The musculoskeletal syndrome of menopause
An evidence-based article outlining how estrogen decline contributes to joint pain, muscle loss, and osteoporosis in menopause.
Fifty-one percent of humans are born with ovaries. As the ovarian production
of estrogen diminishes in midlife and ultimately stops, it is estimated that
more than 47 million women worldwide enter the menopause transition annually.
More than 70% will experience musculoskeletal symptoms and 25% will be disabled
by them through the transition from perimenopause to postmenopause. This
often-unrecognized collective of musculoskeletal symptoms, largely influenced
by estrogen flux, includes arthralgia, loss of muscle mass, loss of bone density
and progression of osteoarthritis, among others. In isolation, it can be difficult
for clinicians and patients to adequately appreciate the substantial role of
decreasing estrogen, anticipate the onset of related symptoms and actively treat
to mitigate future detrimental processes. Thus, in this review we introduce a new
term, the musculoskeletal syndrome of menopause, to describe the collective
musculoskeletal signs and symptoms associated with the loss of estrogen. Given the
significant effects of these processes on quality of life and the associated
personal and financial costs, it is important for clinicians and the women they
care for to be aware of this terminology and the constellation of musculoskeletal
processes for which proper risk assessment and prophylactic management are of
consequence.
Keywords: Musculoskeletal system; estrogen deficiency; menopause; perimenopause.
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Every year, about 1.3 million American women enter menopause—the stage of life when
your estrogen levels diminish and your periods stop completely. It’s a natural part
of aging and nothing to fear.
That said, the symptoms of menopause—including hot flushes, low sex drive, trouble
sleeping, weight gain, UTIs and vaginal dryness, brain fog, heart palpitations, muscle
and joint aches, and mood changes—can be miserable and debilitating. You also lose the
health benefits of estrogen itself, like heart and brain protection, says Avrum Z.
Bluming, MD, a hematologist and medical oncologist who has spent decades investigating
the benefits of estrogen. Women can avoid many of these problems with one treatment:
hormone replacement therapy, or HRT. Alternatively called MHT, for menopausal hormone
therapy, HRT refers to the combination of estrogen and progesterone given to women who
still have their uterus; estrogen alone is given to women who have had a hysterectomy.
Unfortunately, HRT remains controversial, due mostly to the results of the decades-old
Women’s Health Initiative, the largest study done on the health of postmenopausal women
in the United States. In 2002, findings from the WHI were released suggesting that women
on HRT had greater risks of heart disease, stroke, dementia, and, scariest of all, breast
cancer; as a result, millions of women of menopausal age either quit or avoided it at all
costs. Subsequent studies have walked back these claims, but many women remain gun-shy
about taking estrogen. The fallout has been enormous: Among menopausal women in the
United States, just under 5 percent are currently on HRT, and it’s been estimated that
between 2002 and 2012, over 90,000 American women died prematurely, mainly from heart
disease, as a result of avoiding HRT.