Menopause and Gout: What You Need to Know

Menopause and Gout

Gout, a painful form of inflammatory arthritis, has been in existence since ancient times.1 With its painful swelling and redness, gout often occurs in the big toe and may show up in other body parts, such as in the heels, instep, ankles, knees, elbows, hips, thumbs and fingers. Gout results from an overproduction by the body of uric acid, which can build up in tissues if it isn’t excreted.1 While gout is often considered a male disease, with a four-fold lower likelihood of occurring in women prior to menopause,2 the incidence in both sexes has been on the increase in recent decades,2 perhaps because Americans are getting older and heavier.3-5 After age 65, the gap between the genders with gout narrows to one woman to every three men.5 It’s believed that estrogen has a protective effect that is removed at menopause, thus accounting for the rise in gout in women who are postmenopausal.6,7

Menopause and Gout

The Nurses’ Health Study, published in 2010, looked at the association between menopause, age at menopause and risk of self-reported physician diagnosed incident gout among 92,535 women who were gout-free at the start of the study.8 Over 16 years of follow-up, the incidence of gout in women 75 years of age or older was more than 300 percent higher than in women younger than 45 years of age. Compared with premenopausal women, postmenopausal women had a 26 percent higher risk of gout.8

Estrogen and progesterone have a beneficial effect on how uric acid is cleared by the body, so the drop in these hormones when menstruation ends eliminates any protective effect. Gout occurred most often in women who had surgical menopause with sudden complete removal of hormone function. The age of the first period, as well as illnesses, athletic activity and eating disorders can also affect the risk of gout in women.8

Other co-existing diseases, such as high blood pressure, high cholesterol, coronary heart disease, diabetes, kidney and liver problems and heavy drinking are also risk factors in gout for women and men.9 However, women with gout were more likely to have high blood pressure and/or kidney problems, as well as to have taken water pills (diuretics), often prescribed for high blood pressure.10

Along with the later age of onset, women, unlike men, tend to experience more symptoms in the joints of upper limbs, and are less likely to develop tophi.11 Tophi are deposits of uric acid that form in the soft tissues and around joints, making bumps under the skin.1

Women can help prevent gout

Beyond talking to a doctor about prescription medications to help prevent gout flares, women with gout can make beneficial lifestyle changes.

  • Drink more water. Drinking water may be a helpful part of a gout prevention plan because good hydration helps keep uric acid crystals from building up in the kidneys. Any fluids count towards your daily water intake, including coffee and tea, but not alcohol. Eight glasses of water per day is recommended.12
  • Limit alcohol intake. Alcohol may raise your risk of a gout episode.13 Beer—even light, low-carbohydrate beer—appears to be worse than other alcoholic drinks because it contains malt.14
  • Avoid sweet beverages. Skip sugary beverages, especially those containing fructose, which have been linked to a higher risk of gout.15
  • Choose foods that are gout-friendly. Avoid foods that are high in purines, such as seafood (mussels, scallops, trout, haddock, mackerel, tuna, sardines and anchovies), as well as liver, which can increase the uric acid level in your blood. Choose healthy food options that are lower in purines, such as potatoes, squash and fruits and vegetables. According to the Mayo Clinic, a low-purine diet is great for anyone who currently has gout or has struggled with gout.16Eat low-fat dairy products, which may lower your risk of gout.16
  • Exercise and manage your weight. Weight loss can help reduce your body’s burden of uric acid. Maintaining a healthy weight is key to many aspects of overall good health, including preventing gout flares. Talk with your doctor about sensible ways to reduce your weight if necessary, and increase your level of fitness with exercise.17

You can help prevent gout flares. See your doctor if you think you are experiencing symptoms of gout flares and ask what you can do to help prevent them.

 

NOTE: This article was not written by a medical professional and is not intended to substitute the guidance of a physician. These are not West-Ward’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a list of resources and their attributing links, see below. 

References

  1. Centers for Disease Control. Gout. http://www.cdc.gov/arthritis/basics/gout.html. Accessed 1/20/17.
  2. Zhu Y, Pandya BJ, Choi HK. Prevalence of Gout and Hyperuricemia in the US General Population: The National Health and Nutrition Examination Survey 2007-2008. Arthritis and Rheum. 2011;63(10):3136-3141.
  3. Kuo CF, et al. Global epidemiology of gout: prevalence, incidence, and risk factors. Nat Rev Rheumatol. 2015;11:649-662.
  4. Gout on the Rise as Americans Gain Weight. By Katherine Harmon. Scientific American website. Available at: https://www.scientificamerican.com/article/gout-on-the-rise/. Accessed 3/14/17.
  5. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Research and Therapy. 2006;8(Supple 1):S2. Accessed at https://arthritis-research.biomedcentral.com/articles/10.1186/ar1907 Accessed 1/24/17.
  6. Harvard Health Letter. All about gout. at http://www.health.harvard.edu/newsletter_article/all-about-gout. Accessed 1/20/17.
  7. Mumford SL, et al. Serum uric acid in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study. Hum Reprod. 2013;28(7):1853-1862.
  8. Hak A Elisabeth, Curhan Gary C, Grodstein F, Choi Hyon K. Menopause, postmenopausal hormone use and risk of incident gout. Ann Rheum Dis. 2010;69(7):1305-1309. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142742/. Accessed 1/20/17.
  9. O’Sullivan JB. Gout in a New England town: a prevalence study in Sudbury, Mass. Ann Rheum Dis.1972;31:166–9.
  10. Jansen Dirken-Heukensfeldt KJM, Teunissen TAM, van de Lisdonk EH, Lagro-Janssen ALM. “Clinical features of women with gout arthritis.” A systematic review. Clin Rheumatol. 2010;29:575-582.
  11. DeSouza A WS, Fernandes V, Ferrari AJL. Female gout: clinical and laboratory features. J Rheum. 2005;32(11):2186-2188.
  12. Milind P, Sushila K, Neeraj S. Understanding Gout Beyond Doubt. Int Res J Pharm. 2013;4(9):25-34
  13. Harvard Family Health Guide. Fight back against gout. http://www.health.harvard.edu/diseases-and-conditions/fight-back-against-gout. Accessed 1/24/17.
  14. Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Curr Opin Rheumatol. 2006;18(2):193-198. Accessed at http://www.medscape.com/viewarticle/524766_5, Accessed 1/24/17.
  15. Batt C, et al. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout. Ann Rheum Dis. 2014 Dec;73(12):2101-6. Accessed at http://www.ncbi.nlm.nih.gov/pubmed/24026676, Accessed 1/20/17.
  16. Mayo Clinic. Gout diet: what’s allowed, what’s not. Accessed at http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524, Accessed 1/20/17.
  17. Arthritis Foundation. Gout self care. Accessed at http://www.arthritis.org/about-arthritis/types/gout/self-care.php, Accessed 1/20/17.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.