Or how to stay strong after menopause
Understand the symptoms, recognize the need for prevention, and take action early.
Mobility is closely linked to aging. After the age of 50, both men and women experience reduced flexibility, decreased muscle strength, and lower bone density. These changes affect balance, movement, and can lead to musculoskeletal pain or fractures, with or without clear cause. Reduced mobility can also trigger further health issues, such as weight gain, inactivity, and related diseases.
Menopause can accelerate this decline, especially without consistent, long-term exercise. However, awareness of its effects can – and should – motivate us to adopt daily habits that support bone and muscle health.
Effects of menopause on musculoskeletal health
Menopausal musculoskeletal syndrome may include:
- Musculoskeletal and joint pain
- Loss of muscle mass and bone density (increased fracture risk)
- Higher risk of tendon and ligament injuries
- Worsening of osteoarthritis
- Adhesive capsulitis (“frozen shoulder”)
These effects are largely due to the decline in estradiol, a key form of estrogen produced by the ovaries, which plays a vital role not only in reproduction and sexual function but also in maintaining bones, muscles, tendons, cartilage, ligaments, and fat balance.
Five key changes caused by reduced estradiol
- Increased inflammation: Lower estrogen levels disrupt inflammation regulation, leading to joint pain and persistent inflammation.
- Sarcopenia (muscle loss): Reduced muscle mass and strength, often combined with increased body fat; influenced by both hormonal and lifestyle factors (e.g., low protein, vitamin D, creatine intake, and lack of resistance exercise).
- Reduced muscle regeneration: Impaired activation of satellite cells, essential for muscle repair and growth, leading to slower recovery and weaker muscle adaptation.
- Decreased bone density: Higher risk of osteoporosis, fractures, pain, disability, and psychological impact. Prevention includes proper nutrition, resistance training, and, in some cases, hormone therapy.
- Cartilage damage and osteoarthritis: Reduced collagen production affects joint health, commonly impacting knees, hands, and hips, causing pain, stiffness, and reduced mobility.
Prevention and conservative management
Menopause is a natural stage of life, but its effects can be managed. Daily choices in nutrition and exercise are key.
- Adequate intake of vitamin D and K2 supports bone strength
- Protein- and creatine-rich foods help maintain muscle mass
- Resistance training is essential for both prevention and management
A physiotherapist plays a crucial role in designing, monitoring, and adjusting an exercise program to ensure safe progression, improved strength, flexibility, and reduced bone loss.
Effectiveness of Exercise in Women with Early Menopause
A scientific article (August 2021) aimed to evaluate the effectiveness of resistance exercise in improving bone health outcomes in patients who had undergone cancer treatment, reporting significant improvements in bone mass density.
The study was designed as a systematic review and meta-analysis of randomized controlled trials involving cancer survivors (i.e., women who experienced abrupt, treatment-induced menopause). It examined both bone mineral content (BMC) and bone mineral density (BMD).
To ensure unbiased conclusions, the analysis considered differences between exercise and usual care, as well as subgroup analyses evaluating variations in exercise type, intervention duration, supervision level, cancer type, and treatment modalities.
A total of 26 studies were included, with intervention durations ranging from 12 weeks to 2 years. Most participants had been treated for breast cancer, and interventions included mixed exercise programs (aerobic and resistance training).
Significant benefits were observed in favor of both supervised and unsupervised exercise – across aerobic, resistance, combined, and other training modalities – compared with standard care. Improvements were noted in overall bone mineral density, as well as at the hip, trochanter, and femoral neck.
The authors concluded that these findings provide strong evidence for healthcare professionals and physiotherapists to recommend exercise to cancer survivors, in order to prevent bone loss during and after treatment.
