EAN 2025 | Exploring the role of estrogen and hormonal therapy in women with Parkinson’s disease

In women’s midlife during the menopause, the menstrual cycles are becoming less and less frequent and eventually they stop, which is leading to different hormonal changes, including a significant drop in ovarian estrogen. And during the menopause, as a consequence of these hormonal changes, women experience a range of different symptoms, including vasomotor symptoms, urinary symptoms, sleep issues, but also cognitive and psychological problems. And because of the increased longevity in Europe especially, typically a woman in Europe will spend 40% of her life in menopause. Now, Parkinson’s disease is the second most common neurodegenerative disorder and it presents with a set that is unique for each individual and also a constantly evolving set of different symptoms, motor and non-motor. And in Parkinson’s disease there seems to be an important role of estrogen and we know it from the epidemiological studies because Parkinson’s is much more frequent in men than it is in women. And we also know it from the basic science studies from animal models, where it has been shown that under experimental conditions, estrogen can protect dopaminergic neurons from neurodegeneration. And not only that, but also among those symptoms of Parkinson’s disease, some are very similar and may overlap with symptoms of menopause. And that’s why we felt it was very important to investigate whether in women with Parkinson’s a combination of hormonal therapy and standard Parkinson’s treatment can lead to better control of symptoms and better quality of life in comparison with Parkinson’s medication only. And we performed a systematic review. We screened almost 5,000 different publications and identified eighteen relevant studies. And what we have seen here is that in accordance with the previous epidemiological data, women with Parkinson’s have a shorter reproductive fertile lifespan than women who don’t have Parkinson’s. So they have a shorter duration of exposure to endogenous estrogen. And also there seems to be a negative correlation between the age at the onset of menopause and the burden of motor symptoms, meaning that in women with Parkinson who had menopause earlier, who entered menopause earlier, the burden of motor symptoms is more severe. Now, we were really interested in the question if we should recommend women with Parkinson’s to take hormonal therapy during the menopause and postmenopausal period or not. Here in the analysis, we have seen a trend in terms that women with Parkinson’s who were taking hormonal therapy seemed to have milder motor symptoms than those who didn’t, this trend did not reach statistical significance. So it means we don’t really know but it’s important to say that the studies so far are very small, they are methodologically not very sound and they are also pretty old mostly. So really I think we can conclude that there seems to be an important role of both our endogenous estrogen but also hormonal therapy in women with Parkinson’s disease. And this needs to be investigated in larger high-quality trials. And this is not only important for women really, it’s also important for men because if estrogen can modulate Parkinson’s, then in the future it might be possible to find a way to use this effect without hormonal effects also in men.

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