Menopause and your muscles, tendons and ligaments - the effects of estrogen and hormone change.

20 July

Are you an active woman, doing everything you can to keep exercising and staying strong during this period of life and yet your body still feels like it’s falling apart?

If you answered yes, then you aren’t alone. The truth is that once we hit the perimenopause years and our bodies don’t produce the same amount, quality, or consistency of estrogen we used to, it can leave our muscles, tendons and ligaments in a mess.

Estrogen is our muscle builder (like testosterone in men) and once its production starts to become erratic and then slow down, our muscles don’t build as well as they used to. Our tendons and ligaments also suffer, leaving us in a bit of a pickle when it comes to musculoskeletal issues such as tendinopathies, tears and ligament damage. Estrogen loss means our muscles are unable to respond to the stimulus placed on them as effectively as what they used to, meaning we don’t build muscle like we used to, we lose the ability to generate power like we used to, and our muscle strength starts to dissipate.

Our muscles and tendons contain estrogen receptors that respond to the action of estrogen in an anabolic way ie: they are stimulated to grow. Estrogen also acts on the collagen at the site of our muscles and tendons and promotes collagen synthesis, constantly “plumping up” the muscle and tendon. Muscles and tendons are effectively flexible and strong in the correct combination to give us the optimal amount of tensile strength we need to function. When we are pre-menopausal and engage in strength training, this then further increases the tensile strength of our muscles and tendons as they adapt to increasing load under the effect of our anabolic estrogen. When our estrogen signalling starts to go haywire in perimenopause, this process and gradual decline causes muscles and tendons to become less tensile and increasingly unresponsive and stiff.

In terms of our ligaments, pre-menopausal women actually have a higher risk of ligament injury and rupture due to the effects of estrogen through the cycle and increased laxity at some points. You would think menopause then would help here and it does to a certain extent until estrogen becomes too low and has the opposite effect of causing increased stiffness, similar to muscles and tendons.

So, what can we do about it? While there are options to enhance our estrogen with medication or natural therapies, if neither of these are an option for you, then I like to quote Dr Stacy Sims and advise you to “life heavy s**t”. It’s the best way to maintain the muscle we have and continue to train our tendons and ligaments to remain compliant under stress. Even though we are not producing the estrogen anymore doesn’t mean you can’t lift weights, run, cycle, swim or continue to do what you love to do. Even if you are taking hormone replacement, engaging in a proper exercise program will enhance the effects – hormone replacement does not replace all of your natural hormones, so it is important to still exercise to supplement the effect.

However, there is a “prescription” for how to do this that will take into account you’re changing and fluctuating hormones and not put too much pressure on your stiffening connective tissue. In your perimenopausal and menopausal years, it is optimal load (not maximal load), optimal volume (your actual volume of exercise might decrease) and optimal rest and recovery (your rest and recovery need to increase, and you also need to ensure optimal sleep). Exercise is still the best medicine; it may just need to be “tweaked”!

How can you do this? Engage the help of an Exercise Physiologist – we know the exact prescription of exercise your need for where you are right now, taking into consideration all your medical and lifestyle factors. We are the most skilled professional to help you during your perimenopausal and menopausal years. There is never a time not to exercise no matter where you are in life – we can meet you there!!

References:

Frizziero, A et al. (2014), Impact of estrogen and aging on the tendon: a concise review. Muscles, Ligaments and Tendons Journal; 4(3); 324-328

Chidi-Ogbulu, N and Barr, K. (2019). Effect of estrogen on musculoskeletal performance and injury risk. Frontiers in Physiology; 9(1834)

Hansen, M (2018). Female hormones: do they influence muscle and tendon metabolism? Proceedings of the Nutrition Society; 77; 32-41.

Watt, F (2018). Musculoskeletal pain and menopause. Post Reproductive Health; Chronic conditions and menopause; 24(1); 34-43.

Dr Stacy Sims - https://www.drstacysims.com

Amy Harding

Amy Harding is an Accredited Exercise Physiologist working with the team at MVMT Rehab. After completing her studies, Amy commenced working in a clinical role with DVA and Medicare patients, before moving into focusing on musculoskeletal injuries within the NSW Workers Compensation scheme. She has worked with many patients living with Chronic Pain and helped them with their recovery throughout her eight years as an AEP. She is passionate about using movement as a tool for increasing self efficacy, advocating for Exercise Physiologists within the Workers Compensation scheme and supporting injured workers in their return to work. Amy completed a Bachelor of Exercise and Sports Science at the University of Newcastle, as well as a Masters of Clinical Exercise Physiology (Rehabilitation) at Charles Sturt University and a Masters of Sports Rehabilitation at the University of Melbourne. It was here Amy developed a passion for women’s health, particularly in the impacts estrogen loss has on the musculoskeletal system. Amy’s experience with musculoskeletal injuries, chronic pain and mental health conditions within compensable schemes has deepened her understanding of the biopsychosocial complexities of injured workers and the valuable contribution Exercise Physiologists make in patients lives.

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