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.
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].
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.
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.
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.
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.
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.
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.
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.
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.
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.
Last reviewed December 2016
Last updated December 2016
Copyright © 2024 University of Oxford. All rights reserved.