A-Z

Gout

Gender and gout

Gout is often thought of as being a man’s condition. It affects over four times more men than women and can happen in men at any age (Kuo et al Ann Rheum Dis 2015). Women can get gout but rarely before the menopause. This is because a female hormone (oestrogen) that is released during the female reproductive cycle increases removal of uric acid by the kidneys. Uric acid levels rise in women after the menopause meaning that their chances of getting gout are increased. 

Perceptions of gender and gout

A number of people we spoke to did not realise that women could get gout. Men had often met other men with gout but had never heard of women who had it. Sam has not come across another woman with gout. She would like to talk face-to-face with another woman of a similar age to discuss their experiences. 
 

Pat was surprised to be diagnosed with gout because she thought it was more of a man’s condition. She works as a nurse but had not met any female patients with gout.

Pat was surprised to be diagnosed with gout because she thought it was more of a man’s condition. She works as a nurse but had not met any female patients with gout.

Age at interview: 61
Sex: Female
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How did you feel about having this diagnosis of having gout?

A bit strange, because I think previously I’d probably thought it was something that men had more than women. I was quite surprised that I did have it. I hadn’t actually met anyone – any female patients who’d had it, only men. Of course, you still get the traditional, you know, “You drink lots of red wine and eat lots of red meat” type of thing, and I don’t eat any of those [laughs]. 
Not many people knew why there are more men with gout than women. Jeff wondered if it might be because women are ‘more sensible’ while Naresh questioned whether the immune system might play a role. Carole knew that women tended to get gout after the menopause, and this had also been her own experience. Several of the women we spoke to said they’d had hysterectomies. They were not all aware that gout is less likely to affect women before the menopause. One woman wondered whether taking HRT had influenced when she got gout. 

Dealing with the pain and diagnosis

Many people felt that gout had a similar impact on men and women in terms of the pain and restrictions it caused, but some thought that men and women might deal with it differently. Several thought that women might cope better with, or be less likely to moan about, the pain of gout. Peter felt that men were more likely to keep the diagnosis to themselves rather than telling other people about it. Ray thought that men might go to their doctor sooner, meaning that women would put up with the pain for longer. In contrast, Alastair and Ian thought that men might be less willing to visit their GP about gout.
 

Ian did not tell his first GP about all the attacks he was getting. He now wonders if he should have asked his GP for more information about treatments.

Ian did not tell his first GP about all the attacks he was getting. He now wonders if he should have asked his GP for more information about treatments.

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Whether I just grinned and bear it, and didn't really tell my first GP all the attacks I was getting all the time, and how painful it was and whatever, they might have then have put me on allopurinol. I just sort of took the tablets, put a bit of an ice pack on it and got on with it really. As most blokes tend to do, don’t they? So I might have - I might have pushed a bit more maybe in the early years and months to understand more from the GP about what options there would have been, and that would have - could I have started taking allopurinol earlier, is that right? Those are the questions I haven't got any answers to, but that might be something for other people to consider and talk to their GPs about. 
Some women, for example Jacqui, were not diagnosed straight away despite the fact that their GPs recognised the symptoms as consistent with gout. Jacqui wonders if gout is under-diagnosed in women because their GPs do not always consider gout as a possibility. Sam’s GP told her it was ‘very unlikely’ that she would have gout and seemed ‘more surprised than me really’ with the diagnosis. This left Sam feeling uncomfortable about the diagnosis and questioning its accuracy. 
 

When Jacqui first visited her GP, the GP said that she would have diagnosed a man with the same symptoms with gout.

When Jacqui first visited her GP, the GP said that she would have diagnosed a man with the same symptoms with gout.

Age at interview: 56
Sex: Female
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It felt much worse than any cramp I'd ever had and it was in the arch of my foot. And so much so that the next day I couldn't really walk well and my foot started to swell. So it carried on a little bit for, you know, a couple more nights of the same thing, this really acute pain, and I decided eventually to go to the GP. And the GP looked at my foot and the first GP that I saw, and this was now closer to Christmas, so it started early December. This was closer to Christmas. So I didn't see my normal GP and the GP that I saw said, "If you weren't a woman, I would say this is gout." And, and I thought, "Ah, no, it can't be," because I had in my mind all of the old wives' tales that we have in our minds about gout. And also I don't drink excessively and all of the things that people associate with gout. And so I didn't initially take that throwaway comment that seriously.
 

Sam’s GP did not think that she would have gout but tests showed that her uric acid levels were high.

Sam’s GP did not think that she would have gout but tests showed that her uric acid levels were high.

Age at interview: 41
Sex: Female
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It was around February 2011, I'd been to the GP previously, because I've had this continuous swelling in my left foot. So I'd been - I'd had blood tests in the past for diabetes, but this particular foot I'd broken years before and I'd also done the ligaments and different things, so we just assumed there was sort of progression of arthritis in the joint. 

But - and both my parents have been diagnosed with rheumatoid arthritis, so it started off being, looking at that sort of thing. But then kind of about the - well in the August we went on holidays and I was really ill when we were abroad on holidays. My foot - I was in horrendous pain as if somebody was jabbing me with needles. So when I came home then, I went to the GP and explained all the symptoms. And she sort of said to me then, she said, “Well I don’t think you’ve got gout”, she said, “But I'd better test you for it because your symptoms are sort of connected with that.” And she said, “Well it's very unlikely because - female, and your age, and you're not particularly overweight, or anything, but we'll test anyway.” And my - when it came back I'd had the bloods done the beginning of October and a week later the bloods came back that my uric acid level was high.
Younger women with gout were particularly likely to find their diagnosis difficult to accept. Sam had not met anyone of her own age who had gout, even on internet forums for people with gout.

Information for women with gout

As a younger woman with gout, Hazel, aged 32, has had problems that do not apply to men or older women. She has found it difficult to find information about younger women with gout and believes that GPs do not know much about it either. She feels that it is important for health professionals to discuss issues such as pregnancy with younger women with gout. Hazel has attacks every month just before her period. She would like to get pregnant but is worried about treatment for gout and attacks during pregnancy, and breastfeeding. She is trying to find information before she becomes pregnant, but feels unhappy about having to delay starting a family because of gout.
 

Hazel has had several issues related to being a younger woman with gout. She has found it hard to find relevant information and has concerns about gout and pregnancy.

Hazel has had several issues related to being a younger woman with gout. She has found it hard to find relevant information and has concerns about gout and pregnancy.

Age at interview: 32
Sex: Female
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It was happening once a month and then my husband said, "Can you track when you, when you have it?" And then we started looking at it and then he said, "Actually, you know what, you've been having it right around the time before you have your period." And so we're thinking, "Okay, is it then the hormonal imbalance?" Haven't really read any study about that, but then I guess it's because most people that have it are men and those that have it with women are menopaused. So maybe not a lot of people but something to think about maybe, because then we were thinking, "So does that mean that actually when I'm pregnant, because it's the same hormones, I might actually have it more and I can't get the medication. So what are we going to do about that? Am I going to be in a wheelchair because I wouldn't be able to walk or move around?" Just those, those thoughts. Don't really know. I don't have an answer about that. So it happens monthly like that.

Because then the gout medication, for example, is not ideal for women who want to have children. It's either you risk having gout or you don't have children. And there is no option except you stop taking any medication related to gout, at least that I know of. So that's the option we're taking, except that I keep on having attacks and when I have an attack I have to take the medication. So let’s say, "What if I'm one month pregnant, then I get a gout attack, what do I do?" And that's why for us we're using contraception currently as to make sure that I don't conceive and then take something that, you know. So we want - that's why we wanted to have the four month - this is our own sort of protocol because I don't know of any other. So we say, "Okay, four months without it means probably you're safe enough. We then remove the contraception. You then stop eating whatever you need to stop eating for - until you have the baby so that you don't have an attack, because we know that your levels will be low once you get pregnant, because then you don't want an accident wherein, didn't know that I was pregnant already, took the colchicine or the mefenamic acid, then it would have effects”. So that there's not that option. So it's just you deal with the pain when it's there. I think someone said when I was – I think one of the doctors said that, you know, "If it really gets worse and you're already pregnant, then we can inject something for the pain." That's their solution, but it's not dealing with the problem really. It's worst case scenario, "We, we inject you with something." That's it. 

So I mean that, I think, is a factor because of my age, because then I think most people that have been studied before are elderly or are men, none of which have children, none of which want to get pregnant. It doesn’t really, as far as I know, doesn’t affect the fertility of the man so it's not really part of the discussion but, I'm sure I'm not alone. I'm sure there are other women there and okay, if there are women in their 40s who are having gout now, there are women in their 40s who are actually even more desperate to have a baby and they're very likely to be under a salad of medication as well. And then so this should be part of the discussion, I think, because then are we supposed to not have children just because we have gout? Or are we supposed to endure the pain of gout for nine months because we want to actually have children? It's not just nine months, because when you're breastfeeding you can't have it as well, according to the doctor. So it's a sort of - it's, it's one, one concern for me, because then I'm having to sort of delay things. I, I've delayed it quite a bit now, just because of the gout. So I mean it's, it's another thing that, that gout has affected and it's a pretty major thing, I think. So, yeah.
Sam felt that doctors needed to be more aware that women could develop gout. She believed that there was very little information about women with gout. Sam and Shirley both said they had never come across pictures of women with gout in information leaflets or on the internet. 

Other people’s perceptions

Tony said that the lifestyle often associated with gout, such as excessive eating and drinking alcohol, was also seen as more common in men in the past. Several men thought that it might be easier for men to talk about having gout because it is seen as a man’s condition. They believed that women might be more self-conscious about mentioning it. 

Some women felt comfortable with their diagnosis, but the perception of gout as a male condition caused embarrassment and anxiety in others. Jacqui felt uncomfortable that people might think she had been drinking too much alcohol because they did not understand the other causes of gout. Several women felt that gout had affected their identity as a woman and how they felt about themselves. 
 

Val felt that having gout, and not being able to wear the shoes she wanted to, made her feel older and less feminine.

Val felt that having gout, and not being able to wear the shoes she wanted to, made her feel older and less feminine.

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Well the main thing with me has been shoes. I can’t … couldn’t get many of my shoes on and I kept thinking, “Oh it’ll go down, it’ll go down”. But I did get sent for an x-ray and they said that I had arthritis in both big toe joints. And so I thought, “Well if I’ve got arthritis and this gout’s come along to add a bit more to it, I probably am never going to get those shoes on again”. Which in fact was true, I couldn’t get the shoes on again. And that, because they were girlie shoes, that really was a disappointment. I know it might sound a bit trivial to people but it’s like your image of who you are isn’t it? And I felt very old as well. You know that kind of feeling, “Oh dear I’ve joined the old age pensioners now”, you know.

Because of the shoes? 

No, no the shoes and the gout, you know, the fact that … in fact I haven’t told many people I’ve got gout. 

Why do you think that is? 

Because it feels so old I think. It feels as though it’s something that people sort of in their dotage have, not young people. Or young … I mean I’m not young, but in my head I’m young, yeah. 
Some women did not mind telling other people that they had gout. It did not bother Carole, for example, because she saw gout as something that was not her fault. Other women, though, did not like talking about having it. A few said that they had arthritis rather than gout so that people would not assume they ate lots of red meat and drank too much alcohol. 
 

Sam felt that having gout as a woman was not normal. She did not like talking about it to other people.

Sam felt that having gout as a woman was not normal. She did not like talking about it to other people.

Age at interview: 41
Sex: Female
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I was kind of thinking - and I suppose you do don’t you – that, “God, I'm a bit of a freak really” because you know, you talk to people, “Oh my god my grandfather got that, you can't have that surely?” And it's like well - and it was all men. I was thinking “Oh my god, am I half man or something?” You know [laughs]. “Testosterone overload or something?” But yeah so I kind of - sort of put it to the - because I was thinking, “Oh I am - must be some sort of freak because no other women I know have got it” so I kind of don’t end up talking about it anymore much to people. 



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Last reviewed December 2016
Last updated December 2016
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