When Dr. Vonda Wright, an orthopedic surgeon, was in her early 40s, she regularly competed in half marathons. Then, at 47, she entered perimenopause and suddenly found herself struggling to walk even a short distance, crippled by total body joint and muscle pain. “I was in the best shape of my life,” she said, and then, “I could barely get out of bed.”
In her private practice in Orlando, Fla., she heard similar stories from women going through menopause, including other longtime athletes who now struggled to move comfortably. These patients repeatedly told her, “I feel like I’m falling apart,” she said, despite not having endured any obvious injuries.
While doctors have long known that menopause affects bone health, Dr. Wright and others now believe the transition affects the health of muscles and joints, too. In a paper published in July, Dr. Wright gave this phenomenon a name: the musculoskeletal syndrome of menopause.
The syndrome refers to a constellation of conditions and symptoms that become more prevalent during perimenopause and beyond, including joint pain, frozen shoulder, a loss of muscle mass and bone density, and worsening osteoarthritis, among other things. Research suggests that more than half of menopausal women may experience musculoskeletal symptoms, some of which are severe enough to be debilitating — yet health care providers often dismiss them as unavoidable parts of aging.
What does the syndrome look like?
Dr. Wright described a vicious circle she sees in her female patients: Starting in the menopause transition, women become more sedentary as a result of pain. The less they move, the less they are able to move — and the more frail they become, both in terms of cardiovascular health and in their muscles and bones. This puts them at a greater risk for falls and fractures, and often makes both surgery and recovery more challenging.
Dr. Andrea Singer, the director of women’s primary care at Medstar Georgetown University Hospital and the chief medical officer of the Bone Health and Osteoporosis Foundation, has seen a similar pattern among her patients. “We know that there is a significant cross-talk relationship between muscles and bones, and when one has weaker muscles, this increases the risk for falls — and when you fall on weaker bones, that leads to fractures,” she said.
In her recent paper, Dr. Wright argues that the musculoskeletal syndrome of menopause is linked to the decline of estrogen, in part because of the hormone’s role in fighting inflammation. As such, she suggests estrogen hormone therapy as a possible treatment. (She said that she has personally benefited from the therapy.)
While a large body of scientific evidence suggests estrogen helps to keep bones robust and protect against osteoporosis, we don’t yet have the data to say for sure whether, or to what extent, the loss of estrogen is responsible for muscle and joint pain, said Dr. Stephanie Faubion, the medical director of the Menopause Society, the top governing body for menopause medicine in the United States. The society does, however, endorse hormone therapy for women at high risk of developing osteoporosis.
“I think it’s valid to say that some of these symptoms and conditions worsen in midlife, but it’s harder to say whether they relate more to aging, to loss of estrogen because of menopause, or to a combination of these things,” Dr. Faubion said in an email. “We also don’t know if hormone therapy effectively treats (or manages or delays progression) of these symptoms and conditions.”
Several clinicians told the Times that, anecdotally, patients who start taking hormone therapy for approved conditions such as hot flashes or night sweats also report a decrease in muscle and joint pain and discomfort.
“We know that there are many things for which estrogen started early is beneficial,” Dr. Singer said. But, she added, “we just need to be careful not to jump too far ahead before there’s data there.”
What can women do to treat menopausal muscle and joint pain?
Dr. Wright said there are several practical steps women can take to prevent the musculoskeletal syndrome of menopause, as well as address symptoms and conditions they may already have.
For one, a few simple dietary changes can make a big difference, she and other experts said.
Women should consider eating a diet rich in anti-inflammatory foods, such as the Mediterranean diet, she said, and limit processed foods and added sugars, which can increase inflammation in the body and therefore increase muscle and joint pain. In addition, increasing your protein intake can help you maintain (or even build) muscle mass, which decreases with age. And making sure you’re eating enough calcium can protect your bones.
Experts also recommend taking a regular vitamin D3 supplement, which can help your body absorb calcium as you get older. And if you have a family history of osteoporosis or are at high-risk for other reasons, plan to get a bone density scan early in your menopause transition, if not sooner.
Physical activity is also essential for protecting muscles and bones as you age. Along with regular aerobic exercise to strengthen your heart (such as walking, jogging, swimming, dancing or using an elliptical machine), experts recommend doing at least two weekly 20-minute or longer sessions of resistance training. Strong muscles help to keep your bones strong, too.
A regular stretching routine can also help to prevent injury, but be sure to stretch either after a workout or, ideally, before bed, since research now suggests that stretching temporarily weakens muscle. Jumping and skipping are particularly beneficial for maintaining strong bones. And regularly working on your balance, with exercises such as single-leg balances, weight shifts, Pilates, yoga and tai chi, can help you to avoid falling as you age.
What’s in a name?
While there isn’t yet a medical consensus on whether the musculoskeletal conditions menopausal women experience can be officially called a “syndrome,” Dr. Wright and her collaborators hope that, by giving them a name, health care providers can better treat and possibly prevent these issues. They also hope it will inspire future research. In a similar move, in 2014, a group of experts introduced the term “genitourinary syndrome of menopause” to describe a list of vaginal, vulvar and urinary issues common after menopause, which has allowed health care providers to take a more holistic view of these symptoms.
Naming the phenomenon may also help validate menopausal women’s pain when tests come back negative for other conditions, said Dr. Mercedes von Deck, an orthopedic surgeon at the Cambridge Health Alliance, a teaching hospital for Harvard Medical School — as opposed to suggesting their symptoms are all in their head.
“Throughout modern medicine, we’ve considered women just a little bit hysterical” when there isn’t an obvious medical explanation for symptoms, Dr. von Deck said. But “you can’t treat anything if you don’t have a name for it.”
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