It’s been a long time coming but women’s health is finally taking centre stage in the media and in medicine, with the Menopause being the first topic in the limelight. A number of high profile campaigners and menopausal specialists, (including the work of Dr Louise Newson aka the Menopause Doctor), have pushed the drive for improved health education and promotion and equal access to care and treatment. Developments in research and changes in attitudes have encouraged people to speak more freely about symptoms and the impact the menopause has on their lives.
Hormones and the endocrine system are responsible for so many widespread and varied roles within the body and can influence multiple bodily systems. Any changes in hormone levels from puberty to medication side effects can have significant systemic effects. The Menopause being one such dramatic change in hormone levels, when oestrogen levels reduce. Oestrogen is an important factor in brain, heart, bone and tissue health. It also plays a role in the inflammation process and immune system. There are thought to be at least 34 symptoms attributed to the menopause and decreasing oestrogen levels. These span over multiple bodily systems affecting physical, psychological and cognitive function. Although the number, nature and severity of symptoms will vary per individual case, it is estimated that 80% of those going through the menopause will experience symptoms at some point, with 25% severe. There a number of menopause questionnaires and scoring tools available online that are useful to track symptoms and discuss with your GP.
Okay lets get to grips with the terms;
Menopause: This is normally defined by the absence of a period for 1 year. The average age for menopausal onset is 51 and average duration is 4 years, although this can vary per person.
Perimenopausal: During which time you may experience menopausal symptoms due to fluctuating oestrogen levels, but are still menstruating. Onset is normally over the age of 45 and symptoms can last a few months or a few years.
Early menopause: This describes the onset of menopause between the ages of 40-45.
Premature menopause or Primary Ovarian Insufficiency (POI): Effecting 1 in 100 women, this normally occurs before the age of 40 and can be associated with family history, surgery, chemotherapy and auto-immune conditions.
Menopause and the Musculoskeletal (MSK) System
From a physiotherapy perspective we are particularly interested in the symptoms that effect your musculoskeletal (MSK) system, that may be responsible for or contributing to your injury or condition. Joint pain, stiffness and swelling, low energy, fatigue and muscle weakness are common menopausal symptoms. As Oestrogen has a key role in bone, muscle and cartilage health, when levels decline, there is increased risk of bone and muscle mass loss. Post menopause there is a higher prevalence and incidence of Osteoarthritis (and more likely to be symptomatic and progressive), Osteoporosis and Rheumatoid arthritis. Tissues can also lose elasticity, affecting skin, muscle, tendons and the genito-urinary system. The body’s natural pain relief responses are affected by low oestrogen levels and this can cause higher pain severity. For these reasons it is easy to see why many musculoskeletal conditions can be mistaken for (or overlap with) menopausal symptoms e.g joint/spinal pain or fibromyalgia. Other health risks associated with the menopause include type 2 diabetes, obesity, clinical depression, cognitive decline and early dementia.
So how can we reduce the risks?
There are lifestyle changes that are important in reducing health risks during and after the menopause.
- Keeping your weight within a healthy range will help avoid extra pressure on the spine and joints. Obesity and smoking have been linked to early onset of menopause and can also effect cardiovascular health. Carrying excess weight around our waists has also been linked to an increased risk of developing type 2 diabetes.
- Regular exercise can help in improving joint stiffness and pain. Strength and weight bearing activity are particularly useful in maintaining bone density, in the fight against osteoporosis.
- Getting 8-9 hours sleep a night and keeping stress as low as able or well managed.
- Keeping alcohol consumption within the recommended guidelines (14 units per week) and including drink free days.
Hormone Replacement Therapy (HRT)
HRT has always been a controversial topic with contradictory advice about who is eligible and the potential health risks associated with its use. There is no wonder only 12% of menopausal women take it. Like most medications, there are a variety of options and applications (pills, patches, pessary, sprays), it isn’t one size fits all. Dosages and tolerance levels will also vary and a period of trial and error is often needed to find the right combination to help symptoms. Liaising with your GP or consultant is important to find out what works for you.
Benefits
- Taking HRT has been shown to improve bone density and reduce risk of fracture associated with osteoporosis. The good news is these bone health improvements were not dependent on what age HRT was started.
- Those taking HRT had a low rate of osteoarthritis and 45% reduction in total joint surgery. This was better the longer the duration of HRT consumption.
- Destructive joint, bone and cartilage changes present in Rheumatoid Arthritis were also reduced when taking HRT. Joint and systemic inflammation were also reduced.
Risk Factors
On a recent menopause webinar Dr Louise Newson said “For the majority of women, the benefits of HRT outweighs any risks”.
A well documented concern is the risk of developing breast cancer. These risks were associated with older types of progestogen medication. Research has shown there is no increased risk of developing breast cancer in women who are young taking HRT and no risk shown with body identical HRT.
There are many other factors that can increase the risk of developing breast cancer, including family history, increasing age, obesity, alcohol and reduced exercise.
If you have coexisting medical conditions or other health risk factors it does not necessarily rule out HRT, but it may restrict what types you are able to have. A thorough assessment with your GP or consultant is important to discuss what options are best for you.
Medication aside, if you are unsure if your Musculoskeletal health is being affected by the menopause, as physiotherapists we are well placed to assist in this, we can take a detailed history of signs and symptoms and a physical examination to help assess for other conditions. Get in touch, we are here to help. To book an appointment click here
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