Parkinson’s is a progressive disease, meaning symptoms worsen over time. In women, the first symptom upon diagnosis is usually tremors.

Parkinson’s disease (PD) is a condition that affects the nervous system. In PD, nerve cells in the brain that make the neurotransmitter dopamine become damaged or die. When this happens, it leads to symptoms such as tremors, muscle stiffness, and slowed movement.

Your biological sex is an important risk factor for developing PD. When compared to women, 1.5 times as many men have PD.

Usually there’s a physiological reason for a difference in disease between sexes. How does being female protect against PD? And do women and men experience PD symptoms differently? Continue reading to learn more.

The risk of developing PD increases with age. According to the National Institute of Neurological Disorders and Stroke (NINDS), the average age of onset for PD is about 70 years old.

There’s evidence to suggest that PD may develop later in women than in men.

A 2007 study investigated the effect of biological sex on various characteristics of PD. The researchers evaluated 253 people living with PD. They found that, compared to men with PD, the age of disease onset was 2.1 years later in women.

However, a 2015 study found no difference in the age of onset between men and women.

According to a 2017 review, more research is needed.

PD is a progressive disease, which means that symptoms get worse over time. The main symptoms of PD are:

The symptoms of PD can vary greatly between individuals regardless of sex, and women may have different symptoms than men.

When women are first diagnosed, tremor is usually the dominant symptom. This form of PD is associated with a slower deterioration of motor functions, according to a 2020 study.

In contrast, the initial symptom in men is usually changes in balance or posture, which can include freezing of the gait and falling.

Differences in non-motor symptoms

While motor symptoms make up the primary symptoms of PD, people living with PD can experience other potential symptoms as well. These may include:

A 2012 study of non-motor symptoms in 951 people with PD found that women were more likely to experience:

  • pain
  • fatigue
  • feelings of sadness or nervousness
  • constipation
  • restless legs

Meanwhile, researchers found that men were more likely to have non-motor symptoms such as:

Women also often report less satisfaction with their quality of life. A 2019 study surveyed quality of life in men and women with PD. Women with PD reported reduced quality of life due to pain and depression.

There’s currently no cure for PD. However, medications can help improve symptoms associated with the condition.

Levodopa, also called L-DOPA, is a drug that nerve cells can use to make dopamine. Levodopa is often given with carbidopa, which helps to prevent the medication from being converted to dopamine before it reaches the brain. Carbidopa-levodopa is available under the brand names Sinemet, Duopa, and Rytary.

Other types of drugs that may be given for PD include:

  • Amantadine: Amantadine (Gocovri, Osmolex ER) is an antiviral drug that may help treat the symptoms of PD as well as the side effects of PD treatments such as levodopa.
  • Dopamine agonists: Dopamine agonists can mimic the role of dopamine in the brain.
  • Monoamine oxidase inhibitor B (MAO-B) inhibitors: MAO-B inhibitors work to block the activity of monoamine oxidase inhibitor B, a brain enzyme responsible for breaking down dopamine.
  • Catechol-O-methyltransferase (COMT) inhibitors: COMT inhibitors are similar to MAO-B inhibitors in that they work to block a brain enzyme that breaks down dopamine.
  • Anticholinergics: Anticholinergics work to reduce the activity of the neurotransmitter acetylcholine and may help ease tremors.

When medications aren’t effective at managing PD symptoms, other treatment options may be recommended. These include deep brain stimulation (DBS) and brain surgery.

Treatment challenges in women

Women with PD may encounter more problems during treatment than men, and often take longer to seek treatment. A 2011 study found that the time between symptom onset and seeing a movement disorder specialist was 61 percent longer for women.

Women are also exposed to higher doses of PD medications such as levodopa. A 2014 study examined the levels of levodopa in the blood of 128 people with PD over 3 hours. It found that levodopa concentrations were significantly higher in women than in men during this time.

Higher exposure to levodopa can lead to an increased rate of negative side effects such as dyskinesia (abnormal involuntary movements).

Women also receive DBS or surgery less often than men do. A small 2003 study found that at the time of surgery, women had a longer duration of disease than men (15 years vs. 10 years). They also had more severe symptoms. However, after surgery they experienced more improved quality of life.

A 2014 study found that although DBS was equally effective for men and women, women were less likely to be treated due to more severe dyskinesia. Additionally, a 2019 study found that women were less likely to undergo DBS due to personal preference.

Why are there differences in PD between men and women? It seems likely that the hormone estrogen has a protective effect for women.

A 2020 cohort study found that a later age of menopause and longer duration of fertility were associated with a lower risk of PD. These are both markers of estrogen exposure over the course of a woman’s lifetime.

What’s not yet fully explained is why estrogen has this effect.

A 2019 review notes that that estrogen can promote the production, release, and turnover of dopamine. Additionally, the biological effects of estrogen may help protect women from damage due to inflammation or oxidative stress in the brain that can contribute to PD.

There’s evidence that cognitive issues affect men and women differently.

A 2020 study compared the cognitive function of 84 people with PD to 59 participants without PD. Researchers found that men with PD had reduced processing speed and reduced executive function, despite having no significant differences in disease severity.

Processing speed refers to the amount of time that it takes you to perform a specific task. It may take longer for you to process and respond to information in order to get something done.

Executive function is important for a variety of things, including, but not limited to:

  • sustaining focus or attention
  • remembering details or instructions
  • making plans
  • managing time
  • switching from one task to another or multitasking
  • maintaining self-control

Additionally, a 2019 review notes that women with PD also retain more verbal fluency. Verbal fluency is a function that helps you retrieve specific bits of information from your memory.

PD rigidity can cause facial muscles to “freeze,” leading to a mask-like expression. As a result, people with PD have difficulty expressing emotion with their faces. This can result in others misinterpreting their emotions or mood.

A 2018 study identified emotional cues that could give insight into the emotional states of people with PD. However, the researchers noted that smiling and laughing needed to be interpreted with caution, as women experiencing negative emotions or depression appeared to smile or laugh frequently.

People with PD can also have difficulty interpreting the facial expressions of others, but this topic can be controversial.

For example, a 2015 study found that people with PD recognized facial expressions with less accuracy than individuals without PD.

On the other hand, a 2019 study found no difference in facial expression processing between people with and without PD. However, when compared to younger individuals, older age was associated with poor facial expression processing, regardless of whether the study participant had PD or not.

Rapid eye movement behavior disorder (RBD) is a sleep disorder that occurs during the rapid eye movement (REM) sleep cycle. Normally, a sleeping person doesn’t move during sleep. In RBD, a person can move their limbs and seems to act out their dreams.

RBD is rare, but occurs more often in people with neurodegenerative diseases. A 2017 review of studies found that RBD is more common in people with PD who:

  • are male
  • are of an older age
  • have had a longer disease duration
  • have more severe symptoms or a higher level of functional disability

A 2016 study compared women with PD to women with PD and RBD. Researchers found that women with PD and RBD were more likely to:

  • be older in age
  • have had a shorter duration of PD symptoms
  • have fewer tremors
  • experience insomnia, poor sleep quality, and daytime sleepiness
  • have depression or anxiety

Men and women often have different responses to the experience of living with PD. For example, women with PD tend to experience a higher rate of depression than men with PD do. As a result, they may receive medications for these conditions more often.

A 2020 study evaluated 64 people with PD for anxiety and depression. Depression was more common in women, individuals with a lower socioeconomic status, or those with a history of depression. Anxiety was more common in younger individuals or those with a history of anxiety.

A 2018 study assessed anxiety in 311 people with PD. Women with PD experienced more persistent and episodic anxiety.

Men with PD are more likely to exhibit behavioral problems and aggression, such as inappropriate or abusive behavior. Some research has reported that antipsychotic medications are prescribed at higher rates in men and in people with PD, specifically if they’re experiencing dementia.

Social support can be a vital tool for coping with PD. A 2016 study found that good-quality social care greatly benefits both the physical and mental health of individuals with PD.

If you have PD and are seeking support, talk to your care team. They can advise you on various support resources, including support groups, in your area.

Additionally, you can explore the resources below: