Menopause and Musculoskeletal Pain

October is World Menopause Awareness Month with October 18th marked as Menopause Awareness Day!

However, I feel like 2021 must be Menopause Awareness Year because I have never before seen so much content on the topic, from podcasts and blogs to national campaigns with Davina McCall.

I could of course just be getting to that age where I am now the target audience for this kind of content.

From everything that I’ve read and listened to, I should have a few more years, but I certainly never realised that perimenopause can start as early as 42, so I’m now definitely closer to that than adolescence!

As the title suggests, this blog post will focus on menopause and musculoskeletal pain.

I’m afraid it’s generally not good news… but don’t worry there are things we can do to help!

The basics – definitions, signs and symptoms

Ok so first of all lets get clear on the various terminology surrounding menopause.

The menopause is actually a single day marking 12 months since the date of your last period. The average age for this in the UK is 51.

Peri-menopause is the 12-15 years leading up to this date when women will start to develop any number of symptoms associated with the end of ones reproductive years.

These symptoms include:

• Hot flushes
• Night sweats
• Fatigue
• Muscle tension
• Mood swings
• Vaginal dryness
• Headaches
• Burning mouth sensation
• Electric shocks
• The list goes on (sorry)

Pre-menopause is the time before this with regular cycles of stable cycle length (21-35 days).

Post-menopause is therefore the years following the menopause and is considered to be a time when many of those perimenopausal symptoms may ease or become a little more stable.

Prevalence and Severity of MSK Pain

Research shows that the odds of getting musculoskeletal pain (MSP) are greatest in perimenopause and postmenopause. With severe musculoskeletal pain more likely during postmenopause.

Tendinopathy

One particular MSP complaint associated with menopause is tendinopathy; the breakdown of collagen in a tendon, which causes burning pain in addition to reduced flexibility and range of motion.

The breakdown of collagen has been associated with estrogen defficiency which means menopausal women are more likely to get a tendinopathy (Frizziero, 2014).

Estrogen deficiency also impacts inflammation, which means greater irritation and pain (McCarthy, 2020).

And less collagen synthesis means that an injury will then take longer to recover (Frizziero, 2014).

So while predisposition increases, recovery ability decreases.

Osteoporosis

Osteoporosis; the reduction in bone mineral density resulting in brittle bones, is also associated with estrogen deficiency (Ji, 2015).

There are two phases of bone loss in women: the first occurs during menopause transition. The second occurs 4-8 years later and is age related bone loss which also happens in men.

During the menopausal transition period, the drop of estrogen leads to more bone resorption than formation, resulting in osteoporosis.

The average bone loss is about 10%. But about 25% of women can be classified as fast bone losers, losing as much as 10-20% in the 5-6 years around menopause.

Muscle loss

Age-related decline of skeletal muscle mass and strength accelerates with the beginning of menopause (Agostini, et al, 2018).

Muscle and bone tissues have a close developmental and functional relationship.

Bone adapts its mass, architecture, and strength to changes in stress and strain induced by gravitational loading and muscle activity.

Which means reduced muscle mass will negatively impact bone density.

And the good news?

The good news is that exercise and hormone replacement therapy have been shown to delay the effects of the menopause.

Regular exercise

There is growing evidence that exercise prevents at least some of the negative consequences of menopause such as bone loss, reduced muscle mass and a whole host of menopausal symptoms including insomnia and fatigue (Kemmler, et al, 2004).

Warming up

Fast walking and running can help to promote unusual strain distribution with weight-bearing – which means more stimulus for bone growth. It will also increase your cardiovascular fitness!

Jumping

Playing with mutidirectional jumps can help with building bone density while focussing on take-off and landing can help to reduce tendon strain.

Strength training

Strength training can only make you stronger.

There’s not much more to be said really. Strength training will help to increase muscle mass and strength – and as we know already, muscles impact bones. so stronger muscles make stronger bones!

Flexibility training

This not only helps with muscles but tendons, ligaments and other connective tissues too.

Progressive training

But the most important thing is to keep progressing.

Start where you are and allow the exercises to progressively challenge you!

Hormone replacement therapy

I know there is some controversy around HRT when in 2002 the Women’s Health Initiative (WHI) showed that HRT had more detrimental than beneficial effects.

However, since then, there have been some interesting discussions around the design and conclusion of that report – most notably, one major limitation has emerged with regards to the demographics of the participants, as the majority were over a decade past menopause.

The new question is – when is the window of opportunity for taking HRT?

Menopause hormone therapy is now considered the first line of choice for prevention of osteoporosis and its effectiveness has been demonstrated by various studies (Ji, 2015).

However, hormone therapy is recommended for women who are less than 60 years old and/or less than 10 years post-menopausal.

Conclusions

Yes, the menopause sucks.

Estrogen deficiency has a negative impact on muscle, bone and tendon health.

However, regular, progressive exercise combined with HRT at an appropriate time (no more than years postmenopause) can help to reduce and even reverse the effects of menopause.

Ready to get into exercise but not sure where to start?

Why not try my Functional Flow class.

You can join either in-person or online.

Find out more here and use the code FIRSTFREE to get your first class free!

References

Agostini, D., Zeppa Donati, S., Lucertini, F., et al. Muscle and Bone Health in Postmenopausal Women: Role of Protein and Vitamin D Supplementation Combined with Exercise Training. Nutrients. 2018;10(8):1103. Published 2018 Aug 16. doi:10.3390/nu10081103

Cagnacci, A., Venier, M. The Controversial History of Hormone Replacement Therapy. Medicina (Kaunas). 2019;55(9):602. Published 2019 Sep 18. doi:10.3390/medicina55090602

Chang-bo Lu, Peng-fei Liu, Yong-sheng Zhou, Fan-cheng Meng, Tian-yun Qiao, Xiao-jiang Yang, Xu-yang Li, Qian Xue, Hui Xu, Ya Liu, Yong Han, Yang Zhang, “Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis”, Neural Plasticity, vol. 2020, Article ID 8842110, 10 pages, 2020. https://doi.org/10.1155/2020/8842110

Frizziero, A., Vittadini, F., Gasparre, G., Masiero, S. Impact of oestrogen deficiency and aging on tendon: concise review. Muscles Ligaments Tendons J. 2014;4(3):324-328. Published 2014 Nov 17.

Ji, MX., Yu, Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015;1(1):9-13. Published 2015 Mar 21. doi:10.1016/j.cdtm.2015.02.006

Kemmler, W., Lauber, D., Weineck, J., Hensen, J., Kalender, W., Engelke, K. Benefits of 2 Years of Intense Exercise on Bone Density, Physical Fitness, and Blood Lipids in Early Postmenopausal Osteopenic Women: Results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med. 2004;164(10):1084–1091. doi:10.1001/archinte.164.10.1084

McCarthy, M., Raval, A.P. The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease. J Neuroinflammation 17, 317 (2020). https://doi.org/10.1186/s12974-020-01998-9