Growing (older) pains: arthritis, aging, and menopause
And more importantly, what can women do to manage joint and arthritis pain to maintain healthy, happy, active lives?
Dr. Darcy Foral, MD, is a board-certified, fellowship-trained Orthopaedic Surgeon at the Edmonds Orthopedic Center. We squeezed ourselves into her busy scheduled to get a orthopedist’s view of arthritis and other aches and pains.
What is arthritis?
Dr. Darcy: Arthritis literally means “joint pain.”
The word arthritis is thrown around by doctors and lay people alike to refer to a wide variety of aches and pains, and this creates a lot of confusion.
When my orthopaedic colleagues and I use the word arthritis to describe a condition, we are referring specifically to damage to a joint, significant enough that it is causing pain. We usually see this initially on x-rays or some other form of imaging (MRI or CT scans).
When we diagnose someone with arthritis, we have seen changes to the joint, usually narrowing and the formation of cysts or bone spurs, that indicate this process is happening.
Is there more than one kind of arthritis?
Dr. Darcy: There are many kinds of arthritis.
The most common is osteoarthritis, which is the "wear and tear" type that happens to the majority of people as they age. While there is a genetic component to osteoarthritis, as some families get it worse than others, the science behind that is not yet clearly understood.
Another common form of arthritis is traumatic arthritis. If you had an injury, last year or in childhood, it can lead to damage to a joint that eventually causes that joint to wear out. The timing of the joint wearing out is usually dependent on the severity of the original injury. Repetitive injuries, like multiple ankle sprains from "weak ankles" can also lead to arthritis, even if the injury itself doesn't seem that severe.
Finally, rheumatoid arthritis, falls into the category of autoimmune diseases and usually has a much worse prognosis. Autoimmune diseases can affect almost every aspect of the human body, but they have the common denominator of your own body attacking itself because your immune system has mistakenly identified one of your own tissues and foreign and something it must get rid of.
In rheumatoid arthritis, your body is attacking the lining of your joints and can cause wide spread destruction. Luckily, in the last 20 years, we have new medications to suppress this, and our treatments have improved significantly.
There is a strong genetic component to autoimmune arthritis and the diagnoses and treatment is also more complicated, usually being managed by a rheumatologist.
If rheumatoid arthritis, lupus, or a similar disease runs in your family and you are starting to have pain or swelling in multiple joints, muscle pain and weakness, or other unexplained symptoms that are sticking around and don't seem related to activity, you should see your primary care doctor and let them know what you are experiencing sooner rather than later. They should be able to help direct you where to go next in obtaining a diagnosis.
Can menopause cause arthritis or make it worse?
Dr. Darcy: The good news is that menopause does not make your chances of getting any kind of arthritis worse in and of itself, but it can certainly feel that way.
Arthritis and osteoporosis
Most of us know that our bones get weaker with age (osteoporosis), with the maximum density happening before menopause. Once menopause hits and our hormones change, we start to lose bone density if we don't work hard to prevent it, and sometimes even if we do.
Having poor bone density will not give you arthritis, but it will make you more prone to injury. Let's say you start to get some compression fractures in your spine due to osteoporosis. As your spine compresses and the shape of it changes, you then develop arthritis in your spine, or narrowing of the joints, causing pinching of the nerves or narrowing of the spinal canal. These changes lead to back pain, nerve pain and weakness, and can be very debilitating as we age.
Arthritis and weight management
The other common factor that can lead to joint pain and arthritis is weight gain.
Some of us have to be careful our whole lives to avoid excessive weight gain, but for many women, menopause is the first time in their lives that they see their metabolisms change dramatically. I see so many women who come in for very legitimate musculoskeletal issues, and so many of these issues are either caused or made worse by weight gain.
It's a delicate topic, because of course no one wants to be overweight, and when your body isn't working well for you, it's easy to continue to put on more weight.
We know from many scientific studies on osteoarthritis that extra weight will wear out your joints, especially your weight-bearing joints which are your hips, knees, and ankles.
How can I manage my arthritis?
Dr. Darcy: I think that it is important to remember that many things change as we age, and running five miles over lunch may not be the best choice of exercise for you any more, at least not if you have an injury.
There are so many fun, low-impact options that you can choose to keep active without increasing wear and tear on your joints. Swimming, biking, rowing, and yoga are easy for most people to access if they are motivated.
While many women shy away from weight lifting, keeping your muscle mass up is a great way to keep your metabolism from slowing down, and it also is the single best thing you can do to help keep osteoporosis at bay. Staying strong helps your balance as well; good balance means less risk of falls and fractures and the ability to remain independent well into your 80s and 90s.
Does diet affect joint pain?
Dr. Darcy: In the case of weight gain, yes, it really can, but there is a lot about diet we are learning, specifically the role of foods that cause inflammation, that may affect joint pain.
The make-up of our gut bacteria may also play a role in our disease processes and weight. I do not proclaim to be an expert in this area but I do watch it closely for solid recommendations to help direct patients who are looking for advice, as well as advice for myself!
When should I talk to a doctor about the pain?
Dr. Darcy: It is very normal to get a little joint pain here and there. We all get sore and "tweak" a joint lifting something or turning the wrong way. We get excited and over-do it at the gym or on an extra long hike, or if you’re like me, trying to keep up with the kids.
Joint pain or musculoskeletal pain that doesn't go away with a few days of rest, ice, and ibuprofen should probably be checked out by a doctor. The RICE formula is a good one to keep in mind as your first line of treatment for aches and pains (Rest, Ice, Compression, Elevation).
Orthopaedic surgeons like myself are specifically trained to figure out what is wrong with your musculoskeletal system and direct you to your best treatment course (imaging, lab work, physical therapy, massage, acupuncture, bracing, injections or surgery).
Will I need surgery for my arthritis?
Dr. Darcy: Even though we are surgeons, the vast majority of our patients do not need surgery. My goal is always to try to look at the big picture and find the best course of treatment for my patients, taking their whole lives into account, with surgery as a last option if all else fails.
I encourage all of you to find a doctor you feel respects you, takes your life goals into consideration, and helps make a reasonable plan with you to feel better and stay active and keep moving without daily pain.
I know from being a patient myself, it is not always easy to find and develop that kind of relationship with a doctor, especially if you are in a rural area. Reach out to friends, family, and co-workers to help find a doctor you are comfortable working with. If you can’t, online options might be the next best place to look.
While Dr. Google can be right sometimes, I encourage you to visit a physician if at all possible before you waste precious time and money on bad online recommendations or the wrong diagnosis.
Do you suffer from arthritis or joint pain? What are you doing to manage the condition and the pain? We’d love to hear your story and solutions, so please share with us by commenting here, or starting a thread in our community forums. You can also reach out to us on Gennev's public Facebook page or in our closed Facebook group.
Have you taken our Menopause Assessment?
Join over 100,000 women to learn more about your symptoms and where you are in the menopause journey.