Muscoskeletal syndrome of the menopause

[ArabellaSaurus]

A useful article on this condition, which is only recently starting to be recognised. From a great physio who specialises in womens health.

With advice for ways to alleviate symptoms; although I'm afraid it includes exercise...

www.clairecallaghan.com/blog/menopausejointpain

In the early years of menopause I developed a sharp pain in one of my shoulders. It felt like a red hot needle was being stuck in the joint. I had to take painkillers for weeks and was sent to a physio. It stopped when I took hrt.
There are so many symptoms no one tells you about, like tinnitus.

I'm 53 and I've had GTPS for two years. My private physio - who I had to see because who can wait 3 months for a phone call from the NHS - could diagnose me but not the cause of it. Eventually I got referred to the hospital ortho skeletal team and saw their physio who right away was asking about HRT. Even the women's specialist GP referred to HRT as putting oil in your joints.

Oof. That's me. I'm on HRT but it's rather a low dose.

Time to hobble downstairs and make some tea. 😬

The paper referenced:

https://pubmed.ncbi.nlm.nih.gov/39077777/

Says 70% of menopausal women experience symptoms, and 25% are disabled by them.

Sorry, thats the review. This is the paper.

Freely available and thorough:

https://www.tandfonline.com/doi/10.1080/13697137.2024.2380363

I take a very low dose oestrogen pessary and it's made a big difference to joints that I knew were arthritic and also to general aches & pains, like back pain after kneeling to weed the garden.

Only very recently did I read about the benefits of oestrogen to body systems other than reproductive. I keep thinking 'why did nobody tell me before?'

I’ve got a family history of osteoporosis through the female line so when I hit menopause I went to the GP and asked for HRT to prevent bone mass loss. They asked me “how is your bone health?”, which I was a bit WTF?, not having a scanner or xray machine at home. And they declined to prescribe HRT to me as apparently they prefer cure rather than prevention, told to take vitamin D instead.

A few years later the brain fog was killing my career so I saw another medic specialising in women’s health and got HRT straight away and told I should have been given it when I asked the first time. And my goodness, the other symptoms it cleared up that I didn’t know were symptoms! Within 12 hours I was no longer making “ooof” noises when getting up from a chair.

I’ve still got crunchy knees and a crunchy shoulder when I do Pilates but fingers crossed I can hold off serious problems for a bit longer now. After one incident where I took three goes to get up from a standard dining room chair I now practice getting up from chairs without using the arm rests to keep my legs and core muscles strong.

There are so many symptoms no one tells you about, like tinnitus.

WHAT??!

Edit - although it wouldn't have made a difference if I had known that as I cant take HRT

I was extremely affected by this but diagnosed with hyper mobility syndrome. I am hypermobile but hadn’t had many issues previously. In retrospect I was very weak indeed. It scares me how weak I was actually. (No one said go and get strong - they really should and I do now know a woman who was also diagnosed with it at a young age who set up a weights gym, as she was initially told don’t lift any heavy shopping bags. Tried it for a while and then was fuck this shit and got strong.)

Hrt helped a bit but not that much.

got breast cancer and had to come off all that and go on tamoxifen. (Many tears at the time as i was a Davina saved me babe.)

discovered lifting and eating way more protein than I was.

despite being in a low hormone state (no period for several months now) and clearly having meno symptoms based on all my hot flashes (which come and go) I’m feeling stronger than ever. Cognition is so much better. I haven’t had this level of thinking skill since pre kids and in my mid 30s. I can’t believe how strong my legs are in particular. I love it.

im also taking creatine. That and a specific training program has been the bees knees imo. All the fibro like pain I had for years (which hrt did help with for a while) has gone; it’s been specific shoulder lifting exercises that have definitely helped there.

musculoskeletal pain, arthralgia, loss of lean muscle mass

exactly what I had. So bad I had to have time off work.

increasing my lean muscle mass is my main focus.

Sounds great, Warrior! Well done.

The NHS should give out free gym memberships, they'd save a fortune in the long term.

Question from someone who is in early stages with meno. What happens when you finally stop taking HRT? Do all these symptoms come flooding back? Do you have to take it for the rest of your life to prevent that? And can you even do that?

Some take it indefinitely if no other risk factors.

my mum came off it in the 90s after the scare and was absolutely fine, despite really suffering during peri. She’s a sharp as a pin in her 70s and has good bone density. Shes always kept very active though, she was always the one shovelling coal and chopping logs. She reads a lot, keeps a diary etc.

shes also always eaten what we’d now call a gut biome friendly diet. I’ve found that helps. A Zoe study found that diet changes alone reduced meno symptoms in women who were on hrt but still symptomatic by 30%

I think it’s helpful to know hrt is one of many tools in the tool box. When my tamoxifen sweats are bad I do think about asking to try it alongside tam, but I know it’ll have a fight to get it (one oncologist said I could 😳) And I’d maybe consider trying it in the future after 5 years clear - the evidence keeps changing. (I was stage 1 grade 2, no lymph nodes. Liz O riordan would say definitely not though.) but I also know I can live really well with within this current lifestyle without it.

the end of this podcast was really helpful in that regard, she explained the “Hrt is one of many tools” really well: https://podcasts.apple.com/gb/podcast/feel-better-live-more-with-dr-rangan-chatterjee/id1333552422?i=1000726903690

theres some current research looking at women after primary breast cancer and exercise- piggy backing the regime that heart patients get after surgery, prescribed gum visits etc. the reasoning is that it both reduces reoccurrence but also helps the symptoms of menopause which most post bc women do have due to either chemo or the anti hormone drugs they’re on.

Interesting. I know they've recently found exercise massively reduces risk of recurrence in bowel cancer, so it makes sense to look at that for other cancers.

The main aim is recovery and the other benefits exercise brings.

but Liz o riordan has been talking about the importance for reducing reoccurrence alongside mental health etc for a while. The book Moving Through Cancer (and website) has a lot of the research and stats.

https://breastcancernow.org/about-us/podcasts/sam-orange-on-physical-activity-after-breast-cancer

My BONES are fine. MRI and X-Ray show this.

my TENDONS are a mess. That causes me pain around joints but also down the length of my arms and feet and sometimes thigh

Study:

https://www.cancer.gov/news-events/cancer-currents-blog/2020/breast-cancer-survival-exercise

Schmitz co wrote moving through cancer. this is a screenshot from her website

tendons have been an issue here too.

Many thanks for resources posted and sending you well wishes for getting through your treatment @WarriorN for the 5 year all clear.

Does anyone have good links on the best type of HRT? There’s so much, sometimes opposing, evidence it’s difficult to wade through. At one point there was a lot of chatter on bio natural HRT but that’s not talked about so much anymore.

Thank you black bird :)

body identical is best. From experience though the hardest bit to get right is the progesterone. So many women find merina coil is best plus a body identical patch or gel. I’m not allowed that and it was the progesterone part that my consultants said was actually more of the “issue” than the oestrogen. Not much research on body identical progesterone re cancer. Some think it’s not as much of a risk as synthetic prog.

Thank you so much for sharing my blog @ArabellaSaurus ! As a Chartered Physio I specialise in women's physical health and really want to support women with practical, credible info. I also speak at workplaces and for women's groups/sports clubs, so if people want to know more they can see my website and other women's health blogs www.clairecallaghan.com/blog

Magic, Claire, thanks for all that you do!