Menopause and bone health – not just for old ladies!
Menopause is defined by the cessation of periods for a period of 12 months. It is a natural part of female ageing. The average age of onset of menopause in Australia is 51.7 years, however it may occur earlier in some women for a number of reasons including total hysterectomy (including ovaries), chemotherapy or radiation therapy, auto immune diseases, or being a smoker or being obese. A woman’s heritage may also impact age of menopause with Asian women tending to go into menopause a couple of years earlier than those women of anglo-saxon heritage.
Many women have symptoms of varying severity for 5-10 years either side of the actual cessation of the period. These symptoms may include the commonly known hot flushes, poor sleep quality and mood swings but the less commonly reported depression and anxiety.
Other symptoms of changing hormonal levels, particularly the decreasing oestrogen, include the changing of skin (more wrinkles, thinner consistency), as well as change in our ‘figure’ with increasing fat deposits particularly around the tummy, as well as a generalised decrease in muscle mass. Associated with this is a generalised increase in joint aches and pains. Some of this is associated with the weight gain and decreased muscle mass but another part is because of the important role oestrogen plays in maintaining joint and tendon health. There may also be the less discussed issues of vaginal dryness and irritation, increased sensitivity to urinary tract infections and urinary incontinence and other pelvic floor dysfunction.
There are also the symptoms of menopause that we don’t specifically feel but may experience, such as a change in bone health.
Bones are a living tissue. This means they are constantly active which is how they maintain their health. Through your lifespan your bones are constantly breaking down and being rebuilt. It’s what they do and they usually do it well. Until about the age of 30, it is normal to build more bone tissue than what is naturally lost. This is the time known as peak bone mass. It’s where our bones (both men and women are their heaviest). From then on it is a very slow decline in bone growth for both men and women.
Oestrogen (the most significant female sex hormone) levels significantly decline with menopause. Oestrogen is essential for bone development. After menopause, this scale is tipped a bit the other way where bone breakdown overtakes bone growth.
The ‘level’ of bone quality and mass you start at is very important. If a woman has always been very strong and active and had a reasonably good balanced diet since adolescence, then her starting level should be ‘good’ (there are always potential factors affecting this such as chronic illness, long term cortico-steroid use, protein pump inhibitors and genetic abnormalities). This means that there is better quality bone at the commencement of menopause and the decline should be slow and potentially will not result in any symptoms. However if you are a woman who has a lifetime of lower bone mass (because of some of the reasons stated above) it will mean you will have less ‘buffer’ to where your bone density may become an issue and affect your health.
Once a certain level of low bone density is reached, a person has osteopenia – meaning thinning bones have been identified. This is a warning sign of the potential for the more serious – osteoporosis– meaning ‘porous bone’. As you can imagine this makes the bone less strong. This unfortunately means that a woman is less robust and is more likely to break a bone where a woman of strong bones would not.
It is important to note that whilst menopause is the most common cause of osteopenia and osteoporosis, some women suffer from this at a younger age. It is usually associated with eating disorders and REDS (Relative energy deficiency in sports). Neither of these conditions are isolated to the classic examples of ‘anorexia’ or elite sports people. In fact they are both incredibly common in the recreational athlete and our everyday seemingly well functioning adolescents. But that’s a blog for another time…..
What can you do to help yourself?
Keep a regular check in with your GP through these years. Be honest with your symptoms and your concerns.
The great news is weight-bearing, resistance exercise (using weights and your body) is a great way to help improve bone health, along with an adequate and balanced diet including proteins, whole grains and plenty of vegetables.
The even better news – the earlier you start making these lifestyle changes and including regular resistance-based exercise in your routine, the better your bone health will be. In fact girls in early adolescence (start of menstruation) determine how well they will lay done bone through their life. This is the time of peak bone growth and we want to encourage it as much as possible. Teenage girls that are highly active in weight bearing activities (running, jumping, tumbling, climbing) and have a good, balanced, adequate calorie diet will lay down high quality bone. They won’t necessarily see the benefits of this hard work until menopause – but they will see it.
So how does exercise help your bones?
When you exercise your muscles contract/ shorten which in turn makes the tendon pull on your bone. When this happens a lot and at a strong intensity the bone is then triggered to lay down more bone to make that area ‘tougher’. When you put a hard force through a bone such as jumping or stepping up a step the bone is again triggered to lay down more bone and make itself tougher to resist that force.
As a woman passes menopause it is harder for her to build lean muscle mass. In fact she generally loses lean muscle mass too easily, again this is the fault primarily of the sex hormone oestrogen.
Her tendons tend to get more cranky with heavy exercise and her joints get more sore because once again oestrogen is incredibly important in collagen synthesis (a key ingredient in healthy tendons and joints). It can be difficult for her to work ‘hard enough’ for bone health without compromising these other vulnerable tissues. As we said above, it is common to put on weight in the form of fat particularly around the waist which can make a woman feel heavier and more uncomfortable. there are a number of other symptoms that are common at menopause (you can read about that here), that may also limit a woman’s exercising ability.
It is also a very busy time in most women’s lives. She may have children finishing school, she is managing her career. She will often have ageing parents that need caring for also. Her time is very limited. Her bone health may not be at the top of her to-do list. Having a physio in her corner who understands all of this is invaluable. Having a physio who will listen and guide a woman to the best best exercise for her at this time is priceless. This is what we do at Vital Core Physio. We are physio’s with a keen interest and extra training in women’s health. We understand all about the condition and how it can affect different women. We also know exactly what to do to help.
With the right advice and guidance and support you can maintain or even improve you bone density. Call Vital Core on 08 8331 0552 or book online to see one of our physiotherapists. All women of all ages should feel strong and capable of taking on the world!