The menopause and musculoskeletal pain

The Menopause and Physiotherapy The menopause is becoming more of a hot topic with the recent airing of Davina McCall’s documentary for Channel 4. The NHS is also recognising the significant effects on women’s health by introducing measures for employees. The Welsh TUC found that 8 out of 10 women had noticeable symptoms during the menopause whilst 45% found their symptoms troublesome. Most women found the work environment made their symptoms worse. Which is strange when you think that millions of women in fact the majority of women struggle with the menopause one way or another, after all it is natural process of the woman’s body around the ages of 45-55. Main symptoms of menopause are hot flushes, night sweats, vaginal dryness, joint and muscle pain, fatigue, depression and anxiety. All those fun things. The menopause is often talked about in a physiotherapy clinic due to the physiological effects that it has on the body and the fact that women in their 40s onward form a large proportion of people seeking physiotherapy. A woman’s experience of the menopause is massively variable there are around 30 symptoms of the menopause including physical and psychological symptoms and can also have social implications. From a physical health point of view injury risk increases from perimenopausal stage onwards. This can mean an increase in risk from anything from sports injury to repetitive strain conditions. Tendons, ligament and oestrogen levels are important to consider although not fully understood, we do know there is some effect of changing oestrogen levels on connective tissue. It is thought that decreased oestrogen levels impact on the ability of the body to strengthen and repair tissues. It is also worth bearing in mind that the normal aging process effects the ability of type 1 collagen (which comprises around 95% of tendons) to repair. This is also relevant in considering other musculoskeletal issues during aging and the reduced ability of the body to repair itself, think grey hair on the inside. It is also thought although not much researched that oestrogen enables connective tissues to tolerate and adapt to load, think about recovering from an injury. Generally speaking In physiotherapy with teach you during the rehabilitation process to exercise and gradually increase repetitions and resistance. This is because we need to ‘load’ in order to recover from injury be it sports or otherwise. Are we now thinking that reduced oestrogen means longer rehabilitation and more risk of injury? This is what I would say I see in clinic. While an over simplification we can conclude that reduced oestrogen levels play havoc with our musculoskeletal health. It’s also worth mentioning bone health, I often send my ladies off to get a bone density scan.. why? It’s that pesky oestrogen again basically reduced oestrogen makes women lose bone mass. This means after about 50 years old women are at risk from osteopenia (the stage before osteoporosis) and osteoporosis. Risk factors such as ethnicity, eating disorders such as anorexia or low BMI, low bone mass prior to menopause, lactose intolerance which can make it difficult to absorb enough calcium and the usual suspects drinking too much alcohol, smoking, taking no exercise. Why does bone density matter and why do we need to know about? Why do send my ladies to GPs to pretty please ask for a bone density (DEXA) scan. Well it’s good to know because we have to be aware that breaking a bone is more likely, a broken hip is no fun. There are treatments that can be used such as medications that can be prescribed to slow the rate of bone density loss and adjustments to lifestyle such as making sure you get enough Calcium and Vit D and that you are taking enough exercise. There’s so much more to say but what does this mean for your physiotherapy experience? As a woman in her 40s I find it easy to empathise with all of my patients of course. I also feel often when I meet a lady perimenopausal onwards she has not been listened too. Often injury is treated in isolation so for example a back pain, tennis elbow or a rotator cuff issue. The expectation seems to be that given the normal amount of healing time and a generic exercise protocol that it will just go away, that alongside the over reliance of the medical model of pain medication, doesn’t always make for a positive recovery. I do know this group of patients is not alone in this experience. We are no doubt an epidemic of treating many disorders like this due to the enormous pressure on the NHS during the covid-19 pandemic. Given my experience of meeting menopausal patients this is a common experience. Don’t get me wrong pain management is a massively important part of musculoskeletal injury management but it’s a long way from the full story. I get frustrated on behalf of my patients who have not been listened too. And certainly with me the first step of the physiotherapy journey is to really listen to what is happening with that person. It’s not just about assessing the physical attributes of why there is pain and dysfunction but to that person’s lifestyle, social situation, medical history, personal experience and social situation. There is no point in giving a busy career woman who travels 5 times a week or a mother with 3 children a 30 minute exercise programme to do 5 X a week which involves using exercise equipment. But there maybe warrant in giving that to somebody that usually runs or goes to the gym but is unable to due to injury. It fills their frustration at not being able to exercise. It’s about engagement and buy in to the recovery process, not one size fits all. This is what you should be expecting this from your physiotherapist. You can book an appointment with Rebecca Gregson BSc(HONS), MCSP at www.twistphysiotherapy.com Her clinic is based at Evolve Medical Pudsey, Leeds


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Rebecca offers a holistic approach to physiotherapy and believes in a bespoke service for her clients. She is passionate about improving people's quality of life whether it be through getting back to playing sport or running, moving after surgery or illness or managing a chronic condition. She also is a firm advocate of hands on treatments and that the therapy process is a partnership between client and physiotherapist. Whilst the majority of treatment takes place in the state-of-the-art clinic, she can offer bespoke services in the community on negotiation.