Musculoskeletal symptoms of Menopause

20 Oct

October is Menopause Awareness Month

When people think of symptoms of menopause they might think of hot flushes, night sweats and anxiety but how many people know that your musculoskeletal health can alter during perimenopausal and menopausal years.

Understanding Musculoskeletal Symptoms of Menopause

Menopause is a natural phase in a woman’s life that marks the end of menstrual cycles, typically occurring in their late 40s or early 50s. Many women experience muscle and joint pain, stiffness, and even changes in bone health during and after menopause.70% of women that go through menopause experience musculoskeletal symptoms. Let’s explore the musculoskeletal symptoms of menopause, why they occur, and how to manage them.

What Causes Musculoskeletal Symptoms During Menopause?

The primary factor contributing to these symptoms is the decline in oestrogen levels. Oestrogen is not only a key hormone for reproductive health but also plays a vital role in maintaining bone density and regulating inflammation in muscles and joints. As oestrogen levels drop during menopause, several changes occur:

• Bone Loss: Oestrogen helps protect bones by preventing bone resorption. During menopause, the accelerated loss of bone density can lead to conditions like osteoporosis, increasing the risk of fractures.

• Joint Pain and Stiffness: Oestrogen has anti-inflammatory properties that help keep joints flexible and reduce swelling. With lower oestrogen, women may experience joint pain, stiffness, or swelling, especially in the knees, hips, and hands.

• Muscle Weakness: Menopause can also lead to a loss of muscle mass (sarcopenia), contributing to general weakness and fatigue. This can affect daily physical activities, increasing the risk of falls or injuries.

Oestrogen is not the only hormone that can affect musculoskeletal health, hormones such a drop in testosterone levels, and a rise in cortisol, adrenaline and insulin can also have an affect on musculoskeletal health. Inflammation in the body is also driven by sleep disturbance and weight gain.

Common Musculoskeletal Symptoms

1. Joint Pain: Women often report aching or stiffness in their joints, particularly in weight-bearing areas such as the hips and knees. These symptoms may be worse in the morning or after periods of inactivity.

2. Muscle Pain and Cramps: Muscle stiffness, soreness, or frequent cramps can occur, particularly in the legs and back. Some women may notice these symptoms more at night, disrupting sleep.

3. Bone Pain or Tenderness: In some cases, decreased bone density can cause generalized discomfort or tenderness in certain areas of the body, although this is more common in advanced stages of osteoporosis.

4. Back Pain: The lower back is another area commonly affected due to changes in posture, bone density, and muscle strength.

5. Reduced Mobility: Overall stiffness and pain can make it harder for women to stay active, leading to reduced flexibility and range of motion over time.

6. Pain related to inflammation in tendons: It is much more common to develop issues such as rotator cuff injuries and plantar fasciitis

7. Pelvic floor symptoms: This is due to a change in strength of the pelvic floor muscles and external urethral sphincter.

Managing Musculoskeletal Symptoms of Menopause

While these symptoms can be uncomfortable, several strategies can help reduce their severity and improve quality of life:

1. Exercise

• Strength Training: Incorporating weight-bearing exercises, such as resistance training or yoga, can help maintain bone density and muscle mass. It can also improve insulin sensitivity, mood, decrease weight gain, improve brain function, and pelvic floor health. Baron et al ( 2019) found that strength training can also decrease hot flushes by 44%.

• Flexibility and Stretching: Stretching exercises, such as Pilates or simple morning stretches, can improve joint mobility and reduce stiffness.

• Cardiovascular Activity: Walking, swimming, or biking can enhance overall fitness and support bone and joint health.

2. Dietary Changes

• Calcium and Vitamin D: Ensuring adequate calcium intake (through dairy, leafy greens, or supplements) is essential for bone health. Vitamin D aids calcium absorption and can be obtained through sunlight or supplements.

• Anti-inflammatory Foods: Foods rich in omega-3 fatty acids, such as fish, nuts, and seeds, can help reduce inflammation in muscles and joints. A study by Walrabenstein in 2023 recommended that a predominantly plant based whole food Mediterranean diet as well a strength training, education and stress reduction decreased joint pain.

3. Hormone Replacement Therapy (HRT)

• In some cases, doctors may recommend HRT to help restore oestrogen levels, alleviating joint and muscle pain. However, HRT isn’t suitable for everyone, so it’s important to discuss the risks and benefits with a healthcare provider.

4. Supplements

• Some women find relief from musculoskeletal symptoms by taking supplements like glucosamine, chondroitin, or magnesium, which may improve joint flexibility and muscle relaxation.

5. Physiotherapy

• A physiotherapist can create a personalized exercise plan to help maintain mobility, manage pain, and prevent further damage to joints and muscles. This would include advice and treatment for the pelvic floor is necessary.

• Treatment is very holistic and will include discussion on how sleep and stress and diet could be affecting your symptoms.

• Physiotherapists are able to offer pain relief options too such as manual therapy or acupuncture.

When to Seek Help

If musculoskeletal symptoms become severe or interfere with daily activities, it’s important to consult a healthcare provider. Persistent joint pain, back pain, or unexplained muscle weakness could be signs of conditions like osteoarthritis or osteoporosis, which require medical management.

Conclusion

Menopause is a time of significant physical changes, and the decline in oestrogen can lead to a variety of musculoskeletal symptoms. While joint pain, muscle aches, and reduced mobility are common, they don’t have to diminish your quality of life. With the right strategies, including regular exercise, a nutritious diet, and medical support when necessary, it’s possible to manage these symptoms effectively and maintain a healthy, active lifestyle throughout menopause and beyond.

If you are experiencing any of these symptoms, don't hesitate to get in touch with Wendy Farren

Persistent Pelvic Pain

Are you someone that suffers from persistent pelvic pain? It can be truly awful but there is help available for you.

Pelvic pain is a complex condition that can significantly impact an individual's quality of life. It can arise from various causes, including musculoskeletal issues, pelvic organ dysfunction, or neurological factors. I guess if you are reading this you might have been given a diagnosis by a GP or specialist and you are seeking help. Common conditions that contribute to pelvic pain include pelvic floor dysfunction, endometriosis, bladder pain syndrome (interstitial cystitis), prostatitis or even chronic constipation.

Symptoms of pelvic pain may vary widely in intensity and duration. Patients may experience sharp or dull pain, pins and needles, pressure, or discomfort in the pelvic region, which can sometimes radiate to the lower back, hips, and abdomen. This pain can be persistent or intermittent, and it may be exacerbated by activities such as exercise, sexual intercourse, or prolonged sitting.

Although there can be lots of different causes, it can be disruptive of your life, daily activities, sleep and relationships. It can be difficult to feel positive when you have persistent pelvic pain.

Assessment by a qualified physiotherapist specialising in pelvic health is essential for an accurate diagnosis and effective treatment plan. A thorough evaluation may include a detailed medical history and a physical examination focused on the pelvic region, tummy, hips and thorax. My initial assessment for someone with pelvic pain lasts between 75-90 minutes. During that time we will come up with a plan of how we can work together to make you feel more comfortable.

Physiotherapists utilise various techniques, such as manual therapy, therapeutic exercises, and biofeedback, acupuncture, TENs to address underlying musculoskeletal issues and enhance pelvic floor function. We will also discuss the interaction between your brain and the pelvis and utilise techniques to calm the nervous system. Education on pain management strategies and lifestyle modifications also plays a crucial role in treatment. Patients are encouraged to engage in exercises that promote relaxation and if needed to strengthen the pelvic floor while avoiding activities that may exacerbate symptoms.

Each physiotherapy session after the first session is usually an hour. Most patients come for sessions quite close together initially, then as the pain becomes more manageable, we spread the sessions apart, so that people can work on the techniques that they have learned by themselves. Sometimes I might encourage patients to seek help from other health professionals too such as their general practitioner, a hospital consultant, or a mental health specialist. I often see people with persistent pelvic pain for several months.

 Often people start to feel better once they understand the reasons why their pain has become persistent. Treatment is a bit like peeling layers off an onion, we gradually find ways and techniques that help to control and manage the pain. Often the manual therapy really helps to desensitise the muscles and tissues quickly. Learning how to self-manage takes longer but is completely doable with practice. My intention is that patients become so knowledgeable about their body, that they can self-manage really well.

Early intervention is key to managing pelvic pain effectively. If you are experiencing discomfort, consulting a physiotherapist with expertise in pelvic health can provide tailored treatment to improve your symptoms and overall well-being.

If you are unsure whether I would be able to help you please ask for a 15 minute complementary phone call to discuss your problem.

What is a first pelvic health appointment like?

Many people are a little nervous at their first appointment and it has often taken quite awhile to pluck up courage to attend. I aim to make you feel as relaxed as possible, and most people say that they understand a lot more about their condition and we have talked about a plan of care by the time they leave.

My assessment and treatment depend on your condition and will always be directed at your needs.

You can bring a friend or member of your family with you to your appointment. A chaperone can be provided by the clinic if you would like one.

I will start by asking a lot of questions. All the information that I glean from you is confidential. Whilst some of the questions are sensitive in nature, I appreciate that they might be difficult to discuss but this helps me to understand how your problem is impacting on your life.

Your physical assessment often begins with assessing your lower back, pelvis and abdomen, hips, and breathing. I might even need to pay attention to old injuries that have occurred in the past as these can impact on how well your pelvic floor muscles can function.

Most pelvic health issues benefit from an internal assessment to identify tone, strength, and control of the pelvic floor muscles as well as any scarring that might be present. I will also check for prolapses if relevant. This assessment can be vaginal or via the anus and is performed with gloves and gel, without instruments such as a speculum. Your assessment will only ever be carried out with your consent. Please remember that you can withdraw your consent at any time.

It is important that the left and right sides of your pelvic floor, both superficial and deep layers are assessed to work out the strength, endurance, and speed of the muscle contraction.

Following this we can determine your baseline of pelvic floor muscle control so that we can plan your specific exercises.

Please remember that this is just the start of your journey. Muscles take 3-6 months to get stronger! You will be offered regular appointment to progress your exercises and get you back to doing all your favourite things again!

Useful information for your first visit

·       Where is Wendy Farren physiotherapy located?

I work at the HealthHub in Kingsbridge. It is located at the top of Fore Street, just beyond the police station. The full address is The Health Hub, Fore street, Kingsbridge, TQ7 1AX.

 There are three parking spaces available for patients. Two of them have disabled parking signs. You can park here even if you haven’t got a Blue Badge. There is a ramp into the clinic.

The clinic is calm, clean, and quiet. When you arrive, there may not be anyone to greet you as we might be treating other patients. Please take a seat and help yourself to a drink if you would like one.

·       Is there a toilet at The Health Hub?

There are two toilets. One is the right of the entrance door, and the other is through the door next to the studio.

·       How long are the appointments?

Most first appointments benefit from a 90-minute appointment. This allows me to complete an assessment and start your treatment plan. If you would prefer a one-hour assessment only appointment, please discuss this with me prior to booking. Follow up appointments are either one hour or 45 minutes, depending on your treatment!

·       What should I wear to my appointment?

Whatever feels comfortable. You might want to bring a vest top or shorts. Trainers would be useful if you think that you might need to demonstrate something more active at your appointment.

·       Should I bring any information with me?

Yes please! If you have had any investigations or letters from clinics, please bring these with you. It would also be useful if you would spend a few minutes writing down any medical problems, injuries, or operations that you might have had and a list of medication that you are taking.

·       Are babies and children welcome at appointments?

I love babies and children and they are welcome to come with you, however you might prefer to have the treatment time as ‘your time’ to concentrate on you! You are welcome to bring someone else to look after your baby and wait in the reception area.

·       How much is each appointment?

Please look at the prices section of my website for the full list fees.

·       What about if I need to move or cancel my appointment?

I would appreciate a phone call or email at least two working days prior to your appointment. We can then get you rebooked, without you having to incur a cancellation charge.

I look forward to welcoming you to the clinic!