Parkinson's disease across female reproductive stages: Clinical implications from menstruation to menopause

Parkinson's disease (PD) is a neurodegenerative disorder that differs between women and men in epidemiology, clinical manifestations, treatment response, adverse effects, and disease progression. The central hypothesis that sex hormones may modulate dopaminergic and neuroinflammatory/oxidative stress circuits could explain the observed clinical and epidemiological differences. These factors may influence motor and non-motor symptoms, pharmacological management, reproductive counseling, sexual health, and decisions regarding advanced therapies. In this narrative review, we synthesize current evidence and highlight key knowledge gaps on PD across the menstrual cycle, pregnancy, and menopause. We also discuss the potential role of estrogen exposure, menopausal hormone therapy, pregnancy-related medication considerations, deep brain stimulation (DBS) during pregnancy, and clinically relevant knowledge gaps. Available evidence remains limited, heterogeneous, and largely based on observational studies, case series, and expert opinion. Recognizing reproductive-stage influences may improve individualized care for women with PD and should be prioritized in future prospective research.