Gout in women is not as bizarre as you might think. You’ve always heard that gout affects port drinking elderly men but, depending on your age, you too could be affected and fitting none of those stereotypes.
Before menopause, women account for only 5% of newly diagnosed cases of gout but by the age of 60 we account for 50% of them and by the age of 80, more women get gout than men.
Why does age matter? It’s those hormones again, and in this case it is oestrogen. It helps the kidneys divert uric acid out of the blood stream and into the urine stream, more effectively and high uric acid levels are responsible for gout and its pain. At menopause oestrogen levels drop and so the uric acid has more chance to build up.
What Is Gout?
Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. If they are not regularly cleared from your system it can result in them forming crystals in joints. This in turn can cause attacks of painful arthritis, kidney stones and, in severe cases, lead to kidney failure.
Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The small joint at the base of the big toe is the most common site for an attack, but other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the acute pain is so intense that even a bed sheet touching the toe causes severe pain.
These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most people with gout will experience repeated bouts over the years.
Gout in the U.K. can affect 1 in 40 according to the Gout Society and is more common in men than in women. The chances of having gout rises with age, with a peak age of 75 and in women attacks usually occur after menopause.
You will recognise some of these are hormonally related, particularly at menopause. They include:
- being overweight
- high blood pressure
- low thyroid levels
- abnormal kidney function
- heavy alcohol use.
Why gout is different for women
For men, gout attacks typically only show up in one joint at a time. However, for women, gout attacks more often than not will show up in several joints at once. And, once the attacks start, women tend to have gout flares more frequently than men.
- Women tend to have more gout attacks in their fingers, hands, and wrists than feet and there is a much higher incidence of prior joint disease in women with gout as opposed to men. This is half of all women with gout and joint disease can include rheumatoid disease, osteoarthritis or other joint conditions.
- Studies show that there is a much higher rate of “family history of gout” in pre-menopausal women compared to post-menopausal women as 59% of pre-menopausal women versus 34% after menopause have a family history of gout.
- Women with high blood pressure are often prescribed diuretics and they can increase the risk of gout, as well as the frequency of gout attacks. Many suspect it is more than just a coincidence that post-menopausal women have higher rates of insulin resistance as well as gout.
- If you have diabetes you will have low to moderate levels of insulin resistance are this has been found to increase the risk of gout, but if you have higher levels of insulin resistance then that reduces the risk of gout. This is because higher levels of blood glucose seem to have the effect of enabling the kidneys to excrete more uric acid.
How oestrogen affects uric acid levels
90% of gout sufferers get their high uric acid levels from the inadequate elimination of uric acid. For pre-menopausal women, oestrogen helps the kidneys get rid of more uric acid through the urine. This keeps the blood uric acid levels lower, and thus decreases the risk of gout attacks.
However at menopause, when oestrogen production declines, this sees age related increases in the incidence of gout. This decline applies to both oestrogen and progesterone but at different levels.
Many women do continue to produce oestrogen at and post menopause from the fat cells of the abdomen, and from the adrenal glands, but if you are low in oestrogen – with signs such as vaginal dryness – then you may need to consider the lifestyle changes relating to diet and to supplementing with bioidentical hormones.
What can you do?
This is something I have personal experience of as I suffered agonising gout attacks recently and so was very concerned to find out everything I could to make sure I never experienced it again. These are some helpful tips I found worked for me:
1 Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout.
2 Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine-rich foods should be avoided. Foods rich in purines include shellfish and organ meats, such as liver, brains, and kidneys. Researchers have reported that meat or seafood consumption increases the risk of gout attacks, while dairy consumption seemed to reduce this risk and scientists have found that high animal protein slightly increased the risk.
3 Increase your use of bioidentical progesterone as it acts as a natural anti-inflammatory and as a relaxant also helps with the pain levels. You can also use anti-inflammatories such as ibuprofen if you are able to take these.
4 Sour cherry juice is not something your doctor will recommend, but thousands find it relieves gout pain and symptoms very quickly. I tried it and it worked for me and you will find it in your local health store as a liquid in the cooler section (dilute with water) or in tablets. I now carry the latter with me if I go on holiday as a preventive.
5 Lose weight if you can as that is definitely helpful in lowering the risk of recurrent attacks of gout.
6 Reduce your alcohol consumption as it is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. It can also affect uric acid metabolism and causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.