The Musculoskeletal Syndrome of Menopause: My Journey and The Path to Optimal Health
At 43, I started noticing some big changes in my body. My perimenopausal symptoms were hard to ignore: heavy menstrual flow, a 20-pound weight gain with emphasis around my stomach, and persistent soft tissue pain that took forever to heal.
Seeing these changes left me feeling disconnected from my pre-perimenopausal self. I was determined not to enter menopause feeling overweight and unhealthy. I knew from my clinical experience and chats with older women that turning 50 can feel like aging in light speed.
Pushing Back Against The Aging Process
Feeling a sense of urgency, I threw myself into learning about nutrition and fitness, aiming to use these tools to my advantage before menopause hit. My journey first took me to CrossFit, where I encountered several injuries, including elbow tendonitis, a partial ligament tear in my foot, and chronic soft tissue pain. Despite these challenges, I learned the art of Olympic lifting and fell in love with moving around heavy things.
After I couldn’t handle feeling so sore and broken all the time, I transitioned to triathlon, leveraging my background as a collegiate swimmer. Soon, I was competing in sprint, Olympic, and even half-Ironman races.
As much as an athlete learns to “embrace the suck” and endure the “pain cave”, pushing through had its drawbacks. At 48, a severe case of plantar fasciitis sidelined me for 18 months - and 18 months of no running defeats the purpose of the letters “TRI” in triathlon.
This forced break made me rethink the impact of hormones on my soft tissue health. Despite my 25 years of treating overuse injuries and myofascial pain in everyone else, I hadn't fully appreciated or accepted the role of hormones until it impacted my own long-standing injury.
As I dug deeper into research, I realized the need to test my hormone levels, including estrogen, progesterone, testosterone, cortisol, and DHEA. My journey into Functional Diagnostic Nutrition (FDN) reshaped my understanding of optimal health.
I no longer aimed to just get by; I wanted to enter my 50s like Wonder Woman, defying the odds of a society stuck in sick care. This journey revealed the profound impact of stress, environmental toxins, poor sleep patterns, overtraining, under-eating and gut health on my overall well-being.
And I was determined to do something MAJOR - because I was not about to enter the last 1/3 of my life feeling already depleted.
Understanding the Musculoskeletal Syndrome of Menopause
My personal journey resonates deeply with the recent medical publication in Climacteric on the newly introduced concept of” The Musculoskeletal Syndrome” of menopause. According to the article, over 70% of women will experience musculoskeletal symptoms during the transition from perimenopause to postmenopause, and 25% will be DISABLED by them.
My own 18-month struggle with plantar fasciitis is my own disabling experience. I’ve never wanted to be a statistic - but when ones psychoemotional health relies on their ability to be physical, they do become somewhat disabled.
The term musculoskeletal syndrome refers to a mix of symptoms, including musculoskeletal pain, arthralgia (joint pain), loss of lean muscle mass, loss of bone density, increased tendon and ligament injuries, adhesive capsulitis (frozen shoulder), and cartilage matrix fragility (weakness in the tissue that cushions joints) leading to osteoarthritis.
These issues are often misdiagnosed or dismissed in the medical community since imaging and even lab values may show no structural findings.
Women are frequently sent away with anti-inflammatories or antidepressants, which don't address the underlying hormonal imbalances.
An “it’s all in your head” response is no longer acceptable.
The Impact of Hormones on Musculoskeletal Health
The decline in estradiol, the most active form of estrogen, affects nearly all musculoskeletal tissues, including bone, tendon, muscle, cartilage, ligament, and adipose tissue.
The PubMed article outlines five primary changes due to falling estradiol levels:
Increased Inflammation: Estrogen regulates inflammation, and its decline leads to increased joint pain, which peaks in early postmenopause. Estrogen replacement therapy can help reduce fat gain and muscle loss.
Decreased Bone Density: Women lose an average of 10% of bone mineral density during perimenopause and continue to lose 0.6% muscle mass per year after menopause. Estrogen deficiency is linked to significant bone loss, increasing fragility and fracture risk.
Sarcopenia: Age-related muscle loss is worsened by estrogen deficiency. Estrogen helps maintain muscle mass and strength by supporting mitochondrial function and reducing oxidative stress.
Cartilage Damage and Osteoarthritis: Estrogen loss accelerates the onset and severity of osteoarthritis. Estrogen protects cartilage, and its loss can lead to increased degeneration.
Satellite Cell Proliferation: These cells promote muscle repair and regeneration. Estrogen stimulates their activity, and its loss impairs muscle strength and recovery.
How To Combat Dropping Estrogen Levels
Recognizing and addressing the musculoskeletal syndrome of menopause is crucial for improving the quality of life for us midlife women.
Here are some things to consider:
Hormone Testing: Regular testing of estrogen, progesterone, testosterone, cortisol, and DHEA levels is essential. High cortisol levels (associated with high stress and poor stress management) can contribute to the breakdown of tissues (catabolism). While DHEA, the “anti-stress” hormone, is responsible for repair and rebuilding. Checking these markers can help assess the HPA (hypathalamic-pituitary-adrenal) axis and how one copes with stress—a critical aspect since menopause is one of THE MOST STRESSFUL times in a woman’s life.
Nutrition: Adequate intake of proteins, vitamin D, magnesium, and vitamin K2 supports bone and muscle health. Additionally, knowing food sensitivities and evaluating gut health is crucial for hormone production and overall health. Even healthy foods can be stressors if one is sensitive to them, leading to further stress on the body and impacting hormonal balance. Optimal nutrition starts with choosing the right foods for gut health. As a caveat, even with adequate protein intake, a woman must know if and how she is metabolizing protein. If she is having trouble making digestive enzymes or has poor gut microbiome health, she can be eating all the protein but still being malnourished because the protein isn’t being broken down and just sitting in her intestines rotting and putrifying.
Exercise: Resistance training and weight-bearing exercises are vital for maintaining muscle mass and bone density. Incorporating heavier weight-bearing exercises, high-intensity interval training (HIIT), and sprint interval training (SIT) is essential to avoid the "grey zone" of moderate exercise, which can be less effective. Getting on the right exercise regimen can at least slow the progression of bone loss while simultaneously contributing to muscle gains. I’ve personally begun adding in the use of a weighted vest when I take my dog out for her walk.
Hormone Replacement Therapy (HRT): HRT can mitigate the impact of estrogen loss and facilitate a smoother physiological transition. It's essential to find a menopause specialist (from the Menopause Society) for guidance.
Supporting Detoxifcation Pathways: Additionally, supporting detoxification pathways is crucial to ensure that hormonal metabolites are excreted efficiently. This means making sure you are sweating, pooping and flushing out the toxins.
My Programs: The Aging Athlete and A Midlife Wellness Reboot
My personal experience and professional expertise have culminated in the development of two specialized programs: The Aging Athlete and Midlife Wellness Reboot. These two programs are designed to address the unique challenges faced by midlife individuals, including women transitioning through menopause and our male counterparts going through own set of challenges called andropause.
The Aging Athlete program focuses on maintaining physical fitness, strength, and overall health through personalized nutrition and hormone optimization. It caters to former athletes and aging fitness enthusiasts looking to stay active and healthy. Through the functional wellness lens we look at how to optimize body function such as strength and mobility and mitigating pain through the aging process.
Midlife Wellness Reboot offers a comprehensive approach to wellness, addressing hormonal imbalances, stress management, gut health, and overall vitality. It is perfect for those experiencing the multifaceted symptoms of menopause or andropause for men who are looking to reclaim their health and energy.
Finding Your Path Forward
Navigating the changes that come with menopause can be hard and confusing, but you don't have to do it alone. Understanding that your muscle and joint aches aren’t just “in your head” or will “eventually go away” - in fact they are part of the the musculoskeletal syndrome of menopause. By recognizing the significant impact of hormones on our bodies, you can take proactive steps to manage these changes effectively.
If you're experiencing symptoms similar to mine or the ones discussed in this blog, know that there are options available to help you regain your strength, muscle mass and combat the dreaded belly fat. Whether it's through stress and hormone testing, personalized nutrition plans, targeted exercise routines, or exploring hormone replacement therapy, there is a path forward.
My programs, The Aging Athlete and Midlife Wellness Reboot, are designed to support you through this journey. Together, we can create a personalized plan that addresses your unique needs and helps you thrive during this transformative time.
Remember, it's never too late to take charge of your health and well-being.
Reach out if you have any questions or need guidance!
I'm here to help you navigate this phase with compassion, understanding, and expertise.
Let's embark on this journey together towards a healthier, stronger, and more vibrant you.