Musculoskeletal Syndrome of Menopause: What You Need to Know

What you need to know about the musculoskeletal symptoms of menopause

Changes to bone and muscle health aren't talked about as widely as other menopause symptoms, yet about 71% of all women will experience menopause-related symptoms in their bones and muscles.⁽¹⁾ The signs and symptoms range from decreased flexibility and muscle weakness to joint pain to more severe problems, such as adhesive capsulitis (more commonly known as frozen shoulder), that can cause severe pain and difficulty with movement.

The Musculoskeletal Syndrome of Menopause is a new term coined to help classify this group of symptoms. Knowing what to look for will help you better care for yourself and discuss concerns with a healthcare provider.

Menopause, Estrogen, and Musculoskeletal Health

Bones, muscles, tendons, ligaments, and joints are known collectively as the musculoskeletal system. Estrogen plays a crucial role in musculoskeletal health and estrogen in the form of estradiol helps reduce joint pain by reducing inflammation and changes to cartilage.^(2,3) Estradiol, the primary form of estrogen being produced during a woman’s reproductive years, supports muscle strength by reducing muscle breakdown and boosting cells that aid in muscle health.⁽⁴⁾ It also slows the breakdown and remodeling of bone, as well as the destruction of cartilage and reduces the body's inflammatory response.

When someone enters the menopause transition, estradiol is no longer the primary estrogen. Estrone, a weaker form of estrogen, replaces estradiol, and this weaker version cannot preserve the musculoskeletal system as effectively leading to loss of muscle mass, decreased bone density and cartilage.⁽⁴⁾ The resulting physical changes are:

• Muscle weakness
• Reduced flexibility
• Poor balance
• Increased risk of falls
• Osteoporosis (a disease that causes bones to become weak and brittle, making them more likely to break)

When these physical changes occur, women tend to report increased pain. The pain comes from:

• Frozen shoulder
• Tendonitis
• Arthritis in hands, shoulders, knees, and hips

The Musculoskeletal Syndrome of Menopause

For many years, researchers have linked menopause to musculoskeletal pain. Studies show menopausal women are more often diagnosed with arthritis than premenopausal women, and a review of research found that 71% of post-menopausal women experienced musculoskeletal pain. In addition, their pain was described as being more severe than that experienced by women in peri-menopause, with about 25% of women enduring severe symptoms.⁽¹⁾

Dr. Vonda Wright, my friend and colleague, is doing outstanding work in this area and was part of the team of researchers responsible for coining the term Musculoskeletal Syndrome of Menopause. This term encompasses the signs and symptoms of the musculoskeletal system women experience with the loss of estrogen during the menopause transition and encompasses:⁽¹⁾

• Pain to muscles, joints, bones, tendons, and ligaments
• Arthritis and worsening osteoarthritis
• Loss of muscle mass
• Decreased bone density
• Increased risk of bone fracture
• More frequent injuries to tendons and ligaments
• Frozen shoulder

Frozen shoulder affects women four times more often than men and occurs most often between the ages of 40 and 60.⁽⁵⁾ Although it’s a common problem, doctors haven't traditionally associated with menopause, and it can become debilitating. If a woman is experiencing frozen shoulder, the joint becomes stiff with decreased movement and pain and typically symptoms worsen over time making it very difficult to move the shoulder. Symptoms can improve with physical therapy, however, complete recovery can take up to three years!⁽⁵⁾

Managing Musculoskeletal Symptoms

Treatment for musculoskeletal symptoms starts with self-care. You can provide a good foundation for your musculoskeletal health even before the menopause transition begins.

Exercise

Exercise is one of the most fundamental methods of maintaining musculoskeletal health.

• Resistance training helps to increase bone mass, reducing the risk of osteoporosis. In turn, this will reduce low back pain and bone fractures. Aim for strength or resistance training with moderate intensity two to three times a week.
• Exercises such as t'ai chi, yoga, or Pilates improve balance and decrease the risk of falls. These exercises can also help reduce pain from osteoarthritis by increasing flexibility and range of motion of the joints.⁽⁶⁾
• Focused exercises on specific areas, like the shoulder, can improve range of motion and help decrease pain. Dr. Wright has a video demonstrating exercises she recommends for frozen shoulder.

Diet

A solid base of vitamins and minerals helps to keep bones strong and reduce symptoms related to poor bone health. The majority of these should come from food sources.

• Calcium helps keep bones strong and not consuming enough calcium can increase the risk of developing osteoporosis. It’s best for the majority of your calcium needs to come from food sources because supplements just aren't as effective. Adults over the age of 50 should aim for 1,200 mg of calcium a day.
• Vitamin D in the diet helps to improve bone density and reduce falls. The skin produces vitamin D when exposed to ultraviolet light from the sun but with aging and limiting skin’s exposure to the sun, it’s challenging for our bodies to make enough on its own.⁽⁷⁾ Adults over age 50 should consume 800-1,000 iu of vitamin D each day.
• Magnesium helps to boost vitamin D levels and slow osteoporosis. Women especially, should consume 320 mg of elemental magnesium a day. As with calcium, it's best to get magnesium from foods, but supplementing may be helpful.
• Omega-3 fatty acids reduce inflammation. This can reduce pain and stiffness in joints. I encourage you to eat at least one great source of omega-3 each day, but you can supplement as well if you wish.

When to Seek Medical Help

If self-care is no longer helping, and your symptoms are worsening or you’re experiencing musculoskeletal pain or weakness that is affecting your daily life, it’s time to see a healthcare provider

Healthcare professionals can offer testing and more treatment options including:

• Screening for osteoporosis with a DEXA scan to assess bone density levels
• Treatments for musculoskeletal symptoms, such as pain medications or joint injections
• Physical therapy
• Consideration for hormone therapy

Musculoskeletal health is often an underappreciated concern during menopause, and poor musculoskeletal health raises many risks. Knowing the signs and symptoms of musculoskeletal syndrome of menopause, staying physically active and eating the right foods will help reduce those risks.

More information:

Dr. Vonda is an orthopedic surgeon and researcher at the foreftong of the musculoskeletal syndrome of menopause. I recommend you follow her on Instagram @drvondawright to continue learning how to thrive during this phase of life.

If you’re interested in learning more about frozen shoulder, visit the American Academy of Orthopaedic Surgeons.