Musculoskeletal pain and perimenopausal women
Perimenopausal women are over 70% more likely to suffer musculoskeletal pain than premenopausal women and postmenopausal women are at higher risk of moderate to severe musculoskeletal pain than premenopausal women. (1)
At Townsville Podiatry we see an awful lot of middle aged women with musculoskeletal lower limb pain. At perimenopause / postmenopause there is a higher incidence of pain in areas like the plantar fascia, Achilles Tendon, Tibialis Posterior tendon, joint pain, proximal hamstring tendon, lateral hip pain , lateral knee pain, neuroma pain, increased incidence of osteoporosis, loss of muscle mass and increased body weight
But at few definitions first
Perimenopause: This is the period during which a woman is making the transition to the menopause. It can start around 10 years before the menopause and is the time during which your oestrogen levels start to drop. This is when you start observing symptoms like changes to your periods, sleep disturbances, altered moods , weight gain, hot flushes, decreased sex drive, musculoskeletal pain to name a few
Menopause: Menopause lasts a day and marks the day when you’ve not menstruated for a full 12 month cycle. The symptoms are very similar to those of the perimenopause
Postmenopause: This refers to the years after the menopause. Most women spend more than a third of their life in postmenopause
Musculoskeletal system
The musculoskeletal system is made up of the bones, muscles, tendons, cartilage, joints, ligaments and fascia
Lower oestrogen levels produces a myriad of changes in the musculoskeletal system including
Perimenopausal women are over 70% more likely to suffer musculoskeletal pain than premenopausal women and postmenopausal women are at higher risk of moderate to severe musculoskeletal pain than premenopausal women. (1)
At Townsville Podiatry we see an awful lot of middle aged women with musculoskeletal lower limb pain. At perimenopause / postmenopause there is a higher incidence of pain in areas like the plantar fascia, Achilles Tendon, Tibialis Posterior tendon, joint pain, proximal hamstring tendon, lateral hip pain , lateral knee pain, neuroma pain, increased incidence of osteoporosis, loss of muscle mass and increased body weight
But at few definitions first
Perimenopause: This is the period during which a woman is making the transition to the menopause. It can start around 10 years before the menopause and is the time during which your oestrogen levels start to drop. This is when you start observing symptoms like changes to your periods, sleep disturbances, altered moods , weight gain, hot flushes, decreased sex drive, musculoskeletal pain to name a few
Menopause: Menopause lasts a day and marks the day when you’ve not menstruated for a full 12 month cycle. The symptoms are very similar to those of the perimenopause
Postmenopause: This refers to the years after the menopause. Most women spend more than a third of their life in postmenopause
Musculoskeletal system
The musculoskeletal system is made up of the bones, muscles, tendons, cartilage, joints, ligaments and fascia
Lower oestrogen levels produces a myriad of changes in the musculoskeletal system including
- reduces the collagen content of connective tissues, increasing the stiffness in the fascia, ligaments and tendons making them more prone to injury
- a loss in bone density. It is estimated that on average, women lose up to 10 % of their bone mass in the first 5 years after menopause
- a rapid decrease in muscle mass (sarcopenia) and as a result strength.
- increased levels of cortisol, a stress hormone, in the body, High cortisol makes you more sensitive to pain.
A vicious (lack of ) cycle ?
So the research tells us that perimenopause can lead to higher frequency of moderate to severe musculoskeletal pain . We also know that changing levels of oestrogen can contribute to sleep disturbances, anxiety or depressive episodes - all of which impact can on pain severity. Nothing is better when you are tired.
But we also know that being in chronic pain can impact your quality of sleep and cause anxiety and depression. That's a pretty strong dose of double dipping
To add more fuel to the fire
There is a link between menopause and weight gain.
There is a link between weight gain and having pain in your lower limbs.
There is a link between having pain in your lower limbs and not being able to or wanting to exercise
There is a link between not exercising and weight gain
So the research tells us that perimenopause can lead to higher frequency of moderate to severe musculoskeletal pain . We also know that changing levels of oestrogen can contribute to sleep disturbances, anxiety or depressive episodes - all of which impact can on pain severity. Nothing is better when you are tired.
But we also know that being in chronic pain can impact your quality of sleep and cause anxiety and depression. That's a pretty strong dose of double dipping
To add more fuel to the fire
There is a link between menopause and weight gain.
There is a link between weight gain and having pain in your lower limbs.
There is a link between having pain in your lower limbs and not being able to or wanting to exercise
There is a link between not exercising and weight gain
So what do we do to lessen the impacts of menopause on our musculoskeletal system?
We all know that exercise is good for us both physically and mentally. And exercise will be the most effective strategy to maintain healthy bone and muscle in perimenopausal women.
My role is to provide an individual tailored treatment plan based on your symptoms and your goals to help you get moving pain free again.
A combination of both progressive strength training and moderate impact weight bearing exercises can assist in improving and maintaining bone density as well as increasing muscle mass and strength. There are some great personal trainers in Townsville who provide awesome groups classes for women including Just Move it Townsville , Fuel PT Solutions, and Embrace Fitness
The long term goal is to complete 150 minutes of moderate intensity exercise each week in addition to 2-3 resistance training/strength sessions. That might sound a lot but it is definitely achievable, equating to approximately 30 minutes of exercise per day.
My role is to provide an individual tailored treatment plan based on your symptoms and your goals to help you get moving pain free again.
A combination of both progressive strength training and moderate impact weight bearing exercises can assist in improving and maintaining bone density as well as increasing muscle mass and strength. There are some great personal trainers in Townsville who provide awesome groups classes for women including Just Move it Townsville , Fuel PT Solutions, and Embrace Fitness
The long term goal is to complete 150 minutes of moderate intensity exercise each week in addition to 2-3 resistance training/strength sessions. That might sound a lot but it is definitely achievable, equating to approximately 30 minutes of exercise per day.
Further reading
Musculoskeletal Pain during the Menopause transition: A Systematic Review and Meta-Analysis. Lu, Chang-Bo et al Neural Plasticity, vol 2020, Nov 2020
Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Vincenzio B et al BMJ, May 2018
Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in its Management. Grimaldi A. Journal of Orthopedic and Sports Physical Therapy, Nov 2015
Musculoskeletal pain and menopause. Watt FE. Post Reproductive Health. 2018;24(1):34-43. doi:10.1177/2053369118757537
Prevalence of Musculoskeletal Disorder among Postmenopausal Women: A Cross Sectional Study. KULKARNI, S. et al. Indian Journal of Physiotherapy & Occupational Therpay, [s. l.], v. 14, n. 2, p. 278–282, 2020
Obesity and Multisite Pain in the Lower Limbs: Data from the Osteoarthritis Initiative. Vennu V, Alenazi AM, Abdulrahman TA, Binnasser AS, Bindawas SM. Pain Res Manag. 2020;2020:6263505. Published 2020 Jul 9. doi:10.1155/2020/6263505
Physical activity motives, barriers and preferences in people with obesity: A Systematic Review. Aurélie Baillot et al. PLos ONE. Published June 23, 2021
Musculoskeletal Pain during the Menopause transition: A Systematic Review and Meta-Analysis. Lu, Chang-Bo et al Neural Plasticity, vol 2020, Nov 2020
Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Vincenzio B et al BMJ, May 2018
Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in its Management. Grimaldi A. Journal of Orthopedic and Sports Physical Therapy, Nov 2015
Musculoskeletal pain and menopause. Watt FE. Post Reproductive Health. 2018;24(1):34-43. doi:10.1177/2053369118757537
Prevalence of Musculoskeletal Disorder among Postmenopausal Women: A Cross Sectional Study. KULKARNI, S. et al. Indian Journal of Physiotherapy & Occupational Therpay, [s. l.], v. 14, n. 2, p. 278–282, 2020
Obesity and Multisite Pain in the Lower Limbs: Data from the Osteoarthritis Initiative. Vennu V, Alenazi AM, Abdulrahman TA, Binnasser AS, Bindawas SM. Pain Res Manag. 2020;2020:6263505. Published 2020 Jul 9. doi:10.1155/2020/6263505
Physical activity motives, barriers and preferences in people with obesity: A Systematic Review. Aurélie Baillot et al. PLos ONE. Published June 23, 2021
