Women and Myasthenia Gravis

Abstract

Myasthenia gravis (MG) is a prototypical antibody-mediated autoimmune disorder of the neuromuscular junction, characterized by fluctuating skeletal muscle weakness and substantial morbidity. Although therapeutic advances have markedly improved survival and long-term outcomes, MG is not a gender-homogeneous condition. Women are disproportionately affected, exhibit a distinct bimodal age distribution, and experience the disease within unique biological and psychosocial contexts that shape presentation, disease course, quality of life, and treatment response. Accumulating evidence highlights sex-specific differences in immune reactivity, hormonal influences, thymic pathology, clinical severity, fatigue burden, and patient-reported outcomes. Notably, women consistently report poorer quality of life despite comparable disease severity. Reproductive health introduces additional complexity, as pregnancy planning, contraception, teratogenic risk, postpartum exacerbation, and neonatal complications profoundly influence clinical decision-making and patient autonomy. Despite these well-recognized disparities, sex-specific considerations remain insufficiently integrated into routine care and are strikingly underrepresented in clinical trial design. Most MG trials fail to stratify outcomes by sex, account for sex-dependent pharmacokinetics or pharmacodynamics, or include pregnancy-relevant populations, resulting in critical evidence gaps. This narrative review synthesizes current knowledge on gender-related pathophysiological mechanisms, clinical phenotypes, and life stage–specific management of MG, with particular emphasis on the reproductive years. It also briefly examines the evolving role of novel biological therapies, including complement inhibitors, neonatal Fc receptor inhibitors, and B-cell–directed agents, which offer promise for more targeted and potentially safer treatment paradigms. Systematic gender-stratified analyses, dedicated pregnancy registries, and proactive, physician-led counselling are essential to advancing equitable, evidence-based care for women living with MG.