23 May 2023

Joint pain, menopause and fibromyalgia

What happens to our joints and muscles as we age, and why are women susceptible to pain and injury during perimenopause and menopause?

Katie interviewed leading Rheumatologist Professor Hasan Tahir about just why we may suffer aches and pains as we age and what menopause has to do with it.

This episode will be really helpful for you if you’re suffering from any aches and pains but also covers conditions which cause chronic pain, in particular fibromyalgia.

Professor Hasan explains how you can get the correct diagnosis and talks about a range of treatment options, including standard pain relief and lifestyle measures as well as when to know it’s time to seek more specialist help.

Listen to the full conversation in The Latte Lounge podcast episode above.

Some of the key information from this episode:

As we get older, we lose bone mass or density, and that's more common in women as they reach menopause. Osteoporosis or osteopenia is the thinning of the bones. 

It’s well known that we all shrink a bit as we age. In between our vertebrae, there are gel-like cushions called discs which get dehydrated, so as we get older, we become curved to a degree.

Our foot arches become less pronounced, and that also reduces height to a degree. 

We also become stiffer in our joints, and they're less flexible.

fibromyalgia knee pain

As you get older, the fluid in the joints decreases. You hear of wear and tear, especially involving weight-bearing joints or joints that we use a lot.

You see that in muscles too. Overall, you find that lean mass actually decreases. And that's because what you tend to find is you lose muscle tissue.

As we get older, muscle fibres may shrink and then become less flexible and lose their tone, even if you exercise. 

The speed at which these muscle changes occur may be genetic, but generally, in women, this occurs around the age of about 40 to 50 years of age. 

RELATED: Ask the doctors: How to stay fit and healthy without pain and injury

The effect of hormonal changes on joints

As we reach perimenopause or menopause, one of the most notable things is hormonal changes.

One of the key hormones that change is a decline in oestrogen levels, and that has an effect on a multitude of musculoskeletal aspects.

It affects the bones, it can affect the muscles and tendons, and it can affect the cartilage. It's not definitive, but certainly, the opinion is that it probably plays a key role.

We also know that people who have lower oestrogen tend to get more joint pains because they tend to find oestrogen receptors present in a lot of the joint tissues.

RELATED: What happens to your feet as you age? (And here’s what you can do about it)

Fibromyalgia symptoms can be very similar to the perimenopause and menopause symptoms. How is it diagnosed and treated?

Fibromyalgia is a long-term condition, something that you've had for more than three months, and it causes pain and tenderness all over the body. 

It's not arthritis, but you do have problems with your joints, bones, or muscles.

It’s not known why people get it, but it's thought that it’s possibly caused by the nervous system in the brain and spine being unable to control or process pain signals from other parts of the body. 

Fibromyalgia affects women more commonly as a lot of musculoskeletal conditions tend to affect women more than they do men.

Classic symptoms are generally widespread pain. Not just I've got pain in my wrist or pain in my knee. 

It affects most parts of the body and is also associated with tiredness and disturbed or poor sleep, and cognitive dysfunction or brain fog.

Again, classic symptoms in patients who are perimenopausal or menopausal, so there is an overlap.

The first step is to exclude other conditions.

For example, checking people's thyroid or cortisol levels, making sure they don't have vitamin deficiencies like B12 or folic acid deficiencies, and determining, for example, that they don't have coeliac disease.

If all other investigations are entirely normal, you've then got to ask yourself, is this perimenopausal related, menopausal related, or is it fibromyalgia?

If a patient has had symptoms for 10 or 15 years, long before they were perimenopausal or menopausal, then this is more likely to be fibromyalgia. 

RELATED: Scoliosis - What is Menopause doing to my Spine?

What sort of medical treatments are there, and what can we do in terms of lifestyle options?

Everyone perceives pain in a very different way.

And when someone has a chronic pain condition or fibromyalgia, the key is setting expectations and trying to make people understand what we're trying to achieve. 

Fibromyalgia is not like the standard pain, like, for example, you knock yourself on a table, and you get that acute pain and put a bit of ice on it or take some paracetamol or anti-inflammatories. You have to approach it in a very different way. 

Taking paracetamol, codeine or anti-inflammatories, or even tramadol, can give you short-term pain relief. But that’s not the long-term solution. 

Other things that are really important for general pain management would be things like exercise, usually in a supervised manner.

For a lot of pain, like tight muscles or stiffness, stretching, strengthening, and supervised aerobic exercises have been shown to be a benefit.

We also know from general chronic pain management that some psychological support can be of benefit.

Seeing a psychologist who can help with therapies such as mindfulness or cognitive behavioural therapies or an array of other things like relaxation therapies like Tai Chi have all been known to help with pain management.

There are also a whole array of drugs which come under the umbrella of antidepressants and anticonvulsants, and these drugs have been shown to be beneficial in patients with pain management. 

It’s about an understanding of the condition and setting expectations.

Engaging with exercise, which is usually in a supervised fashion, engaging with psychological support and appropriate pain medication.

The real takeaway here is that your treatment is not just a tablet.

It's a multimodal, multidisciplinary support plan. 

RELATED: The 34 symptoms of perimenopause and menopause

Are steroid injections helpful for pain?

The problem with musculoskeletal conditions is that they are so varied, and it all depends on what you're treating. It's not one size fits all.

You have to talk to your treating doctor about what they're doing, what the steroid would do and ultimately, how it will benefit you.

Again, the injection is not the treatment; it's a part of the treatment.

If you were to give an injection to the knee, you'd also need to look at other factors, such as physiotherapy and weight loss, for example.

What can we all be doing now to prevent further injury and pain in the future and protect our long-term health for as long as possible?

Limit your weight.

Try to eat healthily and try to engage with exercise. 

Try to incorporate it into what you do day-to-day.

So, for example, if you drive to work, maybe park the car further away and do a brisk walk. That can be part of your exercise. 

The Latte Lounge, as always, can only offer general medical advice.

Please speak to your own healthcare professionals if you are worried for any reason.

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