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Perimenopause may begin as early as the 30s and most women in their 40s will be perimenopausal. Symptoms can vary but could include menstruation irregularity for some, but the most common symptoms are mood changes, sleep disturbance, and decreased libido. Symptoms are a reflection of hormonal changes. Testosterone starts declining at 35, progesterone around age 40, and estrogen around age 45. The gradual decline of estrogen ultimately results in menopause.
Symptoms of Testosterone Deficiency
Muscle weakness
Fatigue
Low libido
Sexual dissatisfaction
Vaginal dryness
Symptoms of Progesterone Deficiency
Breast tenderness
Irregular periods or spotting in between periods
Vaginal dryness
Mood swings
Symptoms of Estrogen Deficiency
Irregular or absent menstrual periods
Hot flashes
Vaginal dryness
Mood changes such as irritability
Sleep disturbances,
Changes in libido
Difficulty concentrating
Alterations in bone density
Muscle and tendon changes
Estrogen helps regulate musculoskeletal integrity. It influences bone density, collagen synthesis, and general tendon health including the ability for tendons to lengthen. The symptoms of tendon degeneration can be present early in the rotator cuff and Achilles tendon. These are warning signs.
Understanding how hormone changes will affect us, can help us plan for and increase motivation to implement strategies to help actively mitigate these changes. Musculoskeletal Syndrome of Menopause (MSM) is a newer term describing the musculoskeletal changes often seen in menopause. These include:
Sarcopenia
Sarcopenia is the age-related loss of muscle mass, strength and function. Sarcopenia affects any skeletal muscle including the pelvic floor. Careful attention to pelvic floor health early on can help reduce the potential for worsening pelvic organ prolapse.
Sarcopenia also increases injury potential and contributes to fall risk later in life. This reduction in strength can be as much as 40% by age 80. Nutritional interventions including increasing protein intake, ensuring optimal vitamin D levels, and supplementation with creatine are effective in combination with regular resistance training at reducing the extent of sarcopenia.
Increase in inflammation
Estrogen is an inflammatory regulator, so inflammation becomes more difficult to resolve. Addressing tendon health through a safe loading protocol by a physical therapist can help create resilience in these tissues while reducing the chances of inflammation with everyday functional challenges and with exercise.
Satellite Cell Proliferation
Satellite cells are the stem cells of skeletal muscle, and they are activated during an injury to repair muscle tissue. Estradiol is the hormone responsible for stimulating these cells to begin the repair and to aid in the recovery from injury. Building resilience into the musculoskeletal system and considering a functional screen by a PT to identify weak links for injury prevention can be a helpful active strategy towards mitigation.
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Bone Density
Osteoporosis is underdiagnosed and affects 200 million menopausal women. It is preventable and treatable. Studies have shown the benefit of Vitamin D on bone turnover and how magnesium can assist with the activation of Vitamin D to help reduce the progression of osteoporosis. Prevention also includes optimal nutrition, safe resistance training, and hormone treatment if deemed appropriate.
Cartilage Damage and Osteoarthritis
Estrogen has been shown to have protective properties in the intervertebral discs of the spine which could suggest its role in helping to prevent osteoarthritis and further cartilage damage yet more research is needed in this area.
Every woman could benefit from a tailored and individualized exercise program to help prepare the body well for perimenopause and menopause. Pelvic floor therapists have felt strongly for years that every woman deserves pelvic floor therapy, and we spend time lobbying for fourth-trimester care for postpartum women. A strong argument exists that the need for skilled pelvic floor therapy in the perimenopausal years to help prepare the body for the challenges of menopause may be even greater.
Any questions? Brentwood Pelvic Health would love to hear from you.
*Blog content is for informational purposes only and is not considered medical advice
