I’m curious what we know about joint pain and aching muscles in perimenopause. The past few years, I have had way more aches and pains with movement, despite doing more in terms of exercise (strength and mobility work). My pain and tightness seem to be more in the muscles and ligaments than in between the bones (in the joints themselves). It is definitely more than just fatigue from exercise. Is this something that HRT potentially could help with?
—Dreaming of pain-free movement again
It feels like such a cliché that we get stiffer and achier as we get older, but the data suggests that it is true. In the Study of Women’s Health Across the Nation (SWAN), a longitudinal study of more than 3,000 women followed through the menopausal transition, the participants were not asked about muscle and joint pain, but they were asked questions about their physical functioning. About 20% of the participants reported moderate or substantial limitations in physical activity.
The authors note that there was a great deal of variability in the results over time, with upward of 42% of participants reporting any physical limitations at one time point but only 26% reporting limitations at a subsequent study visit. This suggests that musculoskeletal symptoms may ebb and flow over the course of the menopausal transition. It is worth noting that only 32% of SWAN participants reported never having any limitation to their physical functioning.
In medicine, we do think that the types of musculoskeletal symptoms that you describe are, like most symptoms of menopause, related to dropping estrogen levels, though there is no direct evidence supporting our hypothesis. We know that women who have surgical menopause or take estrogen blockers to prevent the recurrence of breast cancer have more severe musculoskeletal symptoms. We think this is related to the sudden and dramatic drop in estrogen and the fact that those women have estrogen levels of essentially zero.
It follows that estrogen might improve these symptoms. There is very little evidence and a lot of speculation on this topic in the literature. What data there is is focused on loss of muscle mass as opposed to symptom management.
My typical approach is to discuss the severity of my patient’s musculoskeletal symptoms and consider whether she has other symptoms, such as hot flushes or night sweats, that might be improved with hormone replacement therapy. Then we consider her risk profile and decide whether to try it. I always try to be clear that we don’t have good data regarding whether HRT is helpful for these particular symptoms. If when we check in again after a few months the symptoms are not improved, we might consider stopping HRT.
The takeaway: Musculoskeletal pain is a common symptom of perimenopause. We do not have evidence that estrogen improves these symptoms, but it would be reasonable to talk to your doctor about trying HRT to see if your symptoms improve.
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