Pain is the most frequently reported symptom reported to a healthcare professional. However, often it is the most neglected. In her presentation at EMAS 2019, Dr. Alessandra Graziottin explained that this is even more pronounced when it comes to menopause.
Chronic pain and menopause
While pain during menopause can often be disregarded as ‘normal’ or ‘stress’, Dr. Graziottin explained that it is a clear issue that can be treated and managed by healthcare professionals.
So, what affect does the menopause have on pain?
First it is key to consider the close relationship between increased inflammation and increased pain.
Fluctuations of estrogen and progesterone trigger cyclic inflammation in the uterus and other inflamed tissues. These fluctuations increase in the perimenopause and menopausal transition.
Loss of sexual hormones after the menopause triggers a low grade inflammation
Looking at this in more detail, Dr. Gaziottin discussed that estrogen fluctuations stimulate mast cell degranulation, promoting a pro-inflammatory effect. The loss of progesterone and testosterone amplifies this pro-inflammatory effect.
The low grade inflammation associated with menopause can affect many areas of the body, including joints, bone, muscles and fat tissue. This is a definite causal factor of the chronic pain that women can experience in the postmenopause.
It is also crucial to consider the psychological pain that women may experience. Dr. Graziottin explained that neurogenic inflammation can affect women’s autonomy, energy levels and sense of dignity. It is important to understand and address these issues with as much attention as the physical elements of pain and inflammation.
Questions to consider
In clinical practice, there are questions that can be considered when managing chronic pain:
What is the pathophysiology of the inflammation behind this pain?
What are the predisposing, precipitating and maintaining factors?
What is the role of lifestyle factors?
What is the role of hormones?
Are there genetic factors?
All of these can help a healthcare professional to identify causal factors to help address the inflammation and pain.
The importance of the gut
The role of the microbiome is important for postmenopausal chronic pain, Dr. Gaziottin discussed. The gut has a role in modulating pain perception, emotional well-being and severity of menopausal symptoms. It is important to take steps to maintain good gut health, while appreciating that the bowel may well be a critical cause of abdominal and pelvic pain.
HRT for reducing pain
Dr. Gaziottin suggested that to reduce pain associated with menopause, HRT should be offered to women at an early stage. Continuous combined regimens can help to reduce mast-cells degranulations and flares of inflammation and pain, especially in women with previous chronic pain.
Androgens were also highlighted as having an important role. Dr. Gaziottin explained that HRT and androgen replacement can not only reduce pain, but also improve mood, increase vitality and improve sexual function.