The menopause is a period of a woman’s life when her periods change due to a decrease in the hormone, oestrogen. It concludes when periods have been non-existent for 12 consecutive months. This can be preceded by as much as 10 years of symptoms related to a reduction in oestrogen levels, a period known as peri-menopause.Post menopausal symptoms can persist for up to another 10 years.
What are the symptoms of menopause?
- alterations in mood
- anxiety
- itchy skin
- an increase in weight
- hot flushes
- night sweats
- hair loss
- memory issues
What symptoms of menopause are of particular interest to physiotherapists?
- joint aches and pains (sometimes with no observable pathology)
- an alteration in tendon and cartilage health
- a reduction in muscle strength
- an increase in pain perception
- an increase in inflammatory processes
- a reduction in bone density
Added to the mix, weight gain can aid load to joints resulting in increased risk of pain and injury. Reduced mood and anxiety and lack of sleep is well established to increase pain levels. There is also evidence to suggest women who suffer hot sweats as a menopausal symptom are more likely to experience muscle and joint pain (Blümel et al, 2013).Being mindful of menopausal symptoms can be hugely important to physiotherapists to ensure an appropriate rehabilitation programme and consider how to manage other symptoms that might be influencing a woman’s symptoms.
Due to the known effects of hormone changes on women’s tendons, research into the best treatment techniques for tendon issues are often performed on men to avoid the confusion of oestrogen-deficient tendons (Radovanović et al., 2022). This often results in physios needing to closely monitor symptoms and adapt evidence-based exercise programmes as best they can to ensure appropriate loading of the tendon.
Ongoing pain, not responding to treatment as expected, can be exacerbated by low mood, anxiety and a lack of sleep. Physiotherapists are in a very strong and knowledgeable position to help advise on this to help reduce pain and improve function. But if these symptoms are due to hormonal issues, rather than lifestyle, perhaps this advice might only be partially effective?
Not only this, but perhaps a woman presents to a physiotherapist with pain, recognises she is under stress, is fatigued and low in mood, due to work and life pressures, but then her physio questions her further, and it is discovered that maybe these symptoms are related to perimenopause. It has been found that many women who report muscle and joint pains who are of menopausal age, don’t relate them to the menopause (Duffy et al., 2012). A discussion with a physio may be the first awareness a woman has to this stage in her life. Sometimes, further discussion with her GP may be recommended to discuss any appropriate blood tests or interventions, such as HRT.
Evidence observing tendons in women on HRT and those not on HRT demonstrate different results (Cook et al. 2006; Cowan et al. 2021). HRT is known to help with symptoms such as low mood, stress and anxiety (NHS, 2019), all of which can contribute to pain. So sometimes, the work of the rehabilitation can be supplemented and be more effective with additional menopause intervention (Watts, 2018).
One of NYP’s Directors, Kate, recently completed her dissertation for her Master’s on Physiotherapists’ Perceptions of musculoskeletal conditions in menopausal aged women, and discovered, in her sample of 11 interviewed physiotherapists, that the menopause and its impact on pain and the musculoskeletal system was overall not well evidence-based and many felt that the majority of their colleagues did not consider the menopause in their physiotherapy management.
Due to Kate’s interest in the area, NYP’s physiotherapists are all trained in how the menopause impacts our treatments and recognising potential menopausal symptoms in our clients. To read the published paper that has been written from Kate’s paper with her supervisors at Manchester Metropolitan University, it can be accessed here.
References
Blümel, J.E,, Chedraui, P., Baron, G., Belzares, E., Bencosme, A., Calle, A., Dancker, L., Espinoza, M.T., Flores, D., Gomez, G., Hernandez-Bueno, J.A., Izaguirre, H., Leon-Leon, P., Lima, S., Mezones-Holguin, E., Monterrosa, A., Mostaio, D., Navarro, D., Ojeda, E., Onatra, W., Royer, M., Soto, E., Tserotas, K. and Vallejo, M.S. (2013) ‘Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women.’ Maturitas, 75 (2013) pp. 94-100.
Cook, J.L., Bass, S.L. and Black, J.E. (2007) ‘Hormone therapy is associated with smaller Achilles tendon diameter in active post-menopausal women’ Scandinavian Journal of Medicine and Science in Sports, 17 (2) pp. 128-132.
Cowan, R.M., Ganderton, C.L., Cook, J., Semciw, A.I., Long, D.M., and Pizzari, T. (2022) ‘Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome?’ The American Journal of Sports Medicine, 50 (2) pp. 515-525.
Duffy, O.K., Iversen, L. and Hannaford, P.C. (2012) ‘The impact and management of symptoms experienced at midlife: a community-based study of women in northeast Scotland’. British Journal of Obstetrics and Gynaecology. 119 (5) pp. 554-564.
National Health Service (2018) Conditions: Menopause. Unknown place of publication: National Health Service. Available at: https://www.nhs.uk/conditions/menopause/