Moving Through Menopause: Adapting to Body Changes
How to combat the common ailments of joint pain and muscle and bone loss
During midlife and menopause, many women may experience often-unrecognized changes that impact their musculoskeletal system that includes muscles, tendons, joints and bones. I spoke with menopause experts about steps women can take to maintain and improve their quality of life during and after this transition.
It is estimated that "70% of midlife women will experience a new onset of musculoskeletal pain," according to Diedra R. Manns, a physical therapist and certified menopause health coach in Santa Monica, California. She explains this can be related to the estrogen depletion that occurs during menopause. Although there can be other causes of musculoskeletal pain, Kathleen Jordan, M.D., chief medical officer of Midi Health, says that menopause should be kept in mind, especially if the pain happens around the time of other signs and symptoms of menopause such as a change in menstrual periods or hot flashes.
"We know one of the most common menopause symptoms is joint aches and that's just more recently recognized."
Stephanie Faubion, M.D., director of the Mayo Clinic Center for Women's Health and Medical Director for The Menopause Society explains, "We know one of the most common menopause symptoms is joint aches and that's just more recently recognized." While everyone experiences menopause symptoms differently, joint pain and stiffness may range from a minor annoyance that comes and goes to a long-term problem that can decrease women's day-to-day quality of life. Manns says women can find themselves having no pain previously and waking up one day being in significant pain. "It could be all over their body; it could be in single joints."
Women experiencing menopause are also likely to be undergoing age-related changes, such as muscle and bone loss. Some bone loss is normal and happens in both men and women. In some women, bone loss is worsened during menopause as estrogen levels decrease. When bones reach a certain stage of weakness, known as osteoporosis, the risk of fractures from minor falls or even performing everyday activities increases.
Faubion explains that starting in midlife, both men and women start to experience muscle loss. "It's about 0.8% of our muscle mass per year, so almost 1%. That's a lot of muscle mass loss ... and that adds up over time." She adds that this decrease in muscle mass can put women at a higher risk for falls, subsequent fractures and decreased independence.
Keep Moving
The good news is there are effective lifestyle modifications and treatments women can talk about with their health care provider before, during and after menopause. Manns reminds women that it is possible that they may live several decades after the menopause transition. How they treat themselves and the decisions they make now will impact their longevity and quality of life going forward.
"Sometimes job and career changes encourage women to become more sedentary and less active. Staying active becomes hugely important and has to be a focus in midlife," Jordan says. She adds that exercise can help improve muscle strength, optimize bone health, help metabolism and keep women healthy and active longer.
"Staying active becomes hugely important and has to be a focus in midlife."
When explaining why being active in midlife is beneficial, Kelly Baez, a physical therapist in Tampa Bay, Florida, says, "You're requiring those muscles and bones to be able to keep up with that activity and amount of resistance." She adds that when performed regularly and correctly this builds the bone and strengthens the muscles.
Baez also advises women to consider being evaluated by a physical therapist if they have any concerns about becoming more physically active, are no longer able to keep up with their normal routine, or see a decline in their ability to perform day-to-day activities.
For women who have a new diagnosis of osteoarthritis or osteoporosis, Manns says, "You should seek advice and treatment from a physical therapist before you go to any gym to understand how to move appropriately and how to prevent potential fractures. Your physical therapist can help you understand how to protect yourself and guide you so that you can exercise safely."
Other Changes
Sleep disturbances are a common symptom of menopause. Jordan says that in this time of life, two-thirds of women experience major sleep disruptions. In her practice, she's seen that healthy sleep hygiene habits can be helpful — as can hormone therapy. "Focus on getting a good night's sleep. It really does help you feel better and positively impacts your health," Jordan says. "It makes you be more active in the day. If you have more energy, being active in the day helps you sleep." This can help women get in a positive health cycle. She cautions that sleeping medications should only be used for extreme situations or time zone changes and are not intended for routine, nightly or long-term use.
Metabolism and body composition changes such as bone and muscle loss can contribute to a decrease in women's calorie needs during midlife and menopause, compared with when they were younger adults. However, these changes may require women to maintain or increase their intake of certain nutrients. Choosing foods that are nutrient-dense along with physical activity can help women adapt to these changes. Jordan explains, "The hormone depletion actually triggers a lot of change." By appreciating that a lot is changing and making changes for themselves, women can stay feeling great. She adds that midlife is a good time to make dietary adjustments to help women feel their best.
"Focus on getting a good night's sleep. It really does help you feel better and positively impacts your health."
While there currently isn't research data to support the use of hormone therapy to treat joint aches or muscle loss, Faubion explains, "It is FDA-approved to reduce bone loss and prevent fracture, [and] approved to prevent osteoporosis." Because menopause symptoms and women's medical histories can vary widely, women can make informed decisions about hormone therapy by discussing the different forms, types, benefits and risks with their health care provider.
Jordan reminds women, "The message should not be, 'Welcome to midlife and welcome to old age: You are meant to feel bad the rest of your life.'" By paying attention to and understanding how their bodies are changing during midlife, women can instead become empowered to take steps to feel their best during menopause and beyond.
