Gout in women is not as bizarre as you might think. You’ve always heard that gout is a “rich man’s disease”, right? Well, depending on your age . . . this may not be true. Here are some surprising statistics:
- Before menopause, women account for only 5% of newly diagnosed cases of gout.
- However, by age 60 women account for 50% of newly diagnosed cases of gout.
- And by age 80, more women get gout than men!
Why does age matter? Estrogen. It turns out that estrogen helps the kidneys divert uric acid out of the blood stream and into the urine stream, more effectively.
Also, menopause-status matters; because that is when women start producing less estrogen. More on estrogen below . . .
The Good News
Alcohol – In women, there does not appear to be the same link between alcohol consumption and the development of gout. Only 9% post-menopausal women with gout, opposed to 45% men with gout, report excessive or chronic alcohol consumption.
Obesity – Weight is another risk factor seemingly less prevalent in women than in men. Women with gout have been found to be 10% less obese than men.
The Bad News
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.
The worst: Women tend to start getting tophi earlier in the progressive stages of gout . . . so it’s best to get on top of this as soon as possible.
Other Differences for Women With Gout
Another odd thing that comes up what assessing what is gout? in relationship to how it affects women, is that women tend to have gout attacks in their fingers, hands, and wrists . . . while men tend to have attacks in their toes, feet and ankles.
In addition, there is a much higher incidence of prior joint disease in women with gout as opposed to men . . . half of all women with gout, as opposed to a quarter of men. This can include rheumatoid disease, osteoarthritis or other joint conditions.
Do Genes Cause Gout in Women?
There is a lower rate of “family history of gout” in men compared to women. This may be related to the genetically inherited structure of the “renal urate transporters”, which control how uric acid is eliminated through the kidneys.
Plus, studies show that there is a much higher rate of “family history of gout” in pre-menopausal women compared to post-menopausal women . . . 59% of pre-menopausal women versus 34% after menopause have a family history of gout.
Do Diuretics Cause Gout in Women?
It is well known that “loop diuretics” increase the risk of gout, as well as the frequency of gout attacks. Studies show that more women than men use diuretics.
The average use of diuretics by women in general is a little more than 30%, but for women with gout over 75% use diuretics and less than 15% of men with gout use diuretics.
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Many suspect it is more than just a coincidence that post-menopausal women have higher rates of insulin resistance as well as gout.
Low to moderate levels of insulin resistance are found to increase the risk of gout, but higher levels of insulin resistance reduce the risk of gout. This is because higher levels of blood glucose seem to have a “uricosuric effect”, meaning the kidneys are then able to excrete more uric acid.
Studies show that 50-80% of women who develop gout have a documented history of “renal insufficiency” compared to less than 15% of men. And one study showed a much higher rate of renal insufficiency in pre-menopausal women with gout.
“Renal Insufficiency” means that the kidneys are not functioning well, and in the case of gout this limits the kidney’s ability to eliminate uric acid via urine, and thus lower the concentration of uric acid in the blood.
How Estrogen Affects Uric Acid Levels
High levels of uric acid in the blood come from one of two sources: Either excess production of uric acid, or inadequate elimination of it. But it turns out 90% of gout sufferers get their high uric acid levels from the latter: Inadequate elimination of uric acid.
For pre-menopausal women, estrogen helps the kidneys get rid of more uric acid then men, because of differences in the kidney “transporters” called URAT1, OAT1 and OAT3.
Estrogen increases the amount of uric acid that gets eliminated via urine (peed out). This keeps the blood uric acid levels lower, and thus decreases the risk of gout attacks.
That is . . . until menopause, when estrogen production declines.
HRT – Hormone Replacement Therapy
Several studies show that women who take hormone replacement therapy (HRT) prevent some of the age related increases in the incidence of gout. This applies to both estrogen only, and estrogen and progesterone in combination.
An interesting related observation: People who go through the “gender reassignment” process (sex change) to go from being a woman to being a man have to take testosterone supplements. The testosterone “suppresses” estrogen, and then they have a documented increased risk of gout.
(Moral of the story: If you’re thinking of having a sex-change operation, you’ll have less gout if you choose to go from being a man to being a woman, than the other way around.)
Making Sense of It All
The changes associated with menopause seems to provide a combination of reasons women develop gout in later life, including:
- The decreased excretion of uric acid from decreased estrogen.
- The increased weight gain that seems to appear with menopause.
- The increased incidence of glucose intolerance.
- The increased incidence of renal insufficiency.
The combination of all the above creates a collection of risk factors that favors elevated blood uric acid levels and gout attacks. In addition, for women with a strong family history of gout, and/or a history of other joint disease (particularly osteoarthritis) . . . the risks escalate even more.
What to do About Gout in Women
If you’re a woman who has already had your first gout attack, it’s time to seriously consider some lifestyle changes in order to PREVENT the progression of gout . . . which if left unchecked could become a very major ongoing problem in your life.
My online video program Kill Your Gout FOR GOOD is all about the PREVENTION of gout. I encourage you to check out this program, which will not only help you prevent ever having another gout attack, but will also help prevent every other age-related disease as well. To your health!
Menopause, Postmenopausal Hormone Use and Risk of Incident Gout
Molecular Physiology of Urate Transport
Molecular Physiology of Renal Organic Anion Transporters