When the Women’s Health Initiative (WHI) study was published in 2002, women across America, including my patients, flushed their hormone therapy down the toilet when they learned the estrogen they had been prescribed would give them breast cancer. Which of course, we now know is not true.
I expected droves of estrogen-deprived women to complain of hot flashes, insomnia, and vaginal dryness, and they did. But what I did not expect were the women who complained of joint pain. I am embarrassed to admit that the first time a patient told me that since she stopped her estrogen, she could barely make it through a game of tennis her joints hurt so much, I told her it was likely unrelated. I referred her to an orthopedic surgeon. He was as clueless as I was and diagnosed fibromyalgia.
Over subsequent months, I saw an increasing number of patients who begged to restart hormone therapy, not just because of hot flashes and insomnia, but also because of achy, stiff, painful joints.
It didn’t take me long to appreciate an association between stopping estrogen therapy and the worsening of arthritis.
Given that the entire musculoskeletal system is loaded with estrogen receptors it is hardly surprising that the loss of estrogen would have a profound impact on not just bones, but also joints and muscles.
Yet here we are 20 years later, and the majority of medical professionals do not appreciate or address the impact of menopause on joints, mobility, muscle wasting, and strength. But, Dr. Vonda Wright, an orthopedic surgeon who has observed these changes in many of her patients, has been on a mission to change that.
Vonda Wright MD coins the term “Musculoskeletal Syndrome of Menopause”
The Musculoskeletal Syndrome of Menopause is a term recently introduced by Dr. Wright to describe the typical symptoms impacted by the precipitous drop in estrogen surrounding the menopause transition.
Earlier this year after I heard Dr. Wright speak, I invited her to be a guest on my podcast. We had a fascinating conversation and discussed how a lack of estrogen sabotages the ability to be active and that lack of activity impacts not only bone health and cardiovascular health but also cognitive function. It was eye-opening for me and the thousands of women who downloaded that episode.
One major theme we keep returning to is the lack of awareness of the impact of menopause on the musculoskeletal system. In most cases, symptoms like frozen shoulder, joint pain, and muscle wasting are simply attributed to aging.
Women are twice as likely to develop osteoarthritis as men. Women are twice as likely to end up in a nursing home with dementia and frailty linked to inactivity. It’s hard to chalk it up to just aging.
Since it was my most downloaded episode of 2024, I decided to close out the year with an update.
At the time of the original recording, Dr. Wright had not yet published her work in a scientific journal. Therefore the term Musculoskeletal Syndrome of Menopause was not recognized or known by the scientific community. That changed in July of this year when her groundbreaking paper was published in Climacteric, The Journal of the International Menopause Society.
For the first time, there was a medical definition and description of the joint, muscle, and bone changes that occur during the transition from pre-menopause to post-menopause. When most scientific papers are published, it’s rare for the scientific community to take notice, much less the public. But suddenly, the Musculoskeletal Syndrome of Menopause was being talked about everywhere including a New York Times article titled- Has Menopause Made You Ache All Over? There’s a Name for That.
As a result of Dr. Wright’s work, there has been an increasing awareness on the part of not only women but also medical professionals about the profound impact menopause has on the entire musculoskeletal system along with the downstream impact of being sedentary on cognitive function and life expectancy. And, just as important, there is an increasing understanding of how specific lifestyle changes can prevent or minimize the chances of long-term catastrophic events.
I encourage you to read the paper to understand the downstream impact of these musculoskeletal changes fully. In it, Dr. Wright describes the symptoms women experience including musculoskeletal pain, joint pain, loss of lean muscle mass, loss of bone density with increased risk of resultant fracture, increased tendon and ligament injury, adhesive capsulitis and cartilage matrix fragility with the progression of osteoarthritis.
Specifically
o Inflammation: Estrogen is an inflammatory regulator that plays a role in the prevention of arthralgia (joint pain). More than half of perimenopausal women report arthralgia symptoms.
o Impact on muscle mass: Estrogen stimulates the activation and proliferation of muscle satellite cells. Muscle satellite cells promote muscle regeneration. There is data that suggests that, in the absence of estrogen therapy, a decrease in satellite cells may compound osteopenia/osteoporosis and increase frailty due to difficulty in generating muscle power and adequate regeneration.
o Bone density: Between 30% and 50% of women suffer a clinical fracture in their life and 70% of hip fractures occur in women
o Cartiledge damage and osteoarthritis- While both mechanical and biochemical factors contribute toward the osteoarthritis progression, it is understood that osteoarthritis incidence in women increases dramatically around the time of menopause and recent literature claims that women experience more debilitating arthritic pain than men
Taken from: Wright VJ, et al. The musculoskeletal syndrome of menopause. Climacteric. 2024 Oct;27(5):466-472.
Musculoskeletal Syndrome of Menopause is not rare!
More than 70% of post-menopause women will experience musculoskeletal symptoms.
25% will be disabled by them through the transition from perimenopause to post-menopause.
· The six symptoms of musculoskeletal syndrome of menopause
· The relationship between musculoskeletal syndrome of menopause and dementia
· Why frozen shoulder is the number one complaint
· The relationship of menopause to osteoarthritis
· The impact of mobility on cognitive function
· The impact of menopause on frailty
· The impact of testosterone on musculoskeletal syndrome of menopause
· Exercise and cancer risk reduction
· How heavy your weights should be to increase muscle power
Most importantly, Dr. Wright recommends specific action steps to prevent or minimize the chances of long-term catastrophic events.
So, read the paper, listen to the podcast, and in 2025, make it your goal to take steps to increase the odds of staying active and cognitively intact as you age!
And stay tuned for Dr. Wright’s book coming out in 2025!
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Excellent article and podcast. (I listened to the podcast while lifting weights!) Now for the challenge of finding a gynecologist who knows and uses this information. Thank you for this.
Excellent article and podcast. (I listened to the podcast while lifting weights!) Now for the challenge of finding a gynecologist who knows and uses this information. Thank you for this.
Amen! What a great topic.