Why Is Restless Legs Syndrome More Common in Women?

Restless legs syndrome (RLS) is a sleep disorder that causes unpleasant sensations in the legs. Gender and sex are risk factors for RLS; women are twice as likely to be diagnosed as men. Most chronic sufferers are over 40 years old.^1-5

Iron, estrogen, and dopamine may explain why sex is a risk factor. The hormone estrogen is generally higher in cisgender women compared to cisgender men, while iron levels tend to be lower in cisgender women than in cisgender men. The amounts of these chemicals and how they change throughout a person’s life may explain heightened RLS risk.^3-5

Other conditions are also linked to RLS. These medical issues often affect more women than men. The treatments for these conditions may further raise the risk for RLS.^3,4

Pregnancy and RLS

A 2018 study showed that 1 out of every 5 pregnant women gets RLS. It usually starts later in the pregnancy. It goes away once the mother has the baby.^4,5

Women who get RLS during pregnancy are more likely to have it again if they have another child. They are also more likely to have chronic RLS as they age.⁵

Fluctuating hormones may provoke RLS. Women who are pregnant or going through menopause, 2 conditions causing big changes in estrogen and iron, have high rates of RLS. In fact, RLS in pregnancy often starts in the third trimester. This is the trimester when estrogen levels are highest and iron is lowest.^4,5

The role of iron in RLS

Low iron is linked to RLS, and some studies have shown that cisgender women have lower iron levels overall compared to cisgender men. Low iron can cause dopamine to be altered. Dopamine is important as most RLS drugs raise dopamine levels to control symptoms.^4,6,7

Iron and dopamine could impact several parts of the brain. This could lead to RLS and other movement disorders.⁴

Medical conditions linked to RLS

Many other health conditions are associated with RLS. Some of these are:^3,4,8,9

• Migraine
• Sleep disorders
• Depression and anxiety
• Low iron, vitamin B12, or folate
• Diabetes and kidney disease
• Parkinson’s disease
• Pregnancy-related high blood pressure

Some conditions affect more women than men. Women are more likely to suffer from insomnia, anxiety, depression, and migraine. Having one of these conditions could raise the risk of RLS.^3,4

RLS affects quality of life, sleep, and mood. Thus, women with frequent, severe RLS symptoms may be even more likely to feel depressed or anxious. Doctors are still trying to understand the full relationship between mental health and RLS.⁸

Treatments for other conditions and increased risk for RLS

Not only are women more likely than men to suffer from other conditions linked to RLS, they are more likely to seek help from a doctor. Many drugs used to treat these other conditions provoke RLS.⁴

Mood disorders, depression, and anxiety can be treated with drugs. Antidepressants and antipsychotic drugs have been shown to cause leg discomfort and insomnia in people with no history of RLS. The RLS symptoms may start within a few days of starting the drugs.

They may stop when the drug is switched or stopped by a doctor. Talk to your doctor if you have recently started antidepressants or antipsychotics and notice leg discomfort.^10,11

RLS and your overall health

RLS could worsen outcomes of your other medical problems. A 2018 study showed that women with RLS and heart disease had higher rates of heart-related death than women without RLS. Those with long-term RLS, with frequent and severe symptoms, had the worst cardiovascular outcomes.¹²

Causes of RLS remain elusive

More research needs to be done to identify cause-and-effect relationships between iron, estrogen, and RLS. A complete understanding of how these chemicals are related to RLS could explain why more women are affected than men. RLS likely has a variety of different causes. It is possible that some causes are not sex- or gender-specific.⁷

If you think you have RLS, talk to your doctor. If you are pregnant or recently started a new drug and notice symptoms of RLS, call your doctor right away. There may be ways to ease your discomfort.