My wife is 58 with Parkinson’s. Should we consider HRT?

Question

Hello doctor,

My 58-year-old wife was recently diagnosed with Parkinson’s disease after months of subtle symptoms we initially attributed to menopause. It began with a tremor in her right hand while applying makeup, now affecting the whole arm. She was started on carbidopa-levodopa but has nausea and dizziness that make her reluctant to take it.

Her handwriting is so small she cannot sign checks, her voice is quieter, and rigidity makes it hard to get out of bed. She moves more slowly, seems depressed and withdrawn, and has constipation and sleep problems that started before the tremor.

The specialist wants to increase her medication dose, but the side effects are already bothersome. I read that women may experience Parkinson’s differently and that hormones could influence progression. Could hormone replacement therapy help women with Parkinson’s? Should we seek a second opinion, given her relatively young age?

Please help.

Thank you in advance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is a lot to take in, especially since the symptoms built up gradually and are now interfering with your wife’s daily life. Let me explain step by step.

Diagnosis and age: At 58, your wife is considered to have young-onset Parkinson’s disease, which means a diagnosis before the age of 60. The symptoms you describe include tremor, which is involuntary shaking, rigidity or muscle stiffness, bradykinesia or slowness of movement, micrographia or very small handwriting, hypophonia or a softer voice, constipation or infrequent and difficult bowel movements, and mood changes such as depression. These are all very typical of Parkinson’s disease. A second opinion can sometimes provide reassurance, but since a movement disorder specialist, who is a neurologist trained specifically in Parkinson’s and related conditions, has already evaluated her, the clinical picture appears quite classic.
Carbidopa Levodopa side effects: Carbidopa-levodopa is the main treatment for Parkinson’s. Levodopa is converted to dopamine, a brain chemical that is low in Parkinson’s, and Carbidopa helps reduce side effects by preventing the breakdown of Levodopa before it reaches the brain. Nausea, which is stomach upset, and dizziness are common early side effects. Doctors may adjust the ratio of Carbidopa to Levodopa, since more Carbidopa reduces nausea. They may use a controlled-release form, prescribe medications such as domperidone to treat nausea, or start at a lower dose and increase gradually. It is very important not to stop the medicine suddenly because this can worsen Parkinson’s symptoms. All adjustments should be discussed with her neurologist.
Non-motor symptoms: Parkinson’s disease affects more than movement. Non-motor symptoms can appear years earlier and include constipation due to slower gut movement, depression and anxiety related to changes in brain chemistry and coping with a chronic illness, and sleep problems such as difficulty falling asleep, restless sleep, or acting out dreams. These symptoms are part of Parkinson’s itself and not only side effects of medication. Treatment may include lifestyle measures such as a diet with more fiber and fluids, regular exercise, good sleep habits, counseling or therapy, and, in some cases, antidepressant medication.
Women and Parkinson’s: Research shows that women may experience more tremor, mood changes, and medication-related complications than men. Estrogen, which is a female hormone, may provide some protection before menopause, and this might explain differences in onset and progression. Hormone replacement therapy, sometimes used for menopausal symptoms such as hot flashes, is not recommended as a treatment for Parkinson’s disease. Studies are mixed, and the risks of hormone replacement therapy, including blood clots and breast cancer, generally outweigh the uncertain benefits for Parkinson’s.
What you can do now? The most important steps are to focus on supportive care along with medication. Helpful measures include:

Work with her neurologist to fine-tune medication and minimize side effects.
Encourage daily exercise such as walking, yoga, or physiotherapy to improve mobility, mood, and slow progression.
Maintain a regular sleep routine and increase dietary fiber, fluids, and physical activity to improve constipation.
Provide emotional support, since depression is common but treatable, and consider counseling or medications if needed.
Seek speech and occupational therapy to strengthen her voice, improve handwriting, and assist with daily tasks.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.