Menopause and Chronic Pain

November 13, 2015

Some women in menopause suffer with generalized achy muscles, bones and joints. “Menopausal women have a number of reasons to have aches and pains,” says Dr. Nathan Wei, The Arthritis Treatment Center, based in Frederick, Maryland, which was named one of the top 10 private arthritis research centers in the country by Rheumatology Research International.  “The first is osteoarthritis, the most common form of arthritis after the age of forty which is a disease of cartilage that affects weight-bearing joints.”

Dr. Nathan Wei

Dr. Nathan Wei

“The cause of menopause related pain is usually multi-factorial,” says Dr. Angela DeRosa, DO, MBA, CPE, founder of DeRosa Medical with offices in Scottsdale, Glendale, Chandler, and Sedona, Arizona.   “Estradiol deficiency causes decrease in collagen structure and joint health which causes increase in joint pain.  Women struggle with sleep which does not allow for proper rest and restoration of the body at night.  Estrogen deficiency also makes the vagina dry and uncomfortable which leads to painful sex.”

As a respected, internationally recognized authority on women’s hormonal health, Dr. DeRosa understands the range of health issues women face leading up to and during menopause. She experienced early menopause at age 35, with symptoms beginning in her mid-twenties, while she was attending medical school. In her quest to find out what was happening to her, it became clear that understanding, research and treatment for this critical phase of women’s health was woefully inadequate.

Dr. Landherr

Dr. Landherr

“While there is no ‘one-size-fits-all’ solution to menopausal pain, it’s important to communicate with your doctor openly so that the two of you can formulate a strategy for overall wellness and comfort during this often tumultuous time,” said Dr. Kathryn M. Landherr, MD, Board Certified OB/GYN.  “An integrative approach to treatment that considers nutrition, lifestyle adjustments and natural supplements can help address a number of disruptive menopausal symptoms.”

“There are various types of pain and discomfort associated with menopause,” says Dr. Landherr.  “The most common are the result of chronic inflammation – such as bone, joint and muscle aches.  Studies have made a connection between estrogen level and joint pain. As the body’s production of hormones changes during menopause, the loss of estrogen can cause inflammation.  Inflammation and accompanying pain can also result from high cortisol levels.  Long-term stress, common for some women going through menopause, and somewhat controversial “adrenal fatigue” that has been associated with peri-menopause can potentially result in higher cortisol levels.  Another common menopause-related pain includes tenderness of the breasts – much like the fluctuating hormones of our monthly cycles caused these symptoms, the changing hormone levels in our menopausal bodies have similar effects.  Probably one of the most significant pains related to menopause is painful intercourse, which is caused the lack of estrogen in the vaginal tissues, leaving it dry and much less distendable and unresponsive to the normal sexual response cycle.”

“Testosterone deficiency (which all menopausal women suffer from as well as the ovaries make estrogen and testosterone) causes joint pain, muscle atrophy and pain as well as increase in firing from pain fibers,” says Dr. DeRosa.  “Testosterone deficiency also causes weight gain which puts more stress on the body.

Dr. Angela DeRosa, founder of DeRosa Medical

Dr. Angela DeRosa, founder of DeRosa Medical

“Many women become vitamin D deficient during this time which can cause ‘fibromyalgia’ like joint and muscle pain,” says Dr. DeRosa.   “In addition, one in two women struggle with sub-optimal thyroid function or hypothyroidism which causes joint aches and pains as well as muscle and weight gain.  By the time a woman is in menopause, it is likely she is struggling with a combination of these issues.   Furthermore, if a woman is overweight the pressure on the joints and skeletal structure can cause increase in pain and dysfunction.”

“A number of other forms of arthritis also commonly occur in the menopausal age group,” says Dr. Wei.  “These include rheumatoid arthritis and interestingly, gout which may develop due to the body’s reaction to the loss of estrogen. In my practice, the most common forms of arthritis that cause pain with menopausal women are rheumatoid arthritis, osteoarthritis and fibromyalgia.”

Weight and menopause go together like peanut butter and jelly for some women.  “Post-menopausal women sometimes have a weight issue,” adds Dr. Wei.  “The additional weight aggravates aches and pains, not just because of the mechanical effect, but also because fat cells produce leptins; proteins that aggravate inflammation. Women are encouraged to follow a diet that is high in brightly colored fruits and vegetables which provides anti-oxidants and anti-inflammatory effects.”

“It’s important to follow a low glycemic diet with moderation on alcohol and caffeine,” says Dr. DeRosa.  “Avoid inflammatory foods such as high sugar, high fat foods as well as ‘white’ processed foods. Eat plenty of fruits and vegetables. Avoid stress or find ways to cope with stress as stress increases cortisol which leads to inflammation and weight gain.”

“Since much of the pain experienced by menopausal women is caused by inflammation, an anti-inflammatory diet can be helpful in relieving symptoms,” recommends Dr. Landherr.  “The “Anti-Inflammatory Food Pyramid” is a good reference tool.  In general, for my peri-and post-menopausal patients, I recommend a diet high in lean proteins and limiting sugar and refined carbohydrates. There is also evidence that Omega 3 fatty acids can help with side effects of menopause, including reducing inflammation, improving mood and helping to reinforce heart and bone health which are at greater risk in menopausal women. Some good sources of Omega 3s are eggs, salmon, walnuts and ground flaxseed.”

“Exercise can help by strengthening muscles, ligaments, and tendons that support joints and also help with weight loss,” says Dr. Wei. “All women, but particularly menopausal women, need to be involved in a regular exercise program that incorporates cardio, resistance and stretching.  This helps with all organ functions, prevents fractures and improves mood.”

“The best exercise recommendations are stretching exercises and yoga and/or Pilates which aid in core strength and balance,” says Dr. DeRosa.  “Walking is always good for the body.”

“There is a growing body of evidence that mind-body practices such as yoga, meditation, tai chi, qui gong and acupuncture may benefit women during menopause,” says Dr. Landherr.  “Small studies have shown that these practices can be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.  As with other protocols, these practices may have different effect for different women.  But considering the low risk of practices like mindful meditation, I advise my patients that it’s worth exploring.”

Are there safe OTC medications to ease menopausal-related aches and pains?  “The Salonpas®  products are a  nice natural way to aid muscle aches and  joint aches and pain by decreasing local inflammation which avoids the needs to take a systemically absorbed product,” says Dr. DeRosa.  “EstroG-100 can help alleviate hot flashes, vaginal dryness, joint aches and pain associated with estrogen deficiency in menopausal women. This product is a blend of herbal substances which mimic estrogen action in the body and reduce the symptoms associated with menopause.”

“I often recommend that women consider nutritional supplements to address the changes in their bodies that occur as a result of menopause,” says Dr. Landherr.  “Beyond nutritional support, some supplements specifically address common symptoms of menopause. Most recently, there has been good clinical research on a specific type of maca – a root grown in the Peruvian mountains – that works to stimulate the body’s own hormone production.  In the studies of this ingredient, available under the brand name Femmenessence, more than eight in 10 women experienced relief from common menopause symptoms.”

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