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Restless legs syndrome and women

Restless legs syndrome and women

Family history, age and gender play a huge part in the prevalence of restless legs syndrome 
Restless legs syndrome can range from being just bothersome to causing great mental, physical and social distress along with sleep disturbance, and interfering with work and personal interactions.
Photo by Anantha Subramanyam K / Happiest Health

As far as common disorders go, restless legs syndrome (RLS) sounds quite harmless. It mostly doesn’t lead to any serious medical problems for one. But don’t be fooled: RLS can range from being just bothersome to causing great mental, physical and social distress along with sleep disturbance, and interfering with work and personal interactions.

“RLS is a neurological condition that causes an irresistible urge to move the legs,” says Dr Anuradha HK, neurology consultant at Aster CMI Hospital, Bengaluru. “The symptoms may begin in childhood or adulthood. However, it’s more severe in older adults.”

The cause of RLS is not known, but it is linked to certain genetic variants. Low levels of iron, undergoing hemodialysis, the use of certain substances (alcohol, nicotine and caffeine) and medications are underlying factors, or are accompanied by RLS.

People with RLS experience crawling, tickling or itching sensations, brief contractions in their legs while asleep (and sometimes while awake), which is a cause of insomnia and a risk factor for depression.

“Sometimes, the symptoms become unbearable and in severe cases they can affect the arms or other parts of the body,” says Dr Anuradha, pointing out the link among RLS, sleep and mood. “Over time, it can affect the quality and duration of sleep which can lead to mood swings, depression or other health problems, hindering the quality of life as well.”

Also called the Willis-Ekbom disease, after the first authors who studied and wrote about the condition, RLS causes difficulty in falling and remaining asleep. When at rest, the symptoms may worsen, and they are usually relieved by stretching or walking. There is also a tendency for the symptoms to occur or worsen in the evening.

RLS is also related to sleep disorders such as apnoea. Leg cramps and snoring at night leads to poor sleep quality. According to the Diagnostic Classification of Sleep and Arousal Disorders, RLS is characterised by an excess desire for sleep, especially during the daytime.

Restless legs syndrome in women

“RLS is a partially heritable disorder more prevalent in women than in men,” says Dr Anuradha. Low iron content and high estrogen levels can influence dopamine and glutamate transmission (a neurotransmitter in the central nervous system responsible for learning, memory and the formation of neural networks). This makes them more vulnerable to the condition, she says.

Steroid hormones like estradiol (the female hormone that regulates menstruation) and serum ferritin (blood protein that contains iron) are far fewer in women than in men after puberty. Family history, age and gender affect the prevalence of RLS. Interestingly, the prevalence of RLS is the same for both men and women over the age of 60.

Restless legs syndrome during pregnancy

Around 26 per cent to 30 per cent of pregnant women experience restless leg syndrome sleep disorder symptoms. The symptoms become more severe in the third trimester, decreasing a little in the second trimester. A study found that a third of people in their third trimester are affected by RLS.  

Those with RLS sleep disorder before may find their symptoms worsening during pregnancy. RLS also interferes in their sleep, causing them to wake up frequently at night in the third trimester. This affects sleep efficiency (how well they sleep) and continuity of sleep (how frequently they wake up at night). For most women, the symptoms disappear after delivery.

Pregnancy complications such as preeclampsia and cesarean sections occur because of RLS, Dr Anuradha says. RLS is also related to hypertension and diabetes in pregnant women.

Dr Anuradha also mentions that people with chronic kidney disease, especially those on hemodialysis, are more prone to RLS. “Anemia, iron deficiency or high calcium levels in the blood are some of the factors that can cause RLS or worsen the symptoms.”

Managing RLS

Methods that don’t involve medication are considered the safest treatment options for RLS, especially during pregnancy.

Some ways to manage the RLS symptoms are:

  • Moving the legs by kicking, stretching or rubbing relieves the discomfort
  • Moderate, regular exercise may also relieve symptoms.
  • Soaking the legs in warm water and massaging them.
  • Sleeping regularly at a fixed time, in a cool, quiet and comfortable environment.
  • Avoiding caffeine, especially close to bedtime. Yoga and cognitive behavioural therapy can improve sleep quality and help relieve the symptoms. In more severe cases, visiting a doctor is recommended since they can prescribe pharmacological and other treatment methods.

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