Women Are Not Immune to Gout

Updated by Linda Rath | Nov. 12, 2023

It was once thought that gout, the so-called “disease of kings,” typically spared queens. But in the last 20 years, cases of gout have more than doubled among women. Today, more than 3 million women and 6 million men in the U.S. have this inflammatory form of arthritis.

Natural Gout Protection and Potential Triggers

Gout occurs when high levels of uric acid build up in the blood and form needle-sharp crystals in the joints, causing pain, swelling and redness. The hormone estrogen usually protects women because it causes uric acid to be flushed out of the body in urine. When women lose estrogen after menopause, the level of uric acid in their blood starts to rise.

It was once thought that hormone replacement therapy (HRT) and even birth control pills helped prevent gout just as well as natural estrogen does. But a 2021study of more than one million postmenopausal women found the opposite. Both HRT and birth control hormones actually increased gout risk. Having less exposure to natural estrogen — going through menopause early and starting menstruation late, for example — also increased the risk, though the risk wasn’t statistically significant in women who were very overweight (high body mass index).

Hormones aren’t the only thing that set women apart. According to a 2023 analysis of more than 100,000 adults hospitalized with gout in Spain between 2005 and 2015, women were 10 years older than men and had very different co-existing conditions. Since it’s rare for premenopausal women to get gout, it makes sense they would develop it later in life than men. But it’s less clear why women and men would have such markedly different conditions associated with gout.

In the study, women who had gout were significantly more prone to heart failure, diabetes, obesity and urinary tract infections, whereas men developed respiratory disease, heart disease and peripheral artery disease. The study authors argue for a new approach to treating gout in women to reduce what they refer to as “gender blindness.”

More Gender Differences

Historically, gout has been described as sudden and severe pain in the big toe, often striking in the middle of the night. That’s often true for men, but women tend to develop gout in several joints slowly over time. It may show up in their knees, toes, wrists and ends of their fingers, where they may already some damage from osteoarthritis (OA). This can be a problem because it means gout in the hands is often misdiagnosed. It’s another example of “gender blindness,” and is reminiscent of how heart attacks may be misdiagnosed in women because their symptoms differ from those in men, and may include fatigue, nausea and vomiting.

Diagnosis is Key

An accurate gout diagnosis is important for both men and women. Switching to a healthy eating plan like the Mediterranean diet and cutting out major gout triggers like beer and high fructose corn syrup can help curb flares as well as prevent some of the conditions commonly associated with gout in women, like diabetes. People who have more than one gout attack a year or whose attacks are severe should talk to their doctor about gout medication. Studies have shown that the safety and effectiveness of uric acid-lowering drugs are the same for women and men.