ALS can affect both males and females. However, females may experience more initial symptoms in their bulbar region, the area of the brain that controls facial and neck muscles.

Amyotrophic lateral sclerosis (ALS), formerly known as Lou Gehrig’s disease, is a chronic condition that affects motor neurons, which are responsible for controlling muscle movements.

While symptoms of ALS progress over time, there may be key signs of this condition in its early phases. Some of these early signs may differ slightly in females with ALS.

It’s especially important to be aware of these signs, as according to The ALS Association, ALS is estimated to be 20% more common in males and might get overlooked in females.

Learn more about the early possible signs of ALS in females, as well as what you can expect in terms of diagnosis, treatment, and outlook.

In this article, we use “male and female” to refer to someone’s sex as determined by their chromosomes, and “men and women” when referring to their gender (unless quoting from sources using nonspecific language).

Sex is determined by chromosomes, and gender is a social construct that can vary between time periods and cultures. Both of these aspects are acknowledged to exist on a spectrum both historically and by modern scientific consensus.

Researchers are still looking into the ways ALS first shows up differently in males and females. To date, experts consider most cases of ALS to be “sporadic,” with the only two established risk factors including age and family history.

In general, some of the earliest signs of ALS for males and females may include muscle symptoms, such as:

  • weakness
  • twitching
  • cramps
  • stiffness

However, the way these symptoms manifest may differ between females and males.

A 2021 study reported that females who develop ALS before age 60 tend to have limb onset types. Limb onset ALS may cause more muscle weakness in the arms and legs. The authors of this study also noted a correlation between ALS development and early menopause.

It’s also thought that about 25% of all people with ALS experience bulbar onset symptoms in the neck and facial muscles, more generally.

There’s no exact timeline for ALS progression after the first stage. While the average survival rate for both males and females is 3 years after symptoms start, ALS can progress quicker or slower than this.

However, one case report from 2022 suggests that bulbar onset ALS may develop rapidly compared with other types.

While more research is needed to understand why this may be the case, the authors of this study believe bulbar onset ALS, which affects more females, is more aggressive overall.

An accurate diagnosis that rules out other conditions is also important, as bulbar onset ALS sometimes mimics other nervous system conditions, such as multiple sclerosis and myasthenia gravis.

Also, since bulbar onset ALS tends to be the most aggressive form of this progressive condition, an early diagnosis can lead to treatments that may help decrease this process and improve your overall quality of life.

Diagnosing ALS, particularly bulbar onset forms often seen in females, may involve the following:

Early diagnosis is critical for accessing ALS treatment. Regardless of the type of ALS a doctor diagnoses you with, a treatment plan usually involves a combination of medications and therapies. These may include:

Researchers hypothesize that the outlook for people with ALS may depend on a combination of genetics and environmental exposures.

However, it’s important to keep in mind that bulbar onset ALS is more aggressive than other forms of this disease and that females are more likely to experience bulbar onset.

The most common cause of ALS-related death is respiratory failure due to the weakening of muscles within the respiratory system. This can develop within 2 to 10 years after initial ALS signs begin, regardless of sex assigned at birth. However, the exact timeline is highly individual.

While ALS is more common in males, early possible signs in females shouldn’t be overlooked. As females age, their risk of developing ALS becomes similar to that of males, and they may also be more prone to develop bulbar onset types that are more aggressive.

If you start experiencing unusual muscle weakness or twitching that affects your ability to speak, eat, or walk, you should speak with a doctor right away. The sooner a doctor diagnoses ALS, the sooner you may begin critical treatment that may decrease disease progression.