Menopause & the Musculoskeletal System: What's the Connection?

You’ve heard of it. Hot flashes, mood swings, sleepless nights. Dry skin, hair loss, achy joints, brain fog, weight gain. All of these symptoms are commonly associated with menopause, which is “the change” that anyone with ovaries will experience at some point in their lives. 

“Clinician awareness of the musculoskeletal syndrome of menopause is critical as an estimated 70% of all midlife women will experience the musculoskeletal syndrome of menopause. (Lu CB, Liu PF, Zhou YS, et al. Musculoskeletal pain during the menopausal transition: a systematic review and meta-analysis)

Though many people recognize these symptoms as being associated with menopause, most don’t realize that musculoskeletal symptoms (i.e. joint pain, joint stiffness, muscle pain) are also very common in this population

Why is this important? Well, I find that some symptoms reported by patients may very well be triggered by hormonal changes and this connection is often overlooked. Understanding this connection doesn’t necessarily mean we have all of the answers for our patients, but it does help with their own understanding of what is going on with their body and how their overall prognosis may be different than a person who is not experiencing pre- or peri-menopausal symptoms. 

So, why does this happen? 

Estrogen directly affects the structure and function of bone, muscle, tendon and ligaments, which can lead to a significant change in musculoskeletal function. By recognizing this, we can help people before, during AND after menopause by preparing both them and their bodies for the changes that their tissues will experience. 

What happens to our muscles?

Estrogen helps protect our muscles by decreasing the rate at which they are broken down. This affects all skeletal muscles within the body and might explain why a woman may start to develop more muscular injuries or aches and pains, even when participating in their regular activities, as they approach menopause. Muscle mass becomes harder to maintain as estrogen levels fall, so subtle strength imbalances can become more apparent as you approach menopause and can lead to joint and muscle pains you may not otherwise experience. 

Estrogen also regulates the production of cortisol, a stress hormone, in the body; when Estrogen levels drop, the cortisol levels rise. Higher levels of cortisol are often associated with stress responses, which can cause muscle tension and pain throughout the body. 

Ligaments and Tendons?

Estrogen helps to make our connective tissue flexible and supple by increasing the collagen content, while also reducing the activity of an enzyme that makes the collagen in our ligaments stronger. With both a reduction in the collagen content of connective tissue and the decrease in the activity of the enzyme mentioned above, both caused by decreased estrogen, we see a reduction in the overall tensile strength of our connective tissue. 

Stiff tendons and ligaments do not stretch well and weak tendons and ligaments do not withstand the loads placed on our joints and muscles well. This can lead to increased load on muscles and inflammation in the tendons that support them. 

This can show up as pelvic pain, rotator cuff tendinopathy, low back pain or plantar fasciitis to name a few common issues I see in the clinic. 

How do we Minimize the Impacts of Menopause on our Musculoskeletal System?

Exercise is the most effective lifestyle strategy to maintain healthy bone and muscle. A combination of both progressive resistance training and weight bearing exercises can assist in improving and maintaining bone density, as well as increasing muscle mass and strength. 

This can be difficult for some people to do, since pain, stiffness or lack of experience can limit their participation in strength training activities, but it’s never too late (or too early) to start taking action!

Take the time to see a skilled Physical Therapist or Strength coach to figure out how you can manage any symptoms you have while getting STRONG!