Musculoskeletal Pain and Menopause : Understanding what happens to your bones and joints during menopause
Let's talk about something many women experience during menopause: joint pain.
As an orthopaedic knee surgeon I see many women with knee pain, and am often asked about the impact of the menopause and how it relates to osteoarthritis (OA) and their joint pains. While we often hear about hot flushes and hormonal shifts, the impact on your joints, particularly your knees, is a significant aspect of this life transition.
Menopause, typically occurring between 45 and 55, signals the end of reproductive years and brings about a natural decline in hormone levels, especially oestrogen. This drop isn't just about hot flushes; it significantly affects your musculoskeletal (MSK) system, especially your knees.
The Oestrogen Connection to Knee Health
Oestrogen plays a crucial role in maintaining healthy musculoskeletal tissues, including the cartilage and supporting structures of your knees. It supports collagen production, joint lubrication, and bone density. When oestrogen levels decrease, we see several changes that can contribute to knee pain and OA:
- Increased Joint Pain and Stiffness: Reduced oestrogen means less of its natural anti-inflammatory benefits, leading to increased joint discomfort, particularly in the knees.
- Cartilage Degradation: Oestrogen helps protect cartilage. A decrease can accelerate the breakdown of this protective tissue, a hallmark of OA.
- Increased Inflammation: Changes in hormone balance can lead to increased inflammation within the knee joint, exacerbating pain and stiffness.
- Muscle Loss (Sarcopenia): This results in reduced strength around the knee, impacting stability and increasing stress on the joint.
- Bone Resorption: Potentially leading to increased risk of bone changes around the knee, impacting the progression of OA.
It's worth noting that knee pain and OA are more prevalent in women, and their occurrence tends to increase with age and during menopause.
The Role of Inflammation: Understanding Macrophage Polarization and its effect on the knee.
Let's delve a bit deeper into the science. After menopause, there's a shift in the balance of immune cells called macrophages. We have M1 macrophages (pro-inflammatory) and M2 macrophages (anti-inflammatory, for tissue repair). Oestrogen helps maintain a healthy balance. However, post-menopause, there's often a shift towards M1 dominance, leading to:
- Increased Pro-inflammatory Cytokines: Like TNF-α, IL-6, and IL-1β, contributing to pain and cartilage breakdown in the knee.
- Chronic Inflammation: This can directly impact the knee joint, speeding up the progression of OA.
What Can You Do? Management Strategies for Knee Pain and OA
The good news is, there are effective strategies to manage knee pain and OA during and after menopause:
- Strength Training and Mobility: Regular exercises, especially those targeting the quadriceps and hamstrings, are crucial for supporting the knee joint. Low-impact activities like swimming and cycling are also beneficial.
- Weight Management: Maintaining a healthy weight reduces stress on the knees, slowing OA progression.
- Hormone Replacement Therapy (HRT): Can help manage symptoms by addressing oestrogen deficiency, potentially reducing joint pain and inflammation.
- Nutritional Support: Ensure adequate calcium, vitamin D, and omega-3 fatty acids for bone and joint health.
- Physical Therapy: Tailored exercises and modalities can improve knee function and reduce pain.
- Orthopaedic Consultation: For advanced OA, options like injections (cortisone, hyaluronic acid) or surgical interventions might be considered.
Taking a Proactive Approach to Knee Health
Menopause is a crucial time to prioritise your knee health. Understanding the biological changes, like oestrogen's role and inflammation, allows you to take proactive steps to prevent and manage knee pain and OA.
You don't have to accept knee pain and functional decline as inevitable. There are tools and strategies to maintain lifelong mobility and strength. If you're experiencing knee pain during menopause, please reach out to a healthcare professional to discuss your symptoms and explore the best management options.
Remember, staying informed and proactive is key to maintaining your quality of life and keeping your knees healthy.
Note: This blog post is for information only and does not constitute medical advice. Please consult with your healthcare provider for any questions or concerns regarding your specific health conditions.
Do you want to talk to an expert who can listen to you and explain your options in detail?
Mr Gareth Stables offers a telephone consultation to review your symptoms, X-ray or MRI images and explain your options
