Arthralgia was revealed as the top symptom experienced by Singaporean women undergoing menopause, according to researchers from the Integrated Women’s Health Programme (IWHP) at the National University Hospital and the Yong Loo Lin School of Medicine, National University of Singapore. After conducting two groundbreaking studies last year, the earlier study published in October 2023 revealed that 62.6 per cent of 1,054 Singaporean women of Chinese, Malay and Indian ethnicities, reported at least one moderate to extremely severe symptom during their menopause. The findings were published in Maturitas, an international journal that focuses on midlife and post-productive health. Arthralgia was ranked as the top menopausal symptom, significantly affecting a third (32.9 per cent) of the cohort.
Arthralgia even outranked other common symptoms such as sleep problems (27.5 per cent), vaginal dryness (20.3 per cent), physical and mental exhaustion (19.6 per cent), and hot flushes (18.6 per cent) in Singaporean women.
What is arthralgia in menopause?
“Arthralgia can be debilitating and may lead to a decline in the quality of life among healthy midlife women. Despite being one of the most frequent complaints, there is a paucity of studies examining the risk factors associated with this condition,” highlights Professor Yong Eu Leong, Emeritus consultant at the National University Hospital’s department of obstetrics and gynaecology.
“Menopausal arthralgia refers to muscular discomfort and joint pain that occur around menopause,” says Professor Yong, a pioneer in the treatment of menopausal osteoporosis and human fertility for over 30 years. “Most people get joint pains and muscle aches occasionally. However, if the muscular discomfort and joint pains occur when menstruation stops, or get worse during this period, we will understand it as menopausal arthralgia.”
Are there any specific factors that trigger menopausal arthralgia?
“We do not know for sure, but we have a strong clue from women taking drugs to lower estrogen levels as part of breast cancer treatment. They suffer from such severe muscle aches and joint pains that about 50 per cent stop anti-estrogen therapy despite the risk of breast cancer recurrence,” shares Professor Yong.
“Based on this well-known finding in breast cancer patients, we think that sudden lowering of estrogens during menopause in healthy women is an important cause of menopausal arthralgia.”
Why does arthralgia in menopause surpass other symptoms such as hot flashes in Singaporean women?
“Two local studies have been conducted,” shares the Professor. One in 2001 and the other one being the one we have published under the Integrated Women’s Health Programme (IWHP) recently in October 2023. Women in both studies consistently complain that muscular discomfort and joint pain is the main problem that they are facing.
“This is in contrast to studies in Caucasian populations, which mostly show that vasomotor symptoms, or hot flashes, are the principal complaint.
“It is relevant to note that menopausal symptoms tend to be associated with one another. In our study, we found that menopausal arthralgia is associated with vaginal dryness and hot flashes. Collectively, these symptoms result in poorer sleep, physical mental exhaustion and consequently lower quality of life.”
What can be done to alleviate the pain?
“Although it is such a common condition, surprisingly there is a lack of studies on menopausal arthralgia,” explains Professor Yong. “We are planning to conduct follow-up studies to understand the condition better and to see what interventions can alleviate the pain.
“Nevertheless, based on evidence from existing studies, we think that judicious use of menopausal hormone therapy and curated exercises might improve the condition.
Can it ever be cured or just managed?
“Estrogen levels plummet drastically during menopause. Conditions caused by sudden estrogen withdrawal, such as joint pain and associated vaginal dryness, mental and physical exhaustion are likely to persist during the post-menopausal period, which might constitute more than a third of the lives of Singaporean women. Menopausal hormone replacement may help in some cases.
“We have women who told us that their joint pains improved when they started exercising, but returned when they paused their exercises.
“Conversations with our physiotherapy team indicate that properly curated exercises can strengthen muscles around affected joints and protect the joints from further injury,” says Professor Yong.
The IWHP is partnering with NUH physiotherapists for a follow-up study to create tailored interventions, such as exercise programs for muscle strength, and investigating the potential of menopausal hormone therapy to alleviate joint pains and enhance overall well-being in women across different menopausal stages. For support, email [email protected] for more.
