Friday, 4 March 2022

How the Menopause effects women’s soft tissue and bone health

The menopause and its effects is a subject that is gaining greater research, press interest and awareness.  Last year some of you may have watched Davina McCall’s TV programme plus a new government Menopause Taskforce was established at the end of last year co-chaired by the Minister for Women’s Health with our own MP Mims Davies being involved in this Taskforce too. One of their first big successes is the reduction of NHS HRT (Hormone replacement therapy) prescription charges for women!

My aim of this article is to make you aware of how the Menopause unfortunately negatively effects women’s soft tissue and bone health (remember our soft tissues are our muscles, tendons, ligaments and fascia). It effects our soft tissues because of the depleting and then continuous low levels of oestrogen. The average age of the Menopause in the UK is 51 so we all have a lot more to achieve and enjoy post menopause and hence the need to be informed to know how to help ourselves. 

As women hit the menopause, and even before this during the peri-menopause (when our menstrual cycles haven’t quite stopped), oestrogen levels are starting to fall. They rapidly fall when the menstrual cycle stops and then remain low for the rest of a women’s life.

To put this fall into perspective, oestrogen levels vary hugely from women to women and also vary hugely and quickly during our menstrual years and cycle. They normally range from 70 to 1480 pmol/L (1) and the highest level is at the pre-ovulation stage. However post the menopause Oestrogen levels are continuously approx. less than 130 pmol/L.

Reduces the strength, structure and healing potential

The lower level of oestrogen in the peri, during and post menopause stage of life REDUCES the strength, structure and healing potential of soft tissues and the density and hence strength of the bones.

This means that some women at this stage of their lives are more likely to suffer soft tissue injuries, such as frozen shoulder (a temporary and still relatively unexplained condition that effects more women than men aged 40 to 65!), plantar fasciitis or lateral hip/gluteal pain.

Oestrogen is a very important hormone, obviously known for the development and regulation of the female reproductive system, also for general health and wellbeing and importantly it is also key for soft tissue and bone health.

Key role of Oestrogen for our musculoskeletal system:

  • Improves and regulates muscle mass and strength - regulates muscle metabolism (for energy and function) and protein synthesis (for growth and regeneration) enabling muscles to generate optimal strength, power and then rapidly repair. 
  • Increases the collagen synthesis of soft tissues. Collagen is a protein and makes up 25% to 35% of the whole-body protein content. It is mostly found in fascia, cartilage, bones, tendons, ligaments and the skin and to a lesser extent the muscles.
  • Decreases the stiffness of tendons and ligaments. This has both positive and negative effects as pre-menopausal women are less likely to get an Achilles rupture, yet overly high levels of oestrogen provide too much ligament laxity and so are a threat for injury. For example, pre-menopausal women are 2-8 times more susceptible to an ACL injury than their male counterparts (2). 
  • Regulates bone metabolism and maintains bone mass - our bones are living tissue constantly regenerating, healthy bones have osteoblasts (bones cells which help to build bone) and osteoclasts (bones cells which resorb bone) and oestrogen helps balance this constant mix of the breakdown and reformation of bone. 

What lower levels of oestrogen mean for our soft tissues, starting from the peri-menopausal stage:

  • Decline in muscle mass and strength owing to slower growth and repair of muscle (and all soft tissues).  Muscle protein synthesis changes with age and this is further affected by sex. In a study in 2014 (3) in postmenopausal women, higher rates of muscle protein synthesis and breakdown were observed when compared to age matched men and premenopausal women. Even though higher rates of protein synthesis might be expected to improve muscle quality, the women in the study still experienced a rapid decrease in muscle mass and strength. Muscle mass is largely dependent on the balance between the synthesis and breakdown of muscle protein. The study noted there still needs to be further research to understand if the decreases in muscle mass in women are due to muscle protein breakdown outstripping protein synthesis or that the muscle proteins being synthesised are not those needed for muscle contraction, tension and mass! 
  • Decrease of collagen production, which effects the tendons, ligaments, bones and cartilage particularly, so again there is reduced strength, increased stiffness and for bones can mean fragility. As I mentioned above oestrogen gives women increased laxity (or flexibility to load) and so pre-menopausal women are less likely to have Achilles tendon injury compared to men, whereas post-menopausal women have the same risk of Achilles injury to their men counterparts (4).
  • Slows the regeneration of bone — fewer bones cells are produced so bone breakdown outstrips bone building which results in weaker, less dense and more fragile bones. The bone mineral density decreases. This is the well researched link to women being at a higher risk to Osteoporosis (a disease that thins and weakens bone) or Osteopenia (decreased bone density).

This leaves us women more vulnerable to age-related musculoskeletal frailty but please don’t take away from this article that this is all negative as it is very important to note that we can help ourselves!

How to help ourselves?

We can minimise the decline in Oestrogen and its effects on our soft tissues through diet. Post exercise consuming protein is a key for to help muscle repair and regeneration (see my article on the Importance of Protein).  Eating nutritious foods can help, an ideal diet should be rich in fruits, vegetables, protein and fibre. Getting enough calcium, magnesium and vitamin D and K are critical for bone density and muscle health (see BBC Food article on foods for the menopause).

Plus, regular resistance exercise (see my article on the importance of strength training) and strength benefits are definitely achieved with regular walking! The good news is the post-menopausal body still responds and adapts well to regular exercise and nutrition.

Soft Tissue Therapy and Massage is also a powerful tool to deal with the menopause and its longer term effects on the soft tissues.

Soft tissue treatment increases the repair rate of tissues (5) and when combined with guided rehabilitation can help keep us moving well, feeling good and recover from any soft tissue injuries or post-operative scars and recovery. It supports good joint health, encouraging the natural flow of joint fluid.

Disturbed, fragmented sleep can be a problem and a relaxing, flowing massage in the evening, will down regulate our nervous system promoting a healthy parasympathetic (our bodies natural healthier balanced and peaceful status) response from the nervous system, encouraging a good nights sleep.

The menopause and ageing is natural process and our goal has to be healthy ageing and to try to slow the deterioration of our physical and mental function as much as possible. 

If you have a niggle that is starting to effect your daily life then don’t ignore it, seek advice!

Please get in touch if you have any comments on this article or would like to discuss how Soft Tissue and Massage treatments can help you.

Nicky Holbrook
March '22

2.The effect of estrogen on tendon and ligament metabolism and function, Leblanc DR, Schneider M, Angele P, Vollmer G, Docheva D, J Steroid Biochem Mol Biol. 2017 Sep;
3. Influence of sex and estrogen on musculotendinous protein turnover at rest and after exercise,
Hansen M, Kjaer M, Exerc Sport Sci Rev. 2014 Oct
5. Massage doesnt just make muscles feel better it helps them heal faster and stronger?