Gout, once deemed a malady exclusive to men and historically known as the “disease of kings,” is increasingly prevalent among women. Over the past two decades, the incidence of gout in women has more than doubled. Currently, in the United States alone, over 3 million women, alongside 6 million men, are affected by this inflammatory arthritis.
The Protective Role of Estrogen and Menopause
Gout arises from elevated uric acid levels in the bloodstream, leading to the formation of sharp, needle-like crystals within the joints. These crystals trigger inflammation, resulting in pain, swelling, and redness. Typically, estrogen plays a protective role in women by facilitating the excretion of uric acid through urine. However, this natural defense diminishes with menopause, as estrogen levels decline, causing uric acid levels to rise.
Hormonal Factors Beyond Menopause
It was previously hypothesized that hormone replacement therapy (HRT) and oral contraceptives could mimic the protective effects of natural estrogen against gout. However, a 2021 study involving over a million postmenopausal women revealed contrary findings. Both HRT and birth control hormones were associated with an increased risk of gout. Furthermore, reduced lifetime exposure to natural estrogen, such as experiencing early menopause or late menarche, also elevated gout risk, although this correlation was not statistically significant in women with a high body mass index.
Gender Differences in Gout Presentation
Beyond hormonal influences, notable gender-based distinctions exist in gout. A 2023 analysis of over 100,000 gout-related hospitalizations in Spain (2005-2015) indicated that women were, on average, a decade older than men at the time of gout diagnosis and presented with different co-existing health conditions. The later onset of gout in women compared to men is understandable given the protective effect of estrogen in premenopausal years. However, the reasons behind the divergent co-existing conditions remain less clear.
The Spanish study revealed that women with gout were significantly more likely to suffer from heart failure, diabetes, obesity, and urinary tract infections. Conversely, men with gout were more prone to respiratory disease, heart disease, and peripheral artery disease. These findings underscore the need for a tailored approach to gout management in women, addressing what researchers term “gender blindness” in treatment strategies.
Historically, gout has been characterized by sudden, intense pain in the big toe, often occurring at night. While this is frequently the case for men, gout in women often manifests differently. Women are more likely to develop gout gradually in multiple joints, including knees, toes, wrists, and finger joints, areas often already affected by osteoarthritis (OA). This atypical presentation can lead to misdiagnosis, particularly when gout affects the hands, highlighting another instance of “gender blindness.” This diagnostic challenge mirrors the misdiagnosis of heart attacks in women due to symptom variations compared to men, such as fatigue, nausea, and vomiting.
Diagnosis and Management
Accurate gout diagnosis is crucial for both sexes. Adopting a healthy eating plan, such as the Mediterranean diet, and minimizing consumption of gout triggers like beer and high fructose corn syrup can help manage gout flares and mitigate the risk of associated conditions common in women, such as diabetes. Individuals experiencing frequent (more than one per year) or severe gout attacks should consult their physician about uric acid-lowering medications. Research confirms that these medications are equally safe and effective for both women and men in lowering uric acid levels and managing gout.
