Key Takeaways

  • Amyotrophic lateral sclerosis (ALS) is a rare nervous system disease that destroys motor neuron cells in the spinal cord and brain. This cell damage leads to loss of muscle weakness, loss of mass, cramping, twitching, and eventually atrophy.
  • Early signs of ALS in people assigned female at birth often include speech changes, such as slurring (dysarthria) and hoarseness, difficulty swallowing (dysphagia), and muscle spasms.
  • There is no cure for ALS, but medication and physical therapies can help slow progression and manage symptoms.

ALS is more common in males than in females and in those over 60. However, it is still important for females to be aware of early symptoms, such as muscle issues and slurred speech.

This article explains the early signs of ALS in females and what to look for.

Early ALS presentation is often similar across sexes. However, one key distinction is that females over 60 have a higher rate of bulbar onset ALS symptoms.

Bulbar-onset ALS results from the loss of motor neurons in the brainstem. This part of the brainstem controls muscles affecting swallowing, chewing, and speech. Initial symptoms may progress slowly, often leading to delays in diagnosis.

For example, speech impairments, such as slurred speech, and difficulty forming vowels, may occur up to 3 years before first diagnosis.

Prompt treatment can lead to more positive outcomes, so being aware of potential symptoms and seeking a timely diagnosis is crucial.

According to the National Institute of Neurological Disorders and Stroke (NINDS), other early signs of ALS can include the following.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Learn more.

Muscle issues

ALS affects motor neurons in the brainstem and spinal cord, causing a trademark variety of symptoms. As the lower motor neurons degenerate, strength declines, and reduced muscle use causes the muscles to shrink.

ALS can have several effects on different muscles in the body. Overall, it causes them to waste away and become smaller — known as muscle atrophy — or stiffen and tighten, known as spasticity.

Twitching and muscle spasms are early symptoms of ALS, as nerve signals to the muscles become affected. As the muscle fibers degenerate over time, cramping, weakness, and atrophy develop, and in the later stages, paralysis affects most muscles.

However, involuntary muscles are unaffected in the early stages of ALS, with mild to moderate symptoms occurring in the later stages. Involuntary muscles help control the following:

  • the heartbeat
  • sexual functions
  • bowel and bladder
  • gastrointestinal tract
  • sensations such as vision and hearing

The muscles in these organs are largely under the control of hormones and nerves of the autonomic nervous system. They receive some control from the motor neurons in the spinal cord and may be affected in the later stages of ALS, especially muscles in the digestive tract.

Difficulty swallowing or chewing food

A common symptom of ALS is difficulty swallowing or chewing food, or dysphagia. As the muscles in the mouth and throat weaken over time, a person with the condition may find it difficult to chew or swallow food, increasing the risk of choking.

This may also result in aspiration, which occurs when saliva, food, or drink enters the lungs.

Slurred speech

Another common early sign of ALS is slurring of speech, or dysarthria. Articulation — which refers to forming clear sounds in speech — may be difficult, as the facial muscles weaken over time. It may start with a person slurring their words or their speech becoming increasingly unintelligible and difficult for others to understand.

Some speech-related symptoms of ALS include:

  • issues managing pitch and tone
  • hoarseness or strained voice
  • issues with pronouncing certain words

Promptly recognizing symptoms early is important for someone with ALS so that they can get an accurate diagnosis. Individuals need to contact a doctor if they experience the early signs of the condition, such as:

  • recurrent muscle spasms
  • twitches or cramps
  • drooling
  • tripping
  • dropping things
  • muscle issues, including stiffness and pain

Severe signs that require immediate medical attention include:

  • difficulty breathing
  • difficulty swallowing
  • a feeling of choking

There is no single test for ALS, often making diagnosis challenging.

Other symptoms of ALS can include:

  • drooling as facial muscles weaken
  • breathing difficulties
  • bowel issues such as constipation
  • an inability to stand or walk without assistance

Eventually, a person with ALS may have difficulty walking and standing, being able to use their hands and legs, or doing tasks such as getting out of bed. A full-time carer may be necessary toward the later stages of ALS.

Recognizing the signs is imperative for early diagnosis and treatment. NINDS states that treatments early on in the disease progression are most effective.

There is no cure for ALS, but treatment aims to manage symptoms. Various types of care may be necessary, including care from physicians, pharmacists, therapists who aid speech and physicality, and home care nurses. A variety of medications for treating ALS can include:

  • riluzole (Rilutek) and edaravone (Radicava) to reduce damage to motor neurons and delay disease progression
  • tofersen (Qalsody) for ALS due to SOD1 gene mutations
  • medications for pain
  • medications for mental health, such as anxiety and depression

Managing early signs can include the following:

  • Speech issues: A person with ALS can aim to take it slowly when speaking. Giving it their full attention can help speech form more clearly, and people can also use hand gestures and facial expressions if necessary. Speech generating devices and voice banking can also help.
  • Swallowing issues: People with ALS can aim to take smaller bites of food, avoid talking with their mouths full, and consume more liquid foods to help minimize the risk of choking. Medications are also available to help stimulate saliva production and prevent dry mouth. Eventually, a person with ALS may use a feeding tube. Swallowing therapy is also available, which can help rehabilitate the swallowing muscles and nerves.
  • Muscle issues: Anti-spasticity medications, such as baclofen, can help with muscle spasms alongside physical therapy. Benzodiazepines can also help with limb spasticity.

While there is no cure for ALS, treatment focuses on managing symptoms. Most people with ALS may eventually begin to lose certain functions, such as being able to walk, talk, or do daily tasks such as dressing themselves.

The average survival time for those with ALS is 3 years, though many can live much longer, with around 5% of people living 20 years or longer.

The most common early symptom of ALS is progressive muscle weakness localized in a specific body area.

Typically, a person will notice their first ALS symptoms between the ages of 55 to 75.

People assigned female at birth are more likely to experience bulbar-onset ALS than those assigned male at birth. This typically presents as speech changes, such as slurring and hoarseness, and difficulty swallowing (dysphagia).

The early signs of ALS for females, or those with ALS in general, tend to be muscle twitches, spasms and cramps, stiffness, difficulty swallowing, and speech issues.

Early diagnosis, medications, and physical therapy can help manage the symptoms as the disease progresses. Although there is no cure for ALS, treatment can help a person feel more well and supported during the course of the condition.