What a pain!

Happy New Year and as promised, my next blog. I wanted to research and share my thoughts about whether the increase in frequency of injuries/ of bodily aches and pains are a consequence of the Peri-menopause in women?

I have noticed over the past few years that I have started to get more injuries and a greater frequency of sporadic and unexplained aches and pains in parts of my body that I don’t feel deserve to ache.  Firstly, in my hands; after swimming. The middle finger joint becomes very tender to touch and difficult to move to the degree that I think I’m developing arthritis. The same occurs in one foot just under the second toe joint; I’ve not over done it on the Port and I don’t have Gout! To me these are mystery niggles and because they are so sporadic, I’ve haven’t been to the doctors to discuss because I know (or rather hope) they will go away just like they have done so far.

Unfortunately, I’ve had an ‘Achilles Tendinopathy’ for 6 years now. This is a ‘degenerative’ condition (D Kader1, A Saxena2, T Movin3, N Maffulli 4) ‘more common in older athletes, particularly Runners and Jumpers’ (Sally Davies ). Despite minimal run training and dedication to my physio exercises, I still get the odd twinge and it flares up regularly mid or towards the end of the Triathlon season. I’m also contending with ‘Tennis Elbow’ which started about 4 years ago after a strenuous bout of gardening (pulling out weeds!). This is a nuisance but not a limiter in terms of my triathlon training. I only notice it when applying the brakes on the bike other than that it’s relatively manageable in term of Triathlon but carrying shopping is another matter!

More recently, I’ve been experiencing pains around the knees. My physio reassures me that it isn’t cartilage; ‘it’s referred tightness’. I always assume the worse and tend to ‘catastrophise’; apparently, it’s part of my increased anxiety (also a side effect of the Peri-menopause but this will be another blog some other time!). She prescribes some serious abductor and adductor exercises and without care, digs her elbow into my legs telling me its normal tightness from my sport. The net result, a physio exercise programme that matches that of my training plan! 15 exercises every other day taking up at least 40 mins to complete after which I need to fit in my Tri' specific training. I’m not complaining, well I am because I think this pretty much it? I’m so often eaves dropping in on AG conversations and hearing about injuries and niggles it’s an age thing, right? However, it can also be brought on by the menopause:

“Falling Oestrogen levels can affect the hydration of the joints, ligaments and tendons and this in turn can affect the joints in several ways: -

Joint pain and inflammation.

Joint stiffness and loss of range of movement – sometimes this is most obvious when you get up and eases as you start to move about.

Creaking joints when you bend your knees or flex your fingers.

Change of posture –If your joints, ligaments and tendons are affected this can alter your whole posture, pulling on your muscles and causing both joint and muscle aches at the same time. This can happen to any group of muscles but mainly the back, shoulders and hips. Muscle changes in the shoulders can also trigger tension headaches or migraines. Falling Oestrogen levels can contribute to weight gain in some women and this in turn will put more pressure on the joints. Falling Oestrogen levels can affect bone density, causing osteoporosis which will affect posture as well. Hot flushes and night sweats can dehydrate you really quickly, so this could be a major contributory factor to your joint pain!

Any of the joints can be affected with this, from little joints such as fingers and toes right up to the major joints such as the hips. (Eileen Durward 2015)

Dr DeRosa believes that it’s also down to “Testosterone deficiency (which all menopausal women suffer from as well because the ovaries make Oestrogen and Testosterone) that causes joint pain, muscle atrophy and pain as well as an increase in firing from pain fibres” (Dr. Nathan Wei 2019)

Studies suggest that ‘as the body’s production of hormones changes during menopause, the loss of Oestrogen leading to inflammation can also cause ‘accompanying pain resulting from high cortisol levels.  Long-term stress, which is common for some women going through menopause, and somewhat controversial “adrenal fatigue” that has been associated with Peri-menopause can potentially result in higher cortisol levels. (Dr DeRosa 2019)

The reason for this Dr DeRosa argues is multifaceted; “Oestradiol deficiency causes decrease in collagen structure and joint health which causes increase in joint pain.  Women also struggle with sleep during the Perimenopause which affects sleep quality and “does not allow for proper rest and restoration of the body at night”.

Whilst a lot of this research has been compiled by Alternative Therapists/ Doctors in this field, I believe it makes perfect sense. These same doctors suggest that our diets may also have an impact on this sudden increase in pain:

Falling Oestrogen can also affect the uptake and utilisation of magnesium; and magnesium is vital for proper muscle function. Low magnesium can cause muscle aches and pains. Low magnesium also can cause muscle fatigue, which makes it more difficult to exercise as your muscles will start to ache more quickly and you can experience increased bouts of muscle cramps. Finally low magnesium, can also affect your mood and sleep pattern and also be a contributory factor in stress, palpitations and sugar cravings!

So where do I find magnesium apart from supplements?

In general, to provide magnesium foods to your body, we need to ‘eat foods packed with dietary fibre including: Almonds, avocado, black beans, bran cereal, brown rice, cashews, cereal, edamame, kidney beans, oatmeal, peanut butter, peanuts, potato with skin, pumpkin, raisins, soymilk, spinach,  whole grain bread and yogurt. Magnesium-rich foods also include dark leafy greens, which play the role of the ultimate 'superfood', offering up crucial vitamins and minerals as well as a host of health benefits. Raw or cooked magnesium greens are best such as baby spinach, collard greens, kale, or swiss chard’. In essence, we can ‘avoid magnesium deficiency’ by filling ourselves with dark leafy greens for very few calories. These foods also support a healthy immune system, improve bone health and may help prevent inflammation’ (Debbie Strong 2019)

Dr. Angela DeRosa also suggests that many women also become ’vitamin D deficient during this time which can cause ‘fibromyalgia’ like joint and muscle pain,”

Vitamin D helps ‘regulate the amount of calcium and phosphate in the body’.

These nutrients are needed to keep bones, teeth and muscles healthy.

A lack of vitamin D can lead to bone deformities such as Rickets in children, and bone pain caused by a condition called Osteomalacia in adults. From about late March/early April to the end of September, most people should be able to get all the vitamin D they need from sunlight.

‘The body creates vitamin D from direct sunlight on the skin when outdoors but between October and early March we don't get enough vitamin D from sunlight.  Vitamin D is also found in a small number of foods sources like oily fish – such as salmon, sardines, herring and mackerel, red meat, liver, egg yolks and fortified foods for example, most fat spreads and some breakfast cereals. Another source of vitamin D is dietary supplements. In the UK, cows' milk is generally not a good source of vitamin D because it isn't fortified, as it is in some other countries.  (NHS UK Vitamins and minerals 2019)

Some research suggests that ‘a number of other forms of arthritis are common in the menopausal age group’. These include ‘rheumatoid arthritis and interestingly, Gout which may develop due to the body’s reaction to the loss of Oestrogen’. The most common forms of arthritis that “cause pain with menopausal women are Rheumatoid Arthritis, Osteoarthritis and Fibromyalgia.” Dr. N. Wei. (2015) And Victoria Allen (January 2018)

There is a medical condition known as “Arthralgia” which occurs when the joints become swollen, stiff or painful during menopause. Joint pain associated with menopause is also referred to as “menopause arthritis”. (Magliano, M. 2010)

This is supported By Dr. Miten Sheth (2017) who suggests that “Aches, stiffness and swelling around the joint are typical symptoms of menopausal joint pain. These may be worse in the morning, improving as the day continues. Joints which experience high impact such as the hips and knees tend to be most affected by this so called ’menopausal arthritis.’ Hands and fingers can also be affected. High impact exercise such as jogging can exacerbate the problem, although this is often eased with rest. Although researchers are still unclear exactly how hormones - particularly Oestrogen - affect the joints, it has been observed that menopausal women are more prone to joint pain. Excess weight, diet, lack of exercise, stress, heredity, injuries and wear and tear also play a role.

Osteoporosis is another symptom of menopause that is related to joint pain. During menopause, the rate of bone loss increases as the amount of Oestrogen produced by the ovaries drops dramatically” and suggests that “Consulting a healthcare professional in early stages of joint pain can go a long way toward managing the problem before it grows into a major health concern (Well, that’s me told!)

A word of caution, whilst discussing this issue with friend of mine who is a qualified nutritionist, she suggested that I should get my thyroid function checked out because one in two women struggle with sub-optimal thyroid function and based on evidence from the British Thyroid Foundation (BTF)  “Symptoms of thyroid disease can be very similar to those experienced as a result of the menopause; “e.g. fatigue, sweating, heat intolerance, weight loss, difficulty sleeping, shaking, palpitations (with a fast or irregular heart beat) and anxiety symptoms it’s not unusual for them to be incorrectly attributed to the menopause or even put down to stress” (BTF 2019)

If you are experiencing a sudden loss of ‘form or any of these ‘Peri-menopausal’ symptoms, please go and see your GP, it is likely they will suggest a blood test which should check your hormone levels and should hopefully check for thyroid function too’ (Dr Jackie Gilbert 2019). I’m booking mine so I will let you know how I get on.

Ok so what can we do about joint pain?

First and foremost, see a Doctor or Physiotherapist to discuss your symptoms. They diagnose, reassure and where possible help you resolve or manage them in the best way.

Then based on my findings, we can:

Hydrate “Water!! Dehydration is so common these days, drinking plenty of plain water is vital for so many menopause issues including keeping the joints well hydrated. If your joints are sore or creaky first thing then ease off as they day goes on, it may mean that you are really dehydrated during the night, so make sure that you have a small glass of plain water about an hour before bed – this is really important if you are getting night sweats as these will dehydrate you further. (Eileen Durward 2015)

Take stock of our diets – follow a diet that is high in brightly coloured fruits and vegetables which provides anti-oxidants and anti-inflammatory effects.” A diet that is “a low glycaemic diet with moderation on alcohol and caffeine,” and “Avoid inflammatory foods such as high sugar, high fat foods as well as ‘white’ processed foods. (Dr. DeRosa). Caffeine, fizzy drinks, citrus fruits, members of the Deadly Nightshade family (potatoes, tomatoes, aubergines and peppers), high salt and sugar foods can all trigger inflammation in the joints and sometimes just cutting these out can make a huge difference. Ensure your diet is high in magnesium-rich foods such as nuts, seeds, dried fruits and dark green leafy veg.  (E. Deward 2015)

Get out doors and enjoy the sun (safely) and maybe take a vitamin D supplement during the winter months of October through to March if your diet is lacking in vitamin D (Dr Jackie Gilbert  2019)

Avoid stress or find ways to cope with stress because “stress increases cortisol which leads to inflammation and weight gain. Since much of the pain experienced by menopausal women is caused by inflammation, an anti-inflammatory diet can be helpful in relieving symptoms,” (Dr. Landherr 2019)

Exercise. Preaching to the converted here! Although joint/muscle aches tend to put you off exercise this is really important for several reasons: Firstly: exercise will strengthen the muscles that support the joints making symptoms less likely. Secondly: exercise will help to control your weight. The best types of exercise to do if your joints or muscles are sore are yoga, swimming and (depending on which joints are affected) cycling. (E. Deward 2015)

(Boom there it is, Triathlon, well ‘Aquabike’! I always find that I feel better after training and it also helps keep my stress levels at bay too. Running should also get a mention too because weight bearing exercise is absolutely essential to good bone health (National Osteoporosis Foundation (NOF) 2019)

Herbs and Supplements. Ok I can’t profess to know a lot about this and to be honest feel a bit nervous adding this section so always check with your doctor beforehand. There are so many web sites and books about supplements it’s difficult to know where to start, who to trust and what to choose.

“Devil’s Claw” this is said to ‘work quickly on relieving pain all over the body (Warning there is some negative press about this herb to so ensure you are clear and maybe speak to your doctor before taking this. Arnica Gel (Arnica gel is an herbal remedy used for pain relief in stiff muscles and joints. It’s a topical gel that you can apply to sore spots a bit like muscle rub, tiger balm etc. I tend to ice, elevate and massage with my own muscle rub ‘Rubeeze’ (http://rubbeez.com/) and then stretch or strength pending what my physio suggests.

Turmeric (Curcuma longa, Cur­cuma domestica) Several recent studies show that turmeric/curcumin has anti-inflammatory properties and modifies immune system responses. A 2006 study showed turmeric was more effective at preventing joint inflammation than reducing joint inflammation (Arthritis Association 2019).

The most well-known supplements to date I think are:

Omega- 3 - Consumption of omega−3 fatty acids from marine sources are said to ‘lowers blood markers of inflammation’ (Wikipedia 2019) Glucosamine which ‘is marketed to support the structure and function of joints” (Wikipedia 2019) and Chondroitin ‘used for osteoarthritis, where cartilage degrades the joints in the body. Chondroitin helps to slow that breakdown” (Wikipedia 2019

I have tried a supplement that contained all three (Omega-3, Glucosamine and Chondroitin) for a while but I can’t say for sure if they helped and the cost of these supplements put me off; plus, the programme ‘trust me I’m a doctor’ BBC which looked at omega 3 and basically suggested that I was probably wasting my money in that my diet should and could provide all the nutrients that my body needs.

My New Year’s resolution therefore, is to see the doctor to check my stage of the menopause and find an affordable nutritionist who will evaluate my diet and make suggestions to modify my diet to help me manage my Peri-menopausal symptoms whilst also providing the right energy for my Triathlon training. I’ll let you know what I find out. In the meantime, if you have tried anything please get in touch and let me know so I can share your ideas with like-minded people.

Thanks for reading,

The Peri-Menopausal Triathlete

tpmtriathlete@gmail.com

References:

Arthritis Foundation 2019 https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/guide/turmeric.php

BBC ‘Trust me I’m a doctor’ Series 6, episode 3 https://www.bbc.co.uk/programmes/b08fqwvv) Davies. S, Expert reviewer, Senior Physiotherapist, Bupa UK https://www.bupa.co.uk/health-information/muscles-bones-joints/achilles-tendinopathy 2019) Dr. DeRosa.  Cited in;  Blog: Menopause and Chronic Pain; http://salonpas.us/blog/menopause-chronic-pain/ 16.1.19

Durward. E 23 July 2015 in; https://www.avogel.co.uk/health/menopause/can-the-menopause-cause-joint-pains-muscle-aches-stiffness-and-creaky-joints/

Dr Gilbert. J British Thyroid foundation: thyroid and menopause: http://btf-thyroid.org/information/articles/107-thyroid-and-menopause 21.1.19 (D Kader1, A Saxena2, T Movin, N Maffulli in the British Journal Science & Medicine  https://bjsm.bmj.com/content/36/4/239 2019) Dr Landherr Cited in;  Blog: Menopause and Chronic Pain; http://salonpas.us/blog/menopause-chronic-pain/ 16.1.19 Magliano, M. (Sep 2010) Menopause arthralgia: Fact or fiction. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20537472 cited in http://menopausehealthmatters.com/symptoms-of-menopause/menopause-joint-pain/ 19.1.19 NHS UK  2015 Vitamins and minerals:  https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/  2019

NOF 2019    https://www.nof.org/preventing-fractures/exercise-to-stay-healthy/weight-bearing/

Dr. Sheth. M  Dec 26, 2017, mid-day online correspondent (https://www.mid-day.com/articles/heres-what-you-should-know-about-peri-menopausal-body-ache/18859163) 14.1.19 Strong. D 2019 “8 Magnesium-Rich Foods That May Boost Energy and Prevent Inflammation” cited on every day health;  https://www.everydayhealth.com/pictures/foods-high-in-magnesium/ Dr. Wei, Nathan Menopause and Chronic Pain  November 13, 2015,  http://salonpas.us/blog/menopause-chronic-pain/ Allen. V, 29 January 2018 cited in Science Correspondent For The Daily Mail, https://www.dailymail.co.uk/health/article-5323221/Menopause-hormone-changes-make-arthritis-symptoms-worse.html Notes:  (Adrenal fatigue or hypoadrenia is a term used by alternative medicine providers to suggest that the adrenal glands are exhausted and unable to produce adequate quantities of hormones, primarily cortisol, due to chronic stress or infections.[1] There is no scientific basis for the existence of adrenal fatigue, and the term should not be confused with a number of actual forms of adrenal dysfunction such as adrenal insufficiency or Addison's disease.[1][2] https://en.wikipedia.org/wiki/Adrenal_fatigue  21.1.19