Menopause and Musculoskeletal Pain - why does menopause feel so painful?
Did you know that 50% of menopausal women will experience significant joint pain or arthritis during menopause? This is one of several symptoms that are part of what has recently emerged in menopause research as the “musculoskeletal syndrome of menopause,” the term used to describe the collection of symptoms associated with a loss of estrogen.
Some common symptoms of musculoskeletal pain:
Athralagia (mild to severe joint pain in one or more joints)
Frozen shoulder
Progression of osteoarthritis
Loss of lean muscle mass
Tendon and ligament injury
Plantar fasciitis
More than 70% of women of menopausal women are affected, and around 25% experience severe symptoms.
The Musculoskeletal system is an integral part of the body that includes (to name a few):
Muscles
Bones
Joints
Tendons
Ligaments & Cartilage.
The musculoskeletal system facilitates physical structure, posture, stability, mobility, strength, and proprioception.
Fortunately, armed with knowledge, medical research, and support, we can transform this time of intense physical and emotional change into a time of empowerment, strength, and hope.
Something I consistently hear from my students and friends, and I am experiencing in my own body, is the ramping up of pain and lack of mobility, particularly in the shoulders and hips.
Read on for more information about why menopause often feels so painful. . . it’s not just in your imagination. [I don’t know about you, but it always makes me feel better knowing there is a solid medical reason for my feelings).
Our perception of pain:
The menopause transition brings lots of unexpected changes to our bodies, including an increase in our experience of pain. The reasons for this are a complex mix of physiological changes like hormonal fluctuations, nervous system adaptations, and lifestyle factors.
You may have heard the phrase “pain is in the brain.” This is because pain is input from our brains, not our bodies. I know this sounds counterintuitive, but pain and how we perceive it are mysterious. Yet, understanding where our pain comes from can help us use the tools we have to influence its effects on our daily lives.
Pain is influenced by everything else, from what we eat to how we sleep and perceive ourselves regarding socioeconomic status and life fulfillment.
Our brains are amazing things. They will amplify or tamp down pain signals based on past experiences, stress and anxiety, mood and emotional health, lifestyle, health, and social factors.
This is known as the bio-psycho-social model of pain. (Lehman, 2019)
If we consider the bio-psycho-social model of pain, it makes sense that these social and hormonal changes would make women more sensitive to pain during this time in their lives.
Here are six primary contributing factors to musculoskeletal pain syndrome:
A decline in estrogen and increased inflammation:
Estrogen plays an essential part in the health of our joints and tissues. When estrogen levels decline during menopause, joint mobility and flexibility also decline. Arthritis already existing in our joints might also accelerate due to this decrease in estrogen. “Osteoarthritis, regardless of the joint, is experienced by up to twice as many women as men, and this difference is amplified during menopause. “ Changes in estrogen levels contribute to the inflammation that causes joint pain.
Changes in muscle and tendon strength:
Estrogen is also key in maintaining muscle mass and tendon strength, making strength training and exercise that builds muscle mass an essential part of our exercise plan, beginning in perimenopause.
Nerve sensitivity:
As hormones shift, the nervous system can become more reactive to pain signals, heightening nerve pain.
Anxiety and pain sensitivity:
As our anxiety increases, our pain threshold decreases. Studies have shown that hormonal fluctuations can increase our susceptibility to anxiety and depression. Anxiety and depression, in turn, increase our susceptibility to sensations of pain and decrease our pain threshold.
Proprioception:
Menopause experts rarely discuss a loss of proprioception that can weaken with menopause, including awareness of limbs, movement, touch, and vibration.
Proprioception is our “sixth sense” and is a vital part of embodiment and feeling embodied. Embodiment is an awareness of what is happening inside our bodies, and to be embodied is to access and cultivate these senses.
Proprioception accompanies our awareness of movement, the position of our body in space, and how we occupy that space. It helps us navigate the world, but few know how to teach it, and it’s unlikely your medical provider will discuss a change in proprioception as a symptom to be considered.
However, studies show that the loss of proprioception is associated with the stiffness and tightening of muscle spindles and collagen, which decreases with a loss of estrogen and progesterone during menopause.
Insomnia and disrupted sleep patterns:
As we experience changes during the perimenopause and menopause transition, our lives and the demands of our lives don’t slow down. Meanwhile, hot flashes and anxiety are keeping us awake at night, disrupting our sleep patterns and leaving us feeling sleep-deprived and foggy.
Our nervous system is even more susceptible to pain signals from the brain when we are exhausted and depleted.
You don’t have to suffer . . .
What we can do to manage menopausal pain.
Understanding the science behind what is happening in our bodies during menopause can help demystify feelings of discomfort and pain.
Here are a few things you can do to learn more and take action:
Strength training and exercise that increases muscle and bone density, such as strength training, will help mitigate musculoskeletal pain and are essential for physical health, mood, and confidence.
Yoga, somatic movement, and meditation practices (!!) are incredibly helpful in regulating our nervous system, calming anxiety and ruminating thoughts, and helping us experience a greater sense of ease and awareness in our movement. Embodiment practices allow us deep rest and access to our inner and proprioceptive senses.
Find a GYN with additional training from the Menopause Society who is understanding and knowledgeable about the symptoms of menopause and can help guide your treatment. Not all GYNs or Primary care doctors have this additional training and expertise. The website also has great resources and up-to-date research.
HRT treatments can help stabilize estrogen levels if you feel it is suitable for you, given your medical history.
Somatic Yoga & Strength with Suzanne specializes in embodied movement and strength practices for an active life in midlife and beyond.
Subscribe to my list and become a member of my community! You’ll stay up-to-date on my latest offerings, blogs, and developments.
Resources:
Pang, H., Chen, S., Klyne, D.M. et al. Low back pain and osteoarthritis pain: a perspective of estrogen. Bone Res 11, 42 (2023). https://doi.org/10.1038/s41413-023-00280-x
Does menopause elevate the risk of developing depression and anxiety? Results of a systemic review. https://pubmed.ncbi.nlm.nih.gov/36961547/
Arthralgia of Menopause - A retrospective review/https://pubmed.ncbi.nlm.nih.gov/37127408/
Bodies of Knowledge. Bo Forbes (2024).
Musculoskeletal Pain and Menopause:
https://pubmed.ncbi.nlm.nih.gov/29412042/