Part 1 of 3 Part Series


In the intricate journey of menopause, one aspect overshadowed by symptoms like hot flashes and mood swings, often remains in the background,: the persistent and perplexing issue of joint and muscle pain. Though research shows that joint pain during menopause is more common than hot flashes, it’s rarely discussed as a typical symptom. Many women, therefore, go through this period of time thinking arthritis is setting in or the joint pain is just part of aging. That’s not necessarily true.

In Part One of our three-part series, we will uncover the intricate interplay of hormones and how this likely contributes to joint and muscle pain in menopause.

Pain in Menopause

During menopause, women often experience a variety of symptoms that can affect their daily lives. We all have either heard about or experienced first-hand, hot flashes, weight gain around the middle, dryness in places like the vagina that shouldn’t be dry, hair thinning, and even dryer skin in general. But what many people don’t realize or recognize is the new muscle aches, or pain in your joints is also one of the most common symptoms of menopause.  I started to experience hip pain that extended down my leg when I turned 50, for no apparent reason.  I hadn’t had any physical trauma to my hip and there was no sign of arthritis.  I know I am not alone. My patients in their late 40’s and early 50’s tell me all the time they started noticing joint and muscle pain popping up here and there.  Sometimes, the pain was related to new activity, but many times, it seemed to show up when they had tried something new like pickleball, but it also seemed to be occurring even if they had been doing the same workout for years.  When we talked about these unwelcome symptoms, the joint aches and pains, many times, could be traced back to when their periods stopped or started to become irregular. But this time around, where a bit of rest and ice would eliminate the symptoms would have eliminated their symptoms in the past completely, the symptoms didn’t seem to want to go away. These symptoms, which can literally be a pain in the a$$, are often written off as just a part of aging or arthritis. But it is that the whole story?

What Causes Joint Pain In Menopause?

Could Hormones Be The Culprit?

As you know menopause is a time of significant hormonal change. We look forward to the day when we don’t have to deal with our period every month. And then wham, some of us are hit with a tidal wave of new symptoms to deal with. But what you may not have known is the decline in estrogen and progesterone levels have direct links to joint and muscle pain as well.

Both estrogen and progesterone have an anti-inflammatory effect on the body (Who knew?) Depending on whether a woman is menstruating or not, estrogen has been shown to contribute to the modulation of pain, i.e., it can either contribute to pain or protect us from pain depending on its levels and how it is balanced with progesterone. Sudden swings of estrogen, tend to be related to pain. 

Progesterone, which decreases in menopause along with estrogen, has been shown to have protective effects against pain as well. For example, research has shown that women who are still menstruating tend to feel less pain in the second half of their cycle (unless endometriosis or other issues related to excess estrogen are present). And sudden drops in progesterone in a menstrual cycle have been associated with increased pain leading up to the period. Like estrogen, when progesterone lowers in menopause, women can lose some of its protective effect, resulting in muscle and joint pain and stiffness. 

Finding out where these hormones levels are sitting during perimenopause or menopause is helpful in so many ways. The cessation of the ovary’s ability to make estrogen or progesterone leads to menopause. But our body does still make these two hormones. The adrenals and thyroid help to create both estrogen and progesterone women while women are menstruating, and they continue to help produce it after the ovaries slow down or stop making the hormones. Therefore, it’s extremely important to assess these hormones, as well as estrogen and progesterone, to address the many symptoms of menopause, including muscle and joint pain.

Gut Health and Menopause Symptoms

New research is exploring how the changes in menopause correlate or potentially cause changes in the gut microbiome, impacting overall health, including joint well-being. A little-known fact related to the gut is that it helps us metabolize our hormones, including estrogen and progesterone, meaning the gut helps us with breaking hormones down to get out of the body but the gut also let’s hormones in the system by either recycling them or allowing some hormones from outside our body (i.e. environmental exposures, or medications) into the system/circulation.

Estrogen and progesterone help keep up the diversity in the gut microbiome. Diversity, as related to the gut, essentially refers to the many different types of species of bacteria (both “good” and “bad”) living alongside each other in the gut. The goal is to keep the trillions of bacteria that our body houses in balance, i.e.,  having more “good” bacteria than “bad” bacteria . At this time, it is believed that a healthy gut is diverse and leans in the direction of more “good” bacteria, than “bad”. 

Therefore there is a symbiotic relationship between the gut microbiome and hormone balance. In menopause, when estrogen and progesterone decrease, this can impact the gut microbiome by decreasing its diversity, which may, in turn, contribute to the onset of inflammation in the joints due to the gut-joint axis. (More info about the gut-joint axis here.) The amount of change and the balance of gut bacteria, though impacted by hormonal changes, also highly depends on a person’s lifestyle and diet.  

Should I Take Hormones To Help With Joint and Muscle Pain?

Many people understand that hormones have an incredible effect on our well-being, so it’s natural that many women are turning to hormone therapy to help with their symptoms. But in my opinion, supplementing with hormone creams are often a downstream intervention that definitely improve symptoms in the short term but don’t often address the cause of the issue in the first place AND can lead to some other issues down the road.

Some would disagree with me saying that if a woman is low in estrogen or progesterone giving them those hormones is addressing the cause, especially if the cause is menopause. However 25% of women go through menopause without issue so is the lowering of these hormones the main cause? Or is it just an effect of other factors that, if addressed, would naturally improve the balance of the hormones that remain in menopause? Do hormone creams and pills work? If given correctly, yes, but there can be a downside.  

Feedback Inhibition and Hormone Replacement

Feedback inhibition is a negative effect of using hormone replacement therapy regularly. This is true whether a person is taking bioidentical hormones or whether the hormones are not bioidentical. Taking a hormone exogenously (from outside the body) can decrease the amount of that hormone your body makes on its own. One example of this is men who are taking testosterone often experience hypogonadism (testicles getting smaller) and lowered or absent production of sperm. When women take the oral contraceptive pill, these hormones inhibit hormones that the brain would normally produce to stimulate the development of follicles and eggs.  

In menopause, when you start taking hormones, this can decrease your body’s own production of the smaller amount of hormones that are already reducing naturally. This can result in dependence upon these hormones for the long term. Any hormone that we take from outside of the body, whether it be thyroid hormone, estrogen, or progesterone, has the potential to decrease the amount of hormone we naturally make. This can cause the brain to stop stimulating the glands that are supposed to be making the hormones because the body thinks it must have enough already.

I feel that the hormone replacement approach, though appealing and doesn’t appear to be associated with cancer as previously thought, is a step to consider AFTER addressing your eating plan, lifestyle choices, exercise program, sleep pattern, stress management has been addressed and is still not working. I have seen patients in the clinic that have taken hormones for the long term (greater than 6 months) which ended up creating other hormone imbalances and caused other symptoms such as weight gain, fatigue, and generally feeling unwell. And I have seen women taking hormones try to come off them and suffer similar symptoms that caused them to go on the hormones in the first place.

Hormone therapy needs to be closely monitored and adjusted appropriately. Hormones are not like nutritional supplements. Hormones have an almost immediate impact on the body and, if not balanced well, can impact other hormone as well. I do see them being beneficial for a few months if the patient is really suffering. This can give the patient time to make the necessary changes they need for long-term health without needing to use hormones long term.  But if someone is on hormones for more than 6 to 12 months, it can be difficult or in some cases impossible for them to stop taking the hormones and maintain feeling well.

There are several alternatives to taking hormones including addressing nutritional deficiencies, adrenal and thyroid health, as well as stress management and adjusting their eating plan. A personalized supplementation program including nutrients and herbs has done the trick for many of my patients.

Your Next Step

If you are struggling with joint and muscle pain during periomenopause or menopause and want a natural approach. Our team is here to help. Visit us for a personalized assessment and to explore treatment options tailored to your needs. Let’s work together to manage your menopausal symptoms effectively, get rid of your joint and muscle pain, and help you feel the best you have felt in your life. Call 414 299 8121 for more information.

In next weeks blog post we will discuss how to address joint and muscle pain in menopause through diet and nutrition, and part three will discuss personalized supplementation and cutting edge technology to address menopausal joint and muscle pain.

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