence on PD symptoms. Qualitative symptom characterization was extracted from free-text responses. Clinical variables (age at onset, disease duration, MoCA, Beck Depression Inventory,) were compared between cycle-influenced and non-influenced subgroups using Mann-Whitney U tests.

Results: Among 82 women with premenopausal PD onset, 13 (15.9%) reported menstrual cycle–dependent symptom worsening. Most common manifestations were increased rigidity (30.8%), reduced antiparkinsonian medication efficacy (23.1%), global symptom exacerbation (23.1%), pain (15.4%), and sleep disturbance (15.4%). Symptom worsening typically occurred during menses or 2–5 days premenstrually (luteal phase), with normalization at cycle onset. Women reporting cycle influence showed a non-significant trend toward younger motor onset (38.5±6.1 vs 41.0±6.7 years, p=0.198) and longer disease duration (11.3±7.5 vs 8.7±6.7 years, p=0.238). No significant differences were observed in cognitive status (MoCA 28.1±1.8 vs 27.4±2.6), or depression severity (Beck 6.7±4.4 vs 8.8±8.5, p=0.679).

Conclusion: Our results corroborate prior studies (1,2) of perimenstrual motor worsening and reduced dopaminergic responsiveness, but suggest a lower frequency in this registry, potentially reflecting under-ascertainment or stricter symptom attribution criteria. The absence of associations with cognitive or affective markers suggests cycle-dependent changes may represent a distinct hormonal-modulation phenotype independent of overall disease severity, warranting prospective hormonal and therapeutic studies.

References: 1. Lie, I. H., Maurtveten, E. H., Andersen, M. S., Dalbro, S. E. J., Tunold, J.-A., & Pihlstrøm, L. (2025). The menstrual cycle and pregnancy commonly impact symptoms of women with early-onset Parkinson’s disease. Movement Disorders Clinical Practice. https://doi.org/10.1002/mdc3.70438
2. Rao, S. C., Li, Y., Lapin, B., Pattipati, S., Ghosh Galvelis, K., Naito, A., Gutierrez, N., Leal, T. P., Salim, A., Salles, P. A., De Leon, M., & Mata, I. F. (2023). Association of women-specific health factors in the severity of Parkinson’s disease. npj Parkinson’s Disease, 9, 86. https://doi.org/10.1038/s41531-023-00524-x

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MDS Abstracts - https://www.mdsabstracts.org/abstract/menstrual-cycle-influence-on-parkinsons-disease-symptoms-in-women-with-early-onset/