- Menopause skeletal and muscular changes are related to a decline in estrogen, resulting in impacts on bone density, joint lubrication, muscle strength, and nerve function.
- Symptoms include arthralgia, body aches, myalgia, neuropathic pain, and ostealgia.
- Diagnosis is made based on a medical history review, physical examination, and diagnostic tests including X-rays, and bone mineral density tests.
- Treatment options include hormone replacement therapy, pain medication, topical treatments, surgical procedures, physical therapies, and dietary supplements.
- Management options include stretching, applying heat or cold to the affected area, a nutritious diet with electrolytes, and low-impact physical exercise and activity.
What is it?
Menopause-related skeletal and muscular changes encompass a range of symptoms that reflect the body’s response to hormonal shifts during this transitional phase. These changes can significantly affect the musculoskeletal system, manifesting in various forms of discomfort and pain.
Commonly experienced symptoms include arthralgia, characterized by joint pain, which can affect daily activities and mobility. Body aches, a general term for widespread or localized discomfort, are also common during menopause, often contributing to a sense of overall fatigue and discomfort. Myalgia, or muscle pain, is another frequent symptom, reflecting the sensitivity of muscle tissues to hormonal fluctuations.
Neuropathic pain, a distinct type of discomfort arising from nerve damage or dysfunction, can occur during this period, presenting unique challenges in pain management. Women may experience ostealgia, marked by bone pain, which may be linked to the onset of osteoporosis.
These varied symptoms collectively highlight the complex interplay of hormonal changes during menopause and their profound impact on the body’s skeletal and muscular systems.
What causes it?
The onset of menopausal skeletal and muscular changes, or muscoskeletal pain, is primarily attributed to the decline and change in estrogen levels, which significantly affects bone, joint, and muscle health. Estrogen is important for maintaining bone density. As estrogen, specifically estradiol, the major form of estrogen, levels drop, and estrone, another form of estrogen which is considered pro-inflammatory, increases, there is a corresponding decrease in bone density, elevating the risk of osteoporosis and increasing susceptibility to fractures. This reduction in bone density can also lead to heightened bone pain.
The decline in estrogen affects the absorption and utilization of calcium. Estrogen plays an important role in bone health, including the regulation of calcium metabolism. When estrogen levels drop, it can lead to lower calcium absorption, further contributing to reduced bone density.
Estrogen’s decline adversely affects muscle health, contributing to increased instances of muscle pain and stiffness. This is partly because of estrogen’s role in inflammation and pain perception, as well as its influence on muscle strength and function.
Joint pain (arthralgia) can be exacerbated by the reduced production of synovial fluid. This fluid is essential for lubricating the joints, and its reduced presence can lead to increased joint stiffness and discomfort.
Beyond hormonal changes, other factors such as aging, lifestyle choices, and genetic predisposition also play significant roles in these skeletal and muscular changes. For example, lifestyle factors like physical activity levels and diet can influence bone and muscle health.
Conditions like fibromyalgia, characterized by widespread musculoskeletal pain, fatigue, and cognitive disturbances, can be exacerbated during menopause, contributing to further musculoskeletal discomfort. Together, these factors contribute to a range of symptoms, including arthralgia, bone pain, muscle pain, and reduced mobility, significantly affecting quality of life during menopause.
What are the symptoms?
Skeletal and muscular changes during menopause encompass a range of symptoms that affect the bones, joints, muscles, and nerves. These include arthralgia, which refers to joint pain; body aches, a general term for widespread discomfort; myalgia, meaning muscle pain; neuropathic pain, a type of nerve pain resulting from nerve damage or dysfunction; and ostealgia, which is pain specifically in the bones.
These symptoms result from the hormonal fluctuations and reductions that occur during menopause, affecting various bodily systems. Experienced pain can range from mild to severe, affecting quality of life. Accompanying symptoms may include stiffness, difficulty moving, which is often heightened in the morning, and fatigue.
Joint Pain (Arthralgia)
Experiencing arthralgia is a symptom associated with menopause-related skeletal changes affecting the joints and connective tissues. This discomfort can manifest in various ways, such as a dull ache, sharp shooting pain, or a burning sensation. The pain may be intermittent or persistent, localized, or widespread, and can range from mild to severe. Often, joint pain comes with stiffness, swelling, and reduced range of motion.
Other associated symptoms may include fatigue, sleep disturbances, and mood changes. Tendinitis, inflammation, or irritation of a tendon can also cause joint pain, and can be exacerbated with hormone fluctuations during menopause as they affect tendons. People with Crohn’s disease or ulcerative colitis may experience joint pain, typically stemming from peripheral arthritis or symmetrical polyarthritis. Persistent joint pain requires medical attention and may be related to osteoarthritis, rheumatoid arthritis, or decreased bone density manifesting as osteopenia or osteoporosis, which can lead to chronic pain and bone fractures.
Some women may experience frozen shoulder (adhesive capsulitis) which is an inflammatory condition. This can result in pain, stiffness, and reduced mobility as fibrous tissue develops around the shoulder joint.
Body Aches
Body aches during menopause can affect various parts of the body, including bones, joints, and muscles. These aches can manifest as a general feeling of discomfort or soreness, ranging from mild to severe. The pain may be constant or intermittent and can often be exacerbated by physical activity or stress.
Estrogen plays a role in regulating inflammation and pain perception, and its decline can lead to increased sensitivity to pain and discomfort. The decrease in estrogen can affect bone density and muscle strength, contributing to the sensation of aches throughout the body.
Women experiencing menopausal body aches may also notice an increase in fatigue, sleep disturbances, and mood changes, which can further exacerbate the perception of pain. Body aches may also be a symptom of other conditions, such as chronic fatigue syndrome (CFS), fibromyalgia, and influenza.
Muscle Pain (Myalgia)
Myalgia can range from mild aches to severe, debilitating discomfort. Symptoms usually present as a deep, constant pain or a random sharp, stabbing sensation. In addition, muscle stiffness, or weakness may be experienced, often leading to reduced mobility. The intensity and duration of muscle pain can vary depending on your physical health, level of activity, and genetics.
The pain might be localized, affecting just one specific muscle group, or it may be widespread, affecting large areas of the body. Persistent or severe muscle pain justifies medical attention, as it may be an indicator of other underlying conditions, such as injuries involving breaks, infections, or conditions like Lyme disease, and Multiple Sclerosis (MS).
Nerve Pain (Neuropathic Pain)
Neuropathic pain is often a result of damage or disease affecting the somatosensory nervous system. This chronic pain is distinct from nociceptive pain, which results from physical damage to non-neural tissue. Neuropathic pain is characterized by sensations that can be described as burning, shooting, or stabbing. It may also present with dysesthesia (abnormal and often unpleasant sensation), paresthesia (pins and needles), allodynia (pain from stimuli that rarely causes pain), electrical shock sensations, numbness, and tingling.
You may notice your grip weaken, problems with balance from numb feet, a burning sensation from pinched nerves or compressed joints, your limbs suddenly going to sleep, and other accompanying conditions like restless legs syndrome (RLS) that affect sleep quality. Some women experience facial pain, called trigeminal neuralgia, where pain originates from the trigeminal nerve, which starts near the top of the ear and splits into three, toward the eye, cheek and jaw.
The fluctuations in hormones, particularly estrogen, during menopause can influence nerve function, nerve cells, and pain perception. This can lead to the development or exacerbation of neuropathic pain.
Bone Pain (Ostealgia)
Ostealgia often manifests as a persistent ache or discomfort within one or more bones. This discomfort may intensify with movement or physical activity, and can also be present during periods of rest.
Ostealgia can occur in any part of the body where there’s bone structure, such as the pelvis, spine, ribs, or limbs. Accompanying symptoms might include stiffness, swelling, or a decrease in mobility.
Besides hormonal fluctuations during menopause, causes of ostealgia can include a bone fracture, cancer in the bones (primary malignancy) or has spread to the bones (metastatic malignancy), disrupted blood cell (which can occur in sickle cell disease or anemia), leukemia, osteomyelitis (infected bone), osteoporosis (loss of mineralization), and overuse.
How is it diagnosed?
Diagnosing menopause-related skeletal and muscular changes begins with a comprehensive medical history review, focusing on symptoms, lifestyle, and dietary habits, and personal health practices. Healthcare professionals will typically want to know about any previous injuries, the onset of pain, family history of related pain, and the type of pain experienced.
Physical examinations are conducted to assess pain, including checking for pain or limited motion in the affected area or joint, and signs of injury to surrounding muscles, tendons, and ligaments. Examinations are also completed to test nerves by checking muscle strength, reflexes, and sensitivity to touch. Muscle function can be assessed through strength tests, like handgrip strength, and electromyography to measure electrical activity in nerves and muscles. Nerve conduction studies may be completed to measure the speed your nerves can carry electrical signals.
Diagnostic tests such as X-radiation (X-rays) can reveal joint deterioration, fluid accumulation, bone spurs, or other issues contributing to pain. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans help visualize muscle injury or damage. A muscle biopsy might be conducted to detect neuromuscular diseases.
Bone mineral density (BMD) tests, known as dual-energy x-ray absorptiometry (DEXA or DXA) or bone densitometry, measure bone density, primarily in the hip and spine, to assess overall bone health. Results are given as a T-score, comparing an individual’s bone density to that of healthy young adults, and classifying the bone as normal, pre-osteoporosis (or osteopenia), or osteoporosis. The T-score only offers a two-dimensional view of a single bone without considering other fracture risk factors like vision or balance issues. A bone density test differs from a bone scan, which uses nuclear imaging to detect cancer, fractures, infections, and other abnormalities in the bone.
Blood tests help confirm a diagnosis or rule out other diseases causing discomfort and pain. Consult with a healthcare professional. If symptoms interfere with your daily activities, you develop new pain, or pain is accompanied with other symptoms such as a fever or unexplained weight loss.
How is it treated?
Treatment for menopause-related skeletal and muscular changes involves a combination of medications, therapies, and dietary supplements.
Hormone Replacement Therapy (HRT) can be effective in maintaining bone density and easing menopausal symptoms. Specifically, Livial (tibolone) may be prescribed to prevent or treat postmenopausal osteoporosis, as well as high-dose estrogen therapy (HDE) (or pseudopregnancy when given in combination with a high dose of progestogen as hormone levels mimic those in pregnancy). HRT may also help slow weight gain by increasing a woman’s resting metabolic rate, which can exacerbate skeletal and muscular symptoms. HRT may not be suitable for women with rheumatoid arthritis due to associated risks.
Medications to manage pain include over-the-counter (OTC) medications like Ibuprofen, Acetaminophen, and Naproxen, and prescription medications like non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). Antidepressants help improve sleep and mood, and treat pain indirectly, and anticonvulsants like gabapentin and pregabalin help treat neuropathic pain. Hyaluronic acid injections may lubricate joints, help cartilage, and bone growth and reduce inflammation. Steroids may be administered via injection for short-term relief of pain and swelling. Topical treatments such as anti-inflammatory gels and ointments can also provide localized pain relief. Where other therapies are ineffective or not tolerated, menopausal women may be prescribed calcitonin, which is a thyroid hormone, for osteoporosis, bone pain, joint pain and frozen shoulder. Medical marijuana (or cannabis) may be prescribed for severe and chronic pain.
Surgical procedures like joint replacements may be necessary, and electrical stimulation, like transcutaneous electrical nerve stimulation (TENS), and percutaneous electrical nerve stimulation (PENS), which use electrical currents to stimulate the nerves to treat acute (short-term) and chronic (long-term) pain.
Conventional therapies, such as hydrotherapy, massage therapy, occupational therapy, physical therapy (physiotherapy), and chiropractic and osteopathic care, can effectively ease pain, improve mobility, and aid in rehabilitation from injuries or surgeries. Cognitive-behavioral therapy (CBT) can provide coping strategies and techniques to handle pain related symptoms.
Natural therapies such as acupuncture can stimulate the body’s natural painkillers, enhance circulation, and provide relief from various types of pain. Biofeedback can help gain a greater understanding and subsequent control over physical responses involved in pain. Hypnosis (Hypnotherapy) can help with acute (short-term) and chronic (long-term) pain and anxiety.
Dietary supplements like cinnamon (Cinnamomum verum or Cinnamomum cassia), curcumin (Curcuma longa or turmeric), Boswellia serrata extract, also known as Indian frankincense, containing acetyl-11-keto-β-boswellic acid (AKBA), olive leaf extract (oleuropein), saffron (Crocus sativus), and stinging nettle (Urtica dioica), are known for their anti-inflammatory properties helping body aches and various types of pain. Alpha-lipoic acid (ALA), Gingko biloba, Acetyl-L-carnitine (ALCAR), N-acetyl cysteine (NAC), and vitamin B12 (cobalamin) can help with neuropathic pain. Phytoestrogens, plant-based compounds that mimic estrogen in the body, can be an alternative to HRT. Creatine, particularly combined with strength training, can help improve exercise performance, reduce bone resorption, inflammation, and oxidative stress, increase bone formation, and counterbalance bone, muscle, and strength loss.
Supportive aids like braces and orthotic devices may be support pain management and recovery.
The effectiveness of these treatments varies among individuals and should be discussed with a healthcare professional.
How is it managed?
Menopause-related skeletal and muscular changes can be managed through lifestyle modifications and behavioral changes.
Mind-body exercises like yoga and Tai Chi and mindfulness practices like meditation, deep breathing from your abdomen, and pranayama (the yogic practice of breath regulation) can help reduce pains symptoms.
Behavioral changes include completing stretches or applying heat (warm water, heat pads, wheat bags, etc.) to affected areas after waking to increase blood flow, reduce stiffness and warm up the muscles before activity. Applying cold (cool water, cool packs, ice packs, etc.) reduces blood flow, inflammation, and pain, which is beneficial following an injury or exercise. As is resting or elevating the affected area when inflamed and painful.
Consuming a diet with nutrient-dense foods with Omega-3 fatty acids to reduce inflammation, B vitamins for neuropathic pain, enough electrolytes (particularly magnesium for muscle cramp relief), and vitamin D (ergocalciferol (D2) and cholecalciferol (D3)) for bone health and efficient calcium absorption. Carbohydrates and sugar can trigger inflammation, so reducing them is recommended. Reducing alcohol and smoking are also recommended as they can exacerbate, and accelerate, bone loss and pain symptoms. Staying hydrated with purified water can help with muscle function and joint lubrication.
Regular physical exercise, including cardiovascular and weight training, can help manage weight (which can exacerbate pain, wear and tear, and joint impact), increase flexibility and strength, and increase bone density, reducing the risk of fractures. Water-based exercises like swimming and aqua aerobics reduce stress on joints and muscles because of the buoyancy of the water. Other low-impact exercises that reduce strain on joints include walking, cycling, yoga, tai chi, stationary lunges, bodyweight squats, dumbbell farmer’s walk, resistance band training, and dumbbell and machine weight exercises for all body parts.
Exercise also helps promote sleep, improve sleep quality, and reduce sleep disturbances. Restorative sleep helps aid recovery from physical strain and daily stresses, and reduce stiffness and swelling, thus helping manage pain.
Menopause related skeletal and muscular changes are primarily attributed to the decline in estrogen, which is important in maintaining bone density, and the absorption and utilization of calcium. As covered, symptoms include arthralgia, body aches, myalgia, neuropathic pain, and ostealgia. Diagnosis is made based on a medical history review including previous injuries, physical examination to assess pain, motion, and signs of injury, and tests including X-rays and other diagnostic imaging scans, and BMD tests. Treatment and management options include hormone HRT, pain medication, physical therapies, dietary supplements including curcumin, applying heat or cold to the affected area, and low-impact physical exercise and activity.
