Symptom Spotlight: Joint Pain

Dr. Mary Jane Minkin is a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University’s School of Medicine. Let’s Talk Menopause spoke to her recently about joint pain, which is one of the most common symptoms of menopause and one that is rarely identified as part of it.

Joint pain is one of the most common symptoms reported by menopausal women, yet most don’t associate the problem with menopause. Why not? 

Awareness is a huge problem. The achiness that begins with perimenopause tends to present like arthritis, or people assume they’ve already got osteoporosis. I can’t count how many patients have already seen a rheumatologist and been tested for Lyme and Lupus before coming to see me. When all these tests come back negative, they get confused because they are feeling so much discomfort. The last thing on their minds is that the pain is linked to menopause. 

Is the decline in estrogen to blame for all these achy knees, hips, backs, etc.? 

I always tell my medical students to go into the OBGYN field, particularly menopause studies, because there is so much room to make discoveries. And whoever figures this all out will surely get a Nobel [Prize]. That’s all to say, we don’t know exactly what causes joint pain during menopause. One leading theory is that the decline in estrogen reduces our stores of synovial fluid, which in turn dries out our joints—just as it does our skin and our vaginas. But we can’t prove that estrogen is the only issue. 

Does joint pain typically start during perimenopause?

Onset can happen at any time during the menopause journey.

Can women expect their pain and stiffness to improve after menopause? 

For some people it does get better; for others, unfortunately, not. 

What are the best remedies for people who are in pain and not able to move much?

I’m a big fan of glucosamine, which is naturally found in cartilage and can be taken in supplement form. And some people find turmeric helpful. Anti-inflammatories such as Motrin and Aleve can make a huge difference—as can Voltaren, which is a topical gel form of diclofenac, another anti-inflammatory, that can be rubbed into the knee or shoulder joints for real relief. 

Can anything be done to prevent joint pain? 

The best prevention is to stay in good shape. Exercise is terrific. It definitely helps. That means aerobic movements as well as strength training and stretching. But even the fittest among us don’t always escape joint pain. I had a patient who was a big bicyclist. Very fit. She was planning a bike trip through Europe but felt she’d have to cancel because it was agonizing to ride. I put her on hormone therapy. After only a few weeks, she made the trip and had the time of her life. That’s a great example of how hormones can make all the difference. ‍

Is hormone therapy the best approach for women whose joint pain is menopausal?‍

It’s a real game changer for lots of women. In many cases, I recommend either oral estrogen or an estrogen patch. There are many, many safe options now. The key is to find a medical provider who knows how to find the right type and dosage for each individual patient. 

You started talking about menopause long before anybody was listening. Now people are not only listening, but ready to talk. Why is menopause suddenly a more acceptable topic? 

To some degree, I think it’s about women’s liberation. Menopause correlates with getting older and women haven’t wanted to acknowledge that they are getting older. This is a culture that worships youth. But today, we have ladies who are, fortunately, awakening to the fact that there's a lot of stuff going on with perimenopause. 

That’s a reason to feel hopeful.

Unlike their mothers, women in their 40s today are not poisoned by the fallout from the 2002 report from the Women’s Health Initiative. The WHI (Women's Health Initiative) was started in 1999 to determine if post-menopausal hormone therapy decreased heart disease in women. It also looked at the risk of breast cancer. The study did show a very slight increase in breast cancer for the women who still had a uterus and took estrogen with a progestin for a lengthy period; it did not show any increased risk of breast cancer for women who no longer had a uterus and therefore took only estrogen. The study was stopped for women with a uterus after five-plus years of therapy. However, the misinterpretation of the data panicked all women, and all estrogen usage in this country plummeted. Any talk about hormone replacement therapy, which was one of the mainstays of therapy for menopause, was buried. Menopause became a dirty word. 

And that was only the first in a series of unfortunate events. Around the same time, medical schools in the U.S. and Canada cut back on residency hours from 120 to 80 hours per week, so something had to go. Menopause became an optional topic.  According to a 2013 study by Dr. Wen Shen of Johns Hopkins University, only 20 percent of residency programs in the U.S. and Canada were teaching menopause after 2002. ‍

So not terribly hopeful after all? 

Younger women now say: ‘I want help!’ But, if they go to a doctor who finished a residency program after 2002, they're likely to be dealing with somebody who has had very little formal menopause education. To me, this is a terrible situation.

What’s the best way for women to find a menopause-informed healthcare provider?

Part of the reason that I put my website up, MadameOvary.com, is so that women can learn about menopause. And I always tell women to go to menopause.org, which is the website of the North American Menopause Society. If you plug in your zip code, you can find somebody who knows something about menopause.