Menopause is a natural biological process that marks the end of a woman’s reproductive years. It typically occurs between the ages of 45 and 55, when the ovaries gradually produce less estrogen and progesterone, leading to the cessation of menstrual cycles. A woman is officially in menopause when she has gone 12 consecutive months without a period.
This transition, known as perimenopause, can bring various physical and emotional changes, including hot flashes, mood swings, sleep disturbances, and you may also feel a lot more pain. It’s not just your imagination. Read on to learn more about the symptoms, causes and types of pain experienced during menopause.
Menopausal Pain Syndrome (MPS)
More than 60% of menopausal women aged 48 – 55 years old seen at Singapore Paincare Center have some form of aches and pain afflicting them, that is related to the effects of menopause. The relationship between menopause and increased pain levels is not well understood.
“Estrogen and other female hormones have complex interactions with pain sensitivity. But whether you’re developing a chronic pain condition for the first time or having flares of a pre-existing condition, these changing hormone levels affect both the symptoms of chronic pain and how you experience it.Many women are having a tough time in menopause, and I prognosticate that those patients most affected by these symptoms were far more likely to have chronic pain.” – Dr. Bernard Lee, Senior Consultant Pain Specialist, Singapore Paincare Center
Broad categories of Pain Conditions in Menopause:
- Non-specific generalised body pain eg headache, neck pain, back pain, arms and legs pain
- Musculoskeletal pain eg muscle spasm and stiffness in elbow, fingers, soles, feet
- Pelvic pain and abdominal pain
- Discomforts related to Menopause eg. Low energy, fatigue
- Other pain conditions outside Menopause but aggravated by its presence – degenerative conditions such as osteoarthritis, disc degeneration
You may start to notice changes months or years before you are in menopause. You may have hot flashes and irregular periods. This time is called perimenopause.
You won’t know exactly when your menopause will hit. All you can do is pay attention to how you’re feeling and notice changes. Keep in mind that symptoms vary greatly from woman to woman. Some women have no symptoms at all.
Changes You May Notice
- Your periods become irregular
- You have hot flashes and night sweats
- You have trouble sleeping.
- You feel moody
- You forget things
- You feel differently about sex
- You have physical changes
Common Pain Symptoms Experienced
The menstrual cycle is regulated by the luteinizing hormone and follicle stimulating hormone. These two hormones are manufactured in the pituitary gland. They stimulate the ovaries to produce estrogen and progesterone. During perimenopause and menopause these hormones wane and fluctuate and can cause the following painful symptoms. Hormonal changes is highly associated with pain.
Some of the more common pain conditions seen during MPS:
Migraine headaches
Fluctuations in estrogen are linked to migraine headaches. You may get migraines for the first time or see an increase in severity or frequency during perimenopause. Rarely, some women have the reverse reaction and see a reduction in migraine occurrence as they enter menopause. This may be because high levels of estrogen can trigger headaches and diminishing levels can cause a decrease.
Joint pain
Aching fingers, tight hips, sore knees… joint pain is one of the most common symptoms of menopause. You may be feeling stiffness, tightness and soreness in the small joints of hands, especially in the mornings or during rainy days. Menopause can also affect other large joints such as the shoulders, back, neck and elbows. Old joint injuries may begin to ache. As time goes on, you may start to notice that you feel more aches and pains in those areas than you used to.
Back pain
During menopause, a drop in estrogen levels over time compromise the health of bones. People with chronic hormone imbalances and postmenopausal women are both frequently affected by bone disease such as osteoporosis and osteopenia (a precursor to osteoporosis). Studies show that the risk of developing osteoporosis is higher in postmenopausal women. Lower estrogen levels lead to the loss of bone density over time. Estrogen also helps to maintain tissues that contain collagen, which can be found in intervertebral discs. Research has associated the lower estrogen levels that follow menopause to more severe lumbar disc degeneration and increased lower back pain in women when compared to men of a similar age. This mechanical cause contributes to increasing back pain in menopause.
Muscle pain
During peri-menopause your hormones begin to fluctuate radically before they fall and remain low as you go through menopause and afterwards. The imbalance of oestrogen and progesterone are the main cause here for the muscles aches and pains, muscle fatigue and muscle cramps that you may experience. While muscle pain can be attributed to the menopause, it is important to know that arthritis often appears around the same age as the menopause, so it is wise to get muscle pains, as well as any joint pains checked by your doctor.
Fibromyalgia
For women diagnosed with fibromyalgia previously, menopause may bring heightened sensitivity to pain. Fibromyalgia is a chronic pain condition that is often diagnosed for the first time in women entering perimenopause or menopause. Some symptoms of menopause like pain, fatigue, and stiffness overlap with those associated with fibromyalgia. For that reason, it is not always easy to determine which issue is causing the symptoms.
Pelvic pain
Abdominal Cramps are a monthly ritual for many women during their menstrual periods. They are a result of the uterus contracting to push out its endometrial lining. Some women naturally have more painful cramps than others. Conditions like endometriosis, uterine fibroids, and pelvic inflammatory disease can also cause painful cramping during your reproductive years. During perimenopause, these cramps may intensify. So can other period symptoms, like tender breasts and mood swings.
Self-Management: How Can You Relief Menopause Pain Symptoms?
Most menopause-related pain can be reduced or eliminated with at-home remedies, medical treatment, or lifestyle changes. Pain, discomfort, and other symptoms of menopause can be treated different ways.
Pain-reducing treatments include:
- Over-the-counter (OTC) pain medication, such as Paracetamol and NSAIDs (ibuprofen) may help with joint pain, or with headache.
- Hot packs or Cold packs can help reduce knee and lower back pain. Generally Hot packs are more suited for MPS pains.
- Dietary supplements, such as evening primrose oil, may help reduce MPS. Since muscle pain is commonly due to hormonal imbalance, a supplement which can naturally balance oestrogen such as soya isoflavones is ideal ie. Phytoestrogens or plant-based estrogen.
There are many lifestyle changes and self-help measures which can help to ease menopause muscle pain. These include:
- Practice relaxation techniques
- Practice good sleeping habits
- Magnesium & Iron Intake
- Healthy & Well-balanced Diet
- Warm shower or heat pads
- Good Posture
- Massages for better blood circulation, relaxation and stress reduction
Don’t wait to seek help for pain. If the pain persists, its time to seek medical help with a doctor. A good way to prepare for an appointment is by writing down your symptoms. The more specific you are, the better. For example, are your headaches on one side of your head, or all over? Is your back pain worse during sitting or walking? Is your heel pain only in the morning upon getting out of bed?
The more detailed about the pain you feel, the better armed your doctor will be to analyse your symptoms and help treat them.
Exercise tips for staying active
Exercise is particularly important for menopausal women, especially aerobic exercises. Keeping active can help reduce body aches and tone muscles, making you less susceptible to injury. Regular but gentle exercise, such as walking, cycling or swimming can help to loosen muscle tension and lessen muscle pain. Exercise also releases feel-good endorphins. These are chemicals in the brain that act as natural painkillers. Exercise can also improve your mood and the ability to sleep, which in turn reduces stress hormones in the body that cause your muscles to tense.
Gently stretching your muscles can also help ease tension, stiffness and muscle pain. Mindful stretching, together with deep breathing, can also aid relaxation and reduce stress hormones in the body. Try yoga or pilates stretches combined with mindfulness meditation for added effect.
“Even on the days you have pain, set minimal goals for activity, like walking 5,000 steps each day.” “If you sit on the couch, you will become deconditioned and the pain gets worse.”
Complementary therapies
Other ways to reduce pain can include deep muscle massage, acupuncture, TCM herbs, and hypnosis. Complementary herbs and spices such as Nettle, Arnica, St John’s Wort and Devil’s Claw have been purported by some unsubstantiated claims.
Massage or muscle and fascia manipulation has short term effect of giving MPS pain relief. However, it should not be more than once a week, otherwise it may create a “dependency” effect and the MPS can become refractory to the original massage effect.
If you smoke, or have other habits which adversely affect your health, work on eliminating them. This may increase feelings of vigor, improve circulation, and reduce stress, which may all help to reduce pain.
Stress management has a significant role in MPS pain management. Reduce major life events and reduce or mitigate exposure to stress during menopause. This will ease the transition of menopause and its related painful effects.
Interventional Pain Treatment
There is no surgical operation for the treatment of MPS. There is nothing to remove or cut off to stop the MPS pain.
In difficult cases of MPS, we may add an interventional pain injection treatment. We can inject at the painful nerves supplying the neck and back and desensitise them with a laser such as radiofrequency. It may be combined with nerve blocks such as paravertebral spinal blocks to achieve good pain relief. The procedure is safe and done as day-surgery or outpatient setting, without any downtime. It is done under mild sedation without need for unnecessary GA (general anaesthesia).
Alternatively, for muscle pain, platelet rich plasma injection can be performed to allow the strained or injured muscles to recuperate and recover. Blood is taken from the patient and this is separated into platelet plasma from the red and white blood cells. We take patient’s own platelet plasma and injected it into the painful muscle for healing.
The spinal nerves injections are done under the guidance of either Xray or Ultra-sound. These will target the placement of the needles onto the nerve plexus such as Lumbar or Cervical plexus supplying the back and neck with great accuracy without any significant risk. Together with surrounding nerve blocks such as sciatica nerve block and suprascapular nerve block, the combined results are very favourable, providing 70% – 90% reduction of pain.
There are no surgical wounds, with only needle puncture marks. This interventional pain procedure provides long lasting pain relief, especially for the refractory painful MPS.
“Interventional Pain Injections targets at the hypersensitive painful nerves supplying the central nervous system, by desensitising their hyper-excited state. In localised pain conditions, injections are targeted at the muscle spasm to reverse the injury, allowing the muscles to heal.”
What is the outlook for pain caused by menopause?
Pain related to menopause is quite common. Most aches and pains, including those related to intercourse, may be reduced or eliminated with treatment. Pain and menopause do not have to impact the quality of your day-to-day life. Menopausal women with MPS should seek care from a team of experts that includes a menopause pain specialist who understands the effect of hormonal fluctuations on pain conditions and avoids excessive painkillers including opioids.
“MPS sufferers should focus on multi-modal therapies like, exercise, relaxation therapies, and combination medication therapies like anti-convulsants and anti-depressants, which interferes with pain transmission and reception.”
“Don’t suffer in silence. In difficult MPS pain cases, patients can be treated with interventional pain injections. Even if the symptoms can’t be completely fixed, they can still be made much better.”
Reference:
Maturitas. Nov-Dec 2005;52(3-4):169-80. doi: 10.1016/j.maturitas.2004.11.004. Epub 2005 Jan 6.
The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study
Foo-Hoe Loh 1, Lay-Wai Khin, Seang-Mei Saw, Jeannette J M Lee, Ken Gu