Despite the increase of gout incidence in recent years, and the substantial prevalence particularly in the older female population, the risk factors for gout in women remain ill defined, write A. Elisabeth Hak, MD, PhD, from Erasmus MC University Medical Center in Rotterdam, the Netherlands, and colleagues. Sex hormones have been postulated to be associated with gout risk among women. Serum urate levels, which are closely associated with gout, increase substantially with age in women, whereas among men urate concentrations are not significantly different between middle and older age.

The aim of the study which investigated data from 92,535 women without gout at baseline who were enrolled in the Nurses’ Health Study, was to examine the association between menopause, postmenopausal hormone use, and risk of self-reported, physician-diagnosed, incident gout. Multivariate proportional hazards regression analysis helped in adjustment for other risk factors associated with gout, including age, body mass index, diuretic use, hypertension, alcohol consumption, and diet.

Over 16 years of follow-up, the incident of gout cases were 1703 (1,240,231 person-years). Gout incidence raised from 0.6 per 1000 person-years in women younger than 45 years to 2.5 in women 75 years or older (P for trend < .001). The risk for incident gout was higher in premenopausal women vs postmenopausal women (multivariate adjusted relative risk [RR], 1.26; 95% confidence interval [CI], 1.03 – 1.55).

Compared with women with who had natural menopause at 50 to 54 years, those women with natural menopause at age younger than 45 years had a RR for gout of 1.62 (95% CI, 1.12 – 2.33). The risk for gout was diminished in women who used postmenopausal hormone therapy (RR, 0.82; 95% CI, 0.70 – 0.96).

These prospective findings indicate that menopause increases the risk of gout, whereas postmenopausal hormone therapy modestly reduces gout risk, the study authors write. This increase in the risk of gout tended to be more evident among women with surgical menopause and among women with younger age at natural menopause….These associations were independent of dietary and other risk factors for gout such as age, body mass index, diuretic use and hypertension.

The study limitations include reliance on self-report of physician-diagnosed gout.