Parkinson’s affects everyone differently, but for women there are some aspects of life that need particular consideration, from pregnancy and breastfeeding to menstruation, menopause and intimacy.

Although almost 50% of people with Parkinson’s are women, there has been very little research into the additional challenges that women may encounter. In fact, most information we do know is anecdotal.

We hope the following advice will be a helpful place to start:

Pregnancy and breastfeeding

The number of pregnancies in women with Parkinson’s is very small (as most people are diagnosed with the condition later in life), so evidence is extremely limited. It should be stressed, however, that there is no evidence that women with Parkinson’s have higher rates of birth or foetal complications.

Pregnancy affects the body in many ways, and no two pregnancies are the same, including for people with Parkinson’s – so keep your doctor informed of any changes or concerns.

How pregnancy can affect Parkinson’s symptoms

Hormonal changes in pregnancy may affect your brain’s sensitivity to dopamine, which in turn can affect Parkinson’s symptoms, particularly tremor. Here are a few examples:

Balance

Your changing body shape and shifting centre of gravity during pregnancy can affect your balance and make falls more likely. Ask your doctor or physiotherapist for advice and use a walking aid if needed.

Slowness of movement and fatigue

Both pregnancy and Parkinson’s can slow your movement, so allow extra time to carry out everyday tasks, and build in more rest times.

Morning sickness

Despite the name, this can occur at any time of day, and may cause you to bring up your Parkinson’s medication before it’s absorbed. Common anti-nausea medications like Stemetil and Maxalon aren’t suitable for people with Parkinson’s, so ask your doctor for advice.

Constipation

This is common in both Parkinson’s and pregnancy, so may become worse

Pregnancy and Parkinson’s medication

Unfortunately, there isn’t yet enough evidence about the safety of Parkinson’s medications during pregnancy, although several medical journals have reported women with Parkinson’s giving birth to healthy babies while taking their usual medications.

The evidence so far includes:

  • Levodopa use has been documented in 148 pregnancies – available data supports its use as the first-line treatment in pregnant women with Parkinson’s with motor symptoms.
  • Dopamine agonist use has been documented in 161 pregnancies and seems to be safe to use
  • Anticholinergic use has been documented in a few pregnancies and seems to be safe to use.
  • There is very limited experience with COMT and MAO-B inhibitors during pregnancy and it is not possible to estimate if this is safe.
  • Amantadine should NOT be taken during pregnancy as it may affect foetal development.

The reality is that the amount of evidence so far is inconclusive, so if you are or wish to become pregnant, you should discuss the risks with your neurologist, obstetrician or Parkinson’s nurse specialist if you have one.

Breastfeeding and Parkinson’s medications

Unfortunately there is currently insufficient evidence to establish whether it is safe or not to breastfeed when taking Parkinson’s medications.

  • Levodopa and MAO-B inhibitors (selegiline, rasagiline) – it is unclear whether they pass into breast milk and, if so, what effects this could have on the child
  • Dopamine agonists (e.g. ropinirole, pramipexole, rotigotine) – can inhibit the production of breast milk, but it is not known if they pass into the milk itself and, if so, what effects this could have on the child
  • Amantadine and COMT inhibitors (entacapone, tolcapone) – do pass into breast milk but the effects that they might have on the child are as yet unclear – they should therefore be avoided during breastfeeding
  • Domperidone (used to combat nausea caused by other medications) – increases the production of breast milk but is secreted in it so caution is required.

If you take Parkinson’s medication and plan to breast-feed seek advice from your doctor, obstetrician or Parkinson’s nurse.

Menstruation and menopause

Menstruation and menopause can pose extra challenges if you have Parkinson’s. Although these have received little recognition in the past there is now growing interest and research is underway to evaluate treatments.

Menstruation

It has been suggested that as many as 11 out of 12 pre-menopausal women with Parkinson’s experience a worsening of their symptoms (particularly tremor, dyskinesia and rigidity) and reduced effectiveness of their medications a few days before and during menstruation.

Treating premenstrual syndrome (PMS) is generally the first line of approach but you may find it helpful to discuss this with your neurologist too as in some cases that taking additional Parkinson’s medications during this part of the monthly cycle appears to help.

Research shows that many women suffer increased menstruation problems following the onset of Parkinson’s, in particular more bleeding and associated pain.

Using sanitary products can be particularly difficult if your symptoms are not well controlled. You may find it helpful to time changing them when you are ‘on’ and have good control.

If menstrual problems are severe then your doctor may prescribe medication to suppress ovulation, although this can worsen some Parkinson’s symptoms.

Medication does not always help and if problems are severe then the following options might be considered:

  • hormone therapy using a combination of oestrogen and progesterone to suppress ovulation
  • surgery, including removal of the lining of the womb or a hysterectomy
  • radiotherapy of the ovaries to induce a premature menopause.

These can all have side effects – hot flushes, for example – but women are all affected differently so what works for one person may or may not work for another.

Menopause

Menopause and Parkinson’s can affect sexual desire and function in women. For some, menopausal symptoms such as sweating can worsen other Parkinson’s symptoms. There can also be confusion between the symptoms of menopause and Parkinson’s – fatigue, depression and increased sweating for example can occur in both conditions.

As with menstrual problems, Hormone Replacement Therapy (HRT) can be helpful in some cases although research and evidence into its use in Parkinson’s is rather limited.

If you experience vaginal dryness (a common sign of menopause) ask your doctor about the use of a vaginal HRT as this may be more helpful than an ordinary lubricant.

Talk with your doctor about any menopause-related problems you have. They may refer you to a gynaecologist or other women’s health professional.

Intimacy and sexuality

Parkinson’s can affect your ability to be intimate with a partner in many ways, from reduced mobility making some sexual positions difficult, to decreased dopamine levels and medication side-effects causing arousal difficulties.

In women, these difficulties can be worse, and many women with Parkinson’s also experience body image issues that inhibit their intimacy and sexuality.

Research involving a group of women with Parkinson’s, aged 35 to 59,  revealed that many were anxious about their bodies and sexual image. Unfortunately, such concerns are rarely addressed by doctors and nurses, so if you feel this way and you think your doctor isn’t taking this seriously, you should talk with your partner, a sex therapist or counsellor.

Our Communication section has lots of advice about dealing with all kinds of intimacy, sex and sensuality issues

Read more on Parkinson's Life

Women and Parkinson's