The Musculoskeletal Syndrome of Menopause: What You Need to Know | Dr. Vonda Wright

**Dr. Vonda Wright** (0:00)
So, your shoulder hurts, and you did nothing. You did not bang it, you did not lift hard. It starts as that niggly feeling of, oh, my shoulder's sore. And then before you know it, you can no longer reach behind your back and hook your bra.
And then you think, well, I think this will go away, I didn't hurt it. And you wait, and you wait. And before you know it, usually within a week or so, you can no longer raise your arm. And then you finally come see your orthopedic surgeon and they say, you got a frozen shoulder. You're like, I didn't do anything. Well, here's the news, you are not falling apart, you are not going crazy. The musculoskeletal changes of menopause are real. And do you know why they happen? Because estrogen is not a sex hormone. It does not only act on your reproductive system, in fact, your entire skeletal system, muscle, tendon, bone, ligament, fat, annulus, stem cells, all have estrogen receptors. And when in midlife, estrogen is no longer sitting in the receptors, none of the great downstream effects can happen. So what happens to your skeletal system when estrogen walks out the door and you get the musculoskeletal syndrome of menopause and frozen shoulder? Estrogen is a profound anti-inflammatory working directly on your immune system via the inflammasome, or helps dampen down the effects of the inflammatory cytokines that your body naturally produces.
Without estrogen, you can get total body inflammation and pain. It's called arthralgia. It's not fibromyalgia. It is the arthralgia of menopause. It happens because of the rapid inflammation from losing your estrogen. It's estimated that up to 70% of all women will have that. I had that. I'm an athlete, and I could barely get out of bed because I was so inflamed. Or you may be someone with frozen shoulder. Out of nowhere, your shoulder hurts and it won't move. And if your clinician gets an MRI 41% of the time, there will be no structural problem.
Those are due to the inflammation that happens when estrogen walks out the door. Well, what else happens?
Well, we can lose 3-8% of our muscle in the decade when estrogen's walking out between 40 and 50 3-8% of skeletal muscle. It's a problem, people.
Because without muscle, we don't have the strength to continue doing what we need to do to live. And it can add up over time to become sarcopenia. You know, sarcopenia, it is the loss of muscle mass, loss of function, loss of muscle speed.
That contributes to the fact that 70% of all people in nursing homes are women. So we don't want to be inflamed. We don't want to lose our muscle. Estrogen is critical for maintenance of muscle mass. Number 3, we don't want to lose our bone density. Remember, during perimenopause and the 3-5 years surrounding the day of menopause itself, you can lose up to 20% of your bone density because estrogen is a critical regulator of osteoclasts and osteoblasts. That will happen silently if we don't understand it and get in front of it. So inflammation, loss of muscle, loss of bone. How about loss of cartilage? We have known for 100 years. The first paper was published in 1925 called The Arthritis of Menopause. We have known that after age 50, women's arthritis and loss of healthy joints rapidly increases. And yet we have really not made a lot of headway in anything except total joint replacement. If we know that with the loss of estrogen, we have the potential to lose our cartilage matrix and therefore have a rapid progression of arthritis and decreased joint health, we need to step in front of that by understanding it and making our hormone optimization decision. So what else is in the musculoskeletal syndrome of menopause? Well, the disc in our back, you know, that chronic back pain people get and the ruptured disc. Our backs have these discs like doughnuts, if you will, that separate the vertebrae. They have a hard outer ring and a kind of jelly type interior. Well, the hard outer ring, the annulus is made of collagen, which is critically dependent on estrogen.
Without it, our annulus will degrade, you'll have more incidence of back pain and even disc rupture. We've talked about muscle, we've talked about annulus. Let's talk about your tendons and ligaments. How many of you show up with the itises? Plantar fasciitis, Achilles tendonitis, patellar tendonitis, lateral epicondylitis, that's tennis elbow. All these itises, why do they suddenly show up so that you come to my office and you're like, I don't know what's happening, doc, I'm falling apart. Here's what's happening, your estrogen is walking out the door, your tendons also have estrogen receptors and are made out of collagen. What happens when we lose our estrogen? We lose 30% of our collagen. Like how? It's like the perfect storm. So you get all these itises, they are real, you are not falling apart, you are not going crazy. But did you know that fat, adipose tissue, the stuff hanging off in inconvenient places, is also a skeletal tissue? And we change the distribution, not to mention the amount of fat we have. Here's something you need to know. Bone, tendon, muscle, fat are not just structural tissues.