MENOPAUSAL PAIN
There is a growing acknowledgement that many women will suffer with an increase in generalised joint pain during the menopause.
Apart from its effect on bone density leading to osteoporosis, sadly there is still a significant lack of research into the effect that the menopause can have on the musculoskeletal system. I have explored the limited research that I can find to try and find a possible explanation.
Menopause is defined as commencing 12 months after the last menstrual period, with the perimenopause is the period prior to this. Oestrogen production is erratic and causes symptoms in 80% of women, with these being severe in 20% (McLaren and Hum, 2022).
All women who live beyond middle age will go through the menopause. For many this will coincide with reaching the peak of their career, while balancing responsibilities of childcare and ageing parents. All of this at a time when oestrogen deficiency is beginning to manifest, thus triggering many of the debilitating symptoms (McLaren and Hum, 2022).
Symptoms
-
- Mood changes
- Hot flushes and Night sweats
- Insomnia
- Anxiety
- Depression
- Cognitive dysfunction,
- Fatigue
- Loss of libido
- Heart palpitations
- Panic attacks
- Hair loss
- Migraines
- Musculoskeletal Pain
Kaur et al (2022) identified significant musculoskeletal pain in women going through the menopause, especially low back and upper back which were present in 55% of patients in their trial.
Heuch et al (2022) indicated that post menopausal women have higher incidences of lower back pain than men with Nagi et al (1973) demonstrating a greater proportion of females (21%) reporting back pain compared to males (14%). Incidence rates increased until age 40 in males and then remained constant, but in females they continued to rise sharply up to and over the age of 65. It was suggested a number of women might have experienced back pain in connection with the biological processes associated with the menopause.
The connection between menopause and musculoskeletal (MSK – bone & joint) changes has been studied for many years with new evidence continuing to link oestrogen deficiency to significant metabolic bone and muscle changes often resulting in osteoporosis (Brittle Bones).
The diminishing oestrogen levels that occur during the menopause trigger the rapid loss in bone density and strength which results in osteoporosis. This alongside a deterioration of muscle mass can potentially explain an increase in joint pains due to the increased joint instability.
A Randomised Contolled Trial (RCT) by Reisbord and Greenland (1985) demonstrated that at the time of menopause 50% of women reported musculoskeletal pain with this being the predominant symptom for 21% of patients. Arthralgia (joint stiffness) is a menopausal symptom in at least 50% of patients. Given that these symptoms are intertwined with fatigue, mood, sleep disturbance, increased weight, anxiety and stress, it is not surprising that many menopausal symptoms can compound musculoskeletal pain.
—————————————————————————————————————-
CAN HORMONE REPLACEMENT THERAPY (HRT) HELP?
Oestrogen plays an important role in the aetiology and pathophysiology of a variety of musculoskeletal degenerative diseases (Terauchi et al, 2014).
Kaur et al (2022) recommended the treatment of osteoporosis and hormone replacement therapy to aid in reducing menopausal and musculoskeletal symptoms within the first year of onset, with his patients that had undergone a hysterectomy (thus inducing an early onset of the menopause).
McLaren and Hum (2022) concluded that despite a lack of a RCT’s in this area, anecdotal evidence suggests the benefit of HRT in reducing MSK pain which is commonly prescribed by specialists in this field.
In the Heuch et al (2022) a Women’s Health Initiative trial, 44% of participating women reported arthritis however all joint pains related to the menopause cannot be linked to osteoarthritis. These symptoms if diagnosed correctly often respond dramatically to oestrogen therapy.
In conclusion, our knowledge of the effects of hormones on cartilage, inflammation, bone and joint pain can explain an increase in these symptoms during the menopause. Burton et al (1996) explains that oestrogen receptors are present in cartilage, bone and ligaments. Oestrogen appears to be protective and promote cartilage growth and reduced degeneration due to its anti-inflammatory properties. Therefore an increase in joint degeneration during the menopause (as a result of a lack oestrogen) is slowed when oestrogen is replaced via HRT. Increased articular cartilage volumes are seen on a knee MRI after HRT treatment to back up this statement.
