[August 2024 update] Since the original publishing of this blog, important research by Dr. Vonda Wright has been published about the musculoskeletal symptoms during menopause. You can read the research article here. This blog post will go into detail about how you can treat and resolve these symptoms.

Menopause is a significant phase in a woman's life and is often accompanied by a lot of  physical and emotional changes. While hot flashes, sleep disturbances, weight gain and mood swings are widely acknowledged, musculoskeletal pain remains a less discussed and often overlooked topic but equally significant aspect of menopause and one that I treat on a regular basis. In this blog, I’ll dive into the relationship between menopause and musculoskeletal pain, understanding its causes, and exploring ways to manage and alleviate the discomfort. Let’s unlock the potential for a vibrant, pain-free life during menopause—let's delve into the keys to musculoskeletal health.

Musculoskeletal symptoms during menopause refers to discomfort or pain affecting the muscles, bones, joints, ligaments, and tendons. During menopause, the decline in estrogen levels can contribute to various musculoskeletal issues since estrogen plays a crucial role in maintaining bone density and joint health. 

Although aches and pains are a normal part of aging, they become much more common during menopause. It is sometimes difficult to differentiate between the normal aging process and menopause symptoms. However, musculoskeletal pain is reported by more than half of all women at the time of menopause and there is a significant increase in arthritis during this time. 

Since estrogen plays a large part in our bones and connective tissues, a decrease in estrogen can impact our:

• Bone health 

• Muscles 

• Ligaments 

• Tendons 

• Cartilage 

When estrogen drops, many women report the following symptoms:

• Joint stiffness and pain

• Fatigue

• Pins and needles

• Swelling 

• Muscle pain

• Connective tissue and tendon pain

• Loss of lean muscle

• Loss of bone density —> Osteoporosis 

• Pelvic floor weakness

• Progression of osteoarthritis

• Arthralgia (Total body and joint pain)

Understanding Musculoskeletal Pain in Menopause and Midlife:

Let’s talk about our joints first to gain a better understanding of the reasons behind pain. Joints are made up of bone, cartilage, muscle, ligaments, and synovium.  These joints contain estrogen receptors, and the decline of estrogen during menopause affects them. Estrogen plays a crucial role in protecting joints by enhancing lubrication, reducing inflammation, and promoting cartilage health, which protects bones from impact. So when estrogen levels decrease, inflammation rises and negatively impacts our joints. All of this can lead to a higher risk of osteoarthritis and osteoporosis. While arthritis is a natural aspect of aging, menopause can accelerate this process. These changes can make it challenging to exercise comfortably and without pain.

I know that this can sound depressing, but don't worry -  I have lots of recommendations to help you maintain and even enhance your bone and musculoskeletal health. 

Empowering strategies to take back control  of your musculoskeletal health: 

1.Anti-inflammatory diet: Decreasing your inflammation level during menopause may help ease joint pain. Focus on adding more anti-inflammatory foods to a nutrient rich diet. Check out my Top 10 foods for achy joints and muscles. Foods high in antioxidants help reduce the amount of free radicals in your body, which reduces inflammation and prevents oxidative stress. Fruits and veggies are particularly high in antioxidants, and it is recommended to incorporate a diverse range of them into our diet and include all the colors of the rainbow since each color has different benefits. 

Herbs, and spices (turmeric and cinnamon) have been proven effective in addressing joint pain. Consuming a balanced diet rich in calcium, vitamin D, Omega-3’s (fatty fish)  and other essential nutrients supports bone health and reduces the risk of osteoporosis. Focus on decreasing simple carbs, stick with complex carbs, focus on getting enough fiber (>25 g/day) and protein (>100 g/day). 

2. Prioritize Protein:  Since hormones impact muscle strength, protein becomes crucial during this time of life. Protein is the building block for muscle tissue, so whether you're aiming to gain muscle mass or simply maintain strength, consuming sufficient protein becomes a key strategy for navigating the challenges associated with musculoskeletal symptoms during menopause. Incorporating protein-rich foods into your diet, such as lean meats, dairy, legumes, and plant-based sources, can contribute to the preservation of muscle health. Aim for getting a minimum of 100g/day. If you would like more information on this topic, please read my blog on meal planning for women in midlife. 

3. Strength Training: Engaging in weight-bearing exercises and strength training can help maintain bone density and alleviate joint pain. Building lean muscle mass by strength training will help to increase muscle mass and strength. And, since muscles impact bones, having stronger muscles will lead to stronger bones. The recommendation is to strength train at least 2x/week and focus on a full body work-out with compound movements.  If you are not sure where to start, feel free to check out my Comprehensive Fitness Guide on how to stay strong and healthy during midlife.

4. Move More, Walk More: Increased mobility is extremely important in addressing musculoskeletal challenges during menopause. I often tell my patients, "motion is lotion," because it is so true. Have you ever noticed that prolonged sitting can result in some discomfort when you finally stand up? The antidote lies in more movement. We need to move our joints to keep them lubricated and feeling good. 

Walking is the most underrated form of movement. Numerous studies show that individuals who incorporate regular walks into their routine are not only less prone to developing sarcopenia (loss of muscle) but also experience an elevated overall quality of life. I recommend that you aim for at least >7500 steps a day. 10k is even better!

5. Prioritize Sleep: Quality sleep serves as a restorative period and plays a crucial role in the recovery process in addressing musculoskeletal symptoms during midlife. When we are sleeping, our muscles repair and rejuvenate, helping to ease aches and pains. It enhances the production of growth hormone, aiding in muscle repair and an overall sense of renewal. AIm for 7-8 hours of quality sleep a night. 

6. Get Outside: Step into the sunshine! Soaking up the sun is more than just a mood lifter; it's a vital source of vitamin D, crucial for maintaining bone density and facilitating calcium absorption. It also plays an important metabolic role in muscle health with studies suggesting a positive correlation between  increased vitamin D and increased muscle mass. The good news is, boosting your vitamin D levels is as simple as enjoying some sunlight or taking a supplement. As much as I love the sun, I also take a supplement since my blood work showed that my levels were low. 

7. Magnesium: Magnesium plays a crucial role in preventing muscle aches and cramps, as low levels of this mineral can contribute to such discomfort. Magnesium is known as the “relaxation mineral” so it’s important to include magnesium-rich foods into your diet. Consider including nuts and seeds, dried fruits, dark leafy vegetables, beans and lentils. You can also opt for a magnesium supplement l(magnesium citrate), with a recommended daily intake ranging between 200 and 400 mg. I take mine prior to bedtime which helps with sleep. 

8. Lifestyle Changes: Embracing a healthy lifestyle, which encompasses prioritizing adequate sleep, effective stress management, sustaining a healthy weight, steering clear of excessive alcohol consumption, and refraining from smoking, can yield positive effects on musculoskeletal health throughout the menopausal journey.

9. Pelvic Floor Physical Therapy: Discussing musculoskeletal health and menopause would be incomplete without addressing the pelvic floor. Hormones affect all of the muscles in your body and that includes our pelvic floor. Symptoms can include: painful sex, urinary incontinence, to more serious conditions like pelvic organ prolapse.  If you are having any of these symptoms, know that there is help for you and that there are women’s health physical therapists who specialize in this. Please reach out to your health care provider or find a PT who can help you. 

10. Menopausal Hormone Therapy (MHT) (also called HRT):  Estrogen deficiency has a negative impact on muscle, bone and tendon health. MHT may be recommended to address hormonal imbalances and alleviate musculoskeletal symptoms in addition to many other menopause related symptoms. Remember that estrogen is an anti-inflammatory and it may be what your body needs to decrease your symptoms and improve your health. Do your own research and find a doctor who will discuss the potential risks and benefits of using hormone therapy. 

I know there is some controversy around HRT since the 2002 Women’s Health Initiative (WHI) which showed that it had more detrimental than beneficial effects. But, that has been disproven. Please read this article from the NYT on why and how women were misled on menopause and hormones. It is an EXCELLENT article and should be required reading for all women over 40 yo. 

Conclusion:

Joint and muscle aches and pain during menopause are frequently underestimated challenges that can significantly impact a woman's life. However, you have the power to transform your musculoskeletal health by taking action. The time is now. And you don't have to face it alone; seek support from a healthcare professional. If you need help adopting a lifestyle that promotes musculoskeletal health for a smoother and more enjoyable journey through menopause, I’m here for you! Please message me on IG @coretotalwellness to share the specific actions you are ready to commit to.

I offer physical therapy solutions and coaching for women in midlife and can help you with strength training, building a healthy lifestyle, and addressing any aches and pains. Contact me to work together.

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