Musculoskeletal Pain in Perimenopause and Menopause
Menopause is when a woman's menstrual periods permanently stop as she ages.
The stages of women’s menstrual life are premenopause (before menopause), perimenopause (the transition phase right before menopause), and postmenopause (after menopause).
The symptoms of perimenopause and menopause vary among women, with some experiencing few and mild symptoms while others may face more frequent and severe ones.
Studies found that 71 out of 100 women going through perimenopause reported having muscle and joint pain (1).
That's a very high number!
The analysis showed that women in perimenopause were 1.63 times more likely to have muscle and joint pain compared to women in premenopause.(1).
When the researchers looked at moderate to severe levels of muscle and joint pain, they found an interesting pattern. The likelihood of experiencing moderate to severe musculoskeletal pain increases steadily with age, progressing from premenopause to perimenopause, and finally to postmenopause.(1).
So why is perimenopause such a risky time for developing muscle and joint pain?
The big hormonal shifts of estrogen and progesterone during the menopause transition seem to disrupt the body's regulation of inflammation and fluid levels in a way that can really impact the joints (1).
The studies also found that other factors like higher body weight, older age, trouble sleeping, anxiety, and depression could contribute to having more muscle and joint pain around menopause (1).
Osteoarthritis and Menopause
Osteoarthritis is a very common condition, especially among older women. Around 18 out of every 100 women over the age of 60 have osteoarthritis. It most often affects the joints in the knees, hips, hands, spine, and feet (2).
For many years, researchers have been interested in studying whether there is a link between osteoarthritis and the hormonal changes women go through around menopause.
Researchers have looked at factors like age at menopause, years of menstruation, number of pregnancies, and use of hormone replacement therapy (HRT) to see how they may be associated with osteoarthritis risk. But the findings have been really mixed and inconsistent (2).
After decades of research, experts still do not fully understand the complex relationship between hormones, menopause, and osteoarthritis development in women. More research is still needed, using updated methods, to figure out how the shifts in hormones during midlife may impact the risk, progression, and severity of osteoarthritis as women age (2).
Chronic Pain Management
Managing chronic pain is complex. The modern science of pain suggests using a model called the Biopsychosocial Model for better understanding and managing long-lasting pain. This model considers how factors such as biology, emotions, and social interactions can all influence an individual's pain experience (3).
Biological factors include:
Older age
Female gender
Multiple health conditions
Fatigue
Sleep problems
Smoking
Alcohol use
Being overweight
Psychological factors include:
Depression
Anxiety
Stress
Substance abuse
Pain catastrophising (focusing too much on pain)
Poor coping strategies
Fear of movement
Low self-efficacy (belief in ability to manage pain)
Social factors include:
Race/ethnicity
Culture
Low socioeconomic status
Ageism (discrimination due to age)
Lack of social support
How can you effectively manage chronic musculoskeletal pain?
1- Roll out any red flags: Red flags are signs and symptoms found in the patient's history and clinical examination that may tie a disorder to a serious pathology. If you are unsure, always talk to your GP.
2- Pain education: A pain toolkit can help people with persistent pain to comprehend and handle their daily life. It can offer straightforward valuable advice and techniques to assist you in managing your pain more effectively.
Talk to a health practitioner (including an exercise physiologist) who is specialised in chronic pain management.
3- Move and Exercise: Start moving and exercise within your pain limits.
Exercise training is a crucial way to help women with chronic pain feel better and improve their ability to do daily activities. While exercise improves muscular strength and endurance, it seems that its benefits for chronic pain may involve factors such as confidence, changes in the nervous system, and pain sensitivity.
Talk to an exercise physiologist to help you with exercise programming regarding your special needs and goals.
4- Adopt a healthy lifestyle: Get help to have a healthier lifestyle, better nutrition, better sleep, and better mental health.
Exercise and Pacing
Pacing is a strategy that can help people with chronic pain manage their symptoms and activities better. The key idea behind pacing is to break down tasks and activities into smaller, more manageable steps, and to take regular breaks. This helps prevent people from overdoing it and experiencing a flare-up of symptoms. People with chronic pain are encouraged to set realistic goals and be flexible, rather than pushing themselves too hard (4).
Using a pacing framework can help you to regulate your activities and exercise intensity or duration better, leading to improvements in your symptoms, daily routines, and overall quality of life.
People with chronic pain reported that pacing allowed them to participate in more of the activities and exercise they enjoy, without feeling completely wiped out afterwards (4).
What type of exercise?
1- Strength exercises make your muscles around joints stronger, helping you do daily tasks more easily. When muscles are strong, it is simpler to move and do activities such as walking, lifting, and bending without feeling tired or in pain.
By progressively overloading the muscles, strength training can help people with osteoarthritis maintain their mobility and independence (5).
2- Stretching and flexibility exercises can lessen stiffness and pain by making your body more flexible. Studies found that stretching exercises can provide pain relief in individuals with knee osteoarthritis (6).
These exercises can improve the range of motion of the joints and help you move better and can make activities like reaching or bending down feel less uncomfortable.
3- Hydrotherapy or exercising in a pool, is great for strengthening muscles when you are in a lot of pain. The water supports your body, so it is easier to move without hurting your joints. Plus, being in water can help you relax and reduce muscle tension (7).
4- Trying different types of exercise you enjoy, like dancing or Yoga, helps keep your joints healthy and your body strong. These activities not only make exercising fun but also improve your balance, flexibility, and overall well-being.
Always talk to an exercise physiologist for exercise guidance, if you are not sure.
References
Lu, C.-B., Liu, P.-F., Zhou, Y.-S., Meng, F.-C., Qiao, T.-Y., Yang, X.-J., Li, X.-Y., Xue, Q., Xu, H., Liu, Y., Han, Y., & Zhang, Y. (2020). Musculoskeletal pain during the menopausal transition: A systematic review and meta-analysis. Neural Plasticity, 2020, 1-10. https://doi.org/10.1155/2020/8842110
Dennison, E. M. (2022). Osteoarthritis: The importance of hormonal status in midlife women. Maturitas, 165, 8-11. https://doi.org/10.1016/j.maturitas.2022.07.002
Belavy, D. L., Van Oosterwijck, J., Clarkson, M., Dhondt, E., Mundell, N. L., Miller, C. T., & Owen, P. J. (2021). Pain sensitivity is reduced by exercise training: Evidence from a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 120, 100-108. https://doi.org/10.1016/j.neubiorev.2020.11.012
Antcliff, D., Keenan, A.-M., Keeley, P., Woby, S., & McGowan, L. (2022). "Pacing does help you get your life back": The acceptability of a newly developed activity pacing framework for chronic pain/fatigue. Musculoskeletal Care, 20(1), 99-110. https://doi.org/10.1002/msc.1557
Latham, N., & Liu, C.-J. (2010). Strength training in older adults: The benefits for osteoarthritis. Clinics in Geriatric Medicine, 26(3), 445–459. https://doi.org/10.1016/j.cger.2010.03.006
Luan, L., El-Ansary, D., Adams, R., Wu, S., & Han, J. (2022). Knee osteoarthritis pain and stretching exercises: A systematic review and meta-analysis. Physiotherapy, 114, 16-29. https://doi.org/10.1016/j.physio.2021.10.001
Geytenbeek, J. (2002). Evidence for effective hydrotherapy. Physiotherapy, 88(9), 514-529. https://doi.org/10.1016/S0031-9406(05)60134-4
