Joint Pain and Women – Women’s Health

Everyone gets the occasional ache or pain — a little soreness in the shoulder, a twinge in the knee — but research shows that women are more frequently and often more severely affected than men. The CDC estimates that from arthritis or chronic joint symptoms affect more than 70 million Americans, 41 million of whom are women. A number of factors contribute to this disparity: Women are more apt than men to have conditions that cause joint pain, experience hormone fluctuations that affect their vulnerability, and may not be physiologically equipped to deal with pain.

Causes of Joint Pain in Women

Of the nearly 27 million Americans with osteoarthritis (AO), 60 percent are women. Rheumatoid arthritis (RA), an autoimmune disease, strikes approximately three times more women than men. Other autoimmune conditions that cause joint pain, such as lupus, scleroderma, and multiple sclerosis (MS), also hit women harder than men: Women are nine times more likely to develop lupus, three times more likely to have scleroderma, and twice as likely to suffer from MS. And fibromyalgia, a little understood condition that can cause joint pain, affects women eight times more frequently than men.

The Estrogen-Joint Pain Connection

“Women typically feel pain more intensively, more often, and in more parts of the body than men,” says Tarvez Tucker, MD, a pain specialist and director of the Pain Clinic at the University of Kentucky Medical Center, in Lexington. Female hormones are believed to play a role in women’s high vulnerability to pain. Many women with OA, RA, lupus, and fibromyalgia report an increase in joint pain just before or during their periods. This is likely because estrogen levels plummet right before menstruation and rise again after a woman’s period is over. “Estrogen is believed to be protective against pain,” says Dr. Tucker. “It peaks during pregnancy, probably to protect women from the pain of childbirth.” Some research shows that 80 percent of women with RA experience a remission of symptoms during pregnancy and a flare-up when estrogen dips during the postpartum period. Additionally, reproductive hormones are suspected as factors in the high incidence of autoimmune diseases in women since conditions such as RA and lupus are most common during the childbearing years.

Women’s Bodies and Joint Pain

Hormones are only part of the picture, however. Female brains may be wired for pain. It’s thought that endorphins, the body’s natural painkillers, work more effectively in men than in women. “Studies have found that females release less of the brain chemical dopamine in response to painful stimulation. Without dopamine, endorphins can’t function effectively,” says Patrick Wood, MD, a pain researcher at Louisiana State University, in Shreveport, and medical advisor to the National Fibromyalgia Association.

Female structural differences may contribute to some kinds of joint pain, too. For example, women are more prone to osteoarthritis of the knee. One possible explanation: “Women tend to be more limber and loose-jointed than men, so there’s more movement in that area, increasing the risk that the kneecap will rub on the bones below it,” notes Bruce Solitar, MD, a rheumatologist at the NYU Hospital for Joint Diseases, in New York City. This may lead to osteoarthritis symptoms in the knee area.

Joint Pain Medication and Women

Women react differently than men to some medications for relieving joint pain. For example, fluctuating hormone levels can reduce the amount of medicine circulating in the bloodstream, which means that women may need more of the standard dose. Plus, female digestive systems are slower, causing certain medications (like pain relievers) to take more time to pass through the digestive tract where they’re absorbed more fully. And because pain sensitivity increases right before a woman’s period, more pain-relieving medicine may be required at this time of the month. “Women need to be aware of these factors, ask the right questions, and be persistent about getting an accurate diagnosis and proper treatment,” says Dr. Tucker. By becoming educated about how joint pain affects them, women can increase the odds of finding relief and getting the best health care possible.

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Your Period, Menstrual Cycle, and Arthritis Flares: What’s the Connection?

Eileen Davidson doesn’t need a calendar to predict the start of her period. In the days leading up to it, she gets bloated, gassy, and ravenous for really bad foods. Her acne flares up, her mood becomes more irritable, and her sleep gets disrupted.

This PMS struggle is real for many women, but for Eileen, who is a patient advocate in the CreakyJoints community and lives with rheumatoid arthritis (RA), this time of the month feels extra tough.

“Night sweats set in about a week or so before, and get worse the closer to my period,” says Eileen, 34. When her sleep is poor, she’s more tired and sedentary during the day, which often exacerbates her rheumatoid arthritis pain.

“I also notice more inflammation in my hands and feet, and tend to run a mild fever,” explains Eileen, who was diagnosed with RA in 2015. “When my period arrives, the night sweats calm down, but the fever and fatigue continue.”

Eileen is not alone: In one study that included 267 members of the CreakyJoints community and its ArthritisPower patient research registry, nearly half of respondents (most of whom had RA) felt that their arthritis disease activity varied over the course of their menstrual cycle, with the worst flares occurring several days prior to or during menstruation.

“Anecdotally, many women note worsening of symptoms primarily during the week or so that is the premenstrual part of the cycle into the menses,” says Lisa R. Sammaritano, MD, a rheumatologist at Hospital for Special Surgery in New York City. But scientifically the link between menstrual cycles and inflammatory arthritis flares remains unclear.

How Your Menstrual Cycle May Affect Inflammatory Arthritis Flares

Experts agree that more research is needed, but there are some theories.

Fluctuating Hormone Levels

Research suggests that variations in hormone levels that occur during your menstrual cycle may influence arthritis disease activity and the severity of symptoms.

In the days leading up to and during your period, levels of the hormones estrogen and progesterone are low. One small study published in the journal Rheumatology found that women with RA reported increased pain, fatigue, and disease activity right before their period. Those with systemic lupus erythematosus (SLE) experienced similar symptom flares during menses.

After your period, estrogen levels rise, peaking right before ovulation (which occurs mid-cycle, when your ovaries release an egg). During ovulation, estrogen dips; then afterward, both estrogen and progesterone levels steadily increase as your body prepares for a potential pregnancy.

Women have reported that their inflammatory arthritis symptoms improve several days after and up to two weeks after their period. One study found morning stiffness was reduced in RA patients during the post-ovulatory phase, when these female hormones were high.

Toward the end of your menstrual cycle, if the egg isn’t fertilized and you’re not pregnant, both estrogen and progesterone plummet again — this is your premenstrual (PMS) week.

Women who are pregnant, however, have reported decreased disease activity during pregnancy — when estrogen hormones and progesterone levels remain high — and may experience flares postpartum, when those hormone levels decrease.

“It seems likely that hormones may impact disease activity directly, such as by promoting or alleviating inflammation,” says Dr. Sammaritano. They may have a systemic effect on the immune system, as well as within the joint.

Pain Perception

Another potential connection between flares in arthritis symptoms and your period is pain perception. When estrogen levels are low, women may report more pain, according to some research.

In one study of 20 women with chronic pain, researchers found rated pain significantly higher in the menstrual and premenstrual phases than in the mid-menstrual and ovulatory phases. “It may be that a change in pain threshold contributes to pain and fatigue during the premenstrual phase, in addition to a true increase in inflammation. ” says Dr. Sammaritano.

Can Oral Contraceptive Pills Ease Arthritis Flares?

The jury is out on this, too: Some research suggests oral contraceptives pills (OCPs) may ease pain and improve function in women with RA. In one study from researchers in Iran, 100 women with rheumatoid arthritis were randomized to take birth control pills or a placebo for eight weeks. Researchers measured patients’ tender and swollen joints, blood levels of inflammation, and self-reports of pain at the beginning and end of the study period. They found that those on the birth control pills reported improvements in disease activity compared to those taking placebo pills.

Other studies have shown conflicting results. In the survey of CreakyJoints and ArthritisPower members with inflammatory arthritis, of those who used oral contraceptive pills, 70 percent of the women did not report changes, fewer than 10 percent reported improvement, and slightly more than 10 percent reported worsening of symptoms.

Talk to your rheumatologist to determine the risks and benefits and if OCPs are right for you.

How to Ease Arthritis Flares During Your Period

You know your when your body is going through PMS, and likely have some go-to strategies for helping to ease symptoms. If you get bloated, you cut back on salty foods and opt for elastic-waist sweatpants instead of jeans. If you get cranky, you might do a little more yoga to reduce stress.

If you suspect that your approaching period exacerbates arthritis symptoms, here are ways to help ease flares:

Follow your prescribed RA treatment plan

Keeping your RA disease activity under control will help reduce inflammation in your body. That’s one less factor possibly contributing to pain, mood swings, sleep disruption, and more.

Ask about pain medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as over-the-counter ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — can relieve pain and reduce inflammation. If you aren’t already taking these medications regularly for arthritis-related pain, says Dr. Sammaritano, your doctor may suggest adding it to your regimen the week before your period. Talk to your health care provider to see if this is appropriate and safe for you.

Remember that even over-the-counter NSAIDs can have side effects, such as stomach problems (pain, constipation, diarrhea, ulcers) and more. Make sure you follow dosing instructions and that your doctor knows about all the medications and supplements you take.

Track your symptoms

That’s what Eileen did to help her better understand her menstrual cycle and how it affected her overall health. “If you know exactly how RA symptoms get worse around your period, you can be a little more proactive,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Texas. For instance, maybe you take extra care to eat well or avoid other arthritis triggers, she says.

You can use our ArthritisPower app to track your symptoms and disease activity and share your results with your doctor.

Carve out time for gentle exercise

The benefit is twofold: Exercise not only helps ease PMS symptoms (such as mood changes and difficulty concentrating), but it can strengthen the muscles around your joints, improve flexibility, and fight fatigue.

“I do some gentle movement every hour to prevent stiffness and relieve pain,” says Davidson.

Apply heat or cold

A warm compress can help ease pain and stiffness, cold can help ease inflammatory symptoms, such as swelling. Try both to see which works best for you or alternate between the two. Here are simple ways to do hot therapy and cold therapy at home.

Give yourself a break

“My period can take so much out of me,” says Eileen. “It can feel like a daunting task trying to refresh myself.” But she allows her body the time it needs to rest and makes it a point during this time to be kind and gentle to herself. “I remind myself that this will pass,” she says.

Muscles hurt during menstruation – Body aches before menstruation

1. home

2. About the pain

3. Periodic pain

August 30, 2021
Period pain

Many women are told about the imminent onset of menstruation not only
calendar, but also the appearance of premenstrual symptoms, which can
disrupt the habitual way of life. One of the symptoms is pain and aches in the muscles.
Let’s find out why there is muscle pain before and during menstruation,
what else can cause such complaints and how you can alleviate the condition.

Why does the whole body hurt during menstruation?

Pain during menstruation is a common phenomenon, its frequency
reaches 90% ¹ . In addition to the classic menstrual pains in
abdomen, women may experience pain in the joints, lower extremities, back
and muscles, feeling of numbness of hands and feet, coldness
limbs ^2.14 . For some, pain may occur sporadically, and
some are stalked throughout their reproductive
age ⁹ . Causes of muscle pain and body aches during menstruation
may be different.

During adolescence and young age

Relative hyperestrogenism

excess estrogen against the background of insufficient production of progesterone ³ . Estrogens
increase uterine contractions, while progesterone, on the contrary, inhibits
excessive contractile activity. With a lack in the body
progesterone increases the action of prostaglandins, which cause spasm
myometrium and muscles of other pelvic organs. Prostaglandins work
on nerve endings, due to which susceptibility to pain is greatly
increases ^3.4 . This is the mechanism of development, the so-called primary dysmenorrhea,
which usually occurs in adolescence 1-3 years after
menarche, with the onset of ovulation ² .

Vitamin deficiency

Vitamin D deficiency has been shown to cause myopathy (muscle damage)
¹⁵ . Atrophy of individual muscle groups can provoke
mechanical stress in intact muscles due to their overload, which can
be the basis for the formation of pain zones in the muscles ¹⁵ . Besides,
increased perception of pain may be due to a lack of B vitamins
B, which normally have a neuroprotective, sedative and analgesic effect
action ^16.17 .

Weak connective tissue syndrome

May be associated with congenital or acquired magnesium deficiency ¹⁸ .
Magnesium deficiency is possible with hyperestrogenism, when the mineral is intensely
washed out of the bone tissue. Violation of magnesium metabolism leads to an increase
the rate of collagen breakdown, which occurs with connective dysplasia
fabric, which in 9times the risk of developing primary dysmenorrhea
for girls ⁶ .

Risk factors for developing muscle pain during
dysmenorrhea characteristic of adult age

Gynecological pathology and previous
operations . A common cause of muscle pain, especially affecting
pelvic floor muscles, is a gynecological pathology ⁸ . At
this chronic pain is localized in the lower abdomen, lower back, in
region of the sacrum. Pain can spread to muscles and fascia from the focus
inflammation or endometriosis in the pelvis, causing symptoms of secondary
dysmenorrhea ^{2. 9} .

Chronic inflammatory process of small organs
pelvis can lead to secondary endocrine disorders, decrease
progesterone synthesis and lowering the threshold of pain sensitivity due to
prolonged existence of pain ⁹ .

Degenerative diseases of the lumbosacral
spine section . If the lower spine is affected, then
pain can spread to the pelvic organs and legs. So, when involved in
pathological process of the lumbar roots pain, sensations
tingling, burning in the thighs, groin, lower abdomen, external
genitals, knees and legs. Muscle pain may accompany
osteochondrosis and other degenerative diseases of the lower part
spine. Due to pain, the muscle contracts, tenses, muscle
spasm, and the spasm makes the pain worse ¹⁰ .

Perimenopausal

Decrease in the level of sex hormones

In women during the menopausal transition, work gradually fades
ovaries, the number of follicles decreases, the production of female
sex hormones. Without estrogen, muscle mass decreases
fibers, degenerative processes begin in the muscles. Decreased muscle
strength, endurance, fatigue quickly appears. No estrogen protection
metabolism is disturbed: the sensitivity of muscle cells decreases
to glucose, lipid metabolism is disturbed, in the vessels that feed the muscles,
the process of fat deposition begins. Muscles starve without glucose
and against the background of insufficient blood circulation, processes are activated
oxidation, which is manifested by muscle pain and swelling ¹¹ .

Exacerbation of inflammatory diseases of the joints

During menstruation, the body releases inflammatory mediators:
prostaglandins, interleukins, cytokines, which can lead to
exacerbation of chronic musculoskeletal diseases. laboratory
C-reactive protein is an indicator of an acute inflammatory process.
(SRP). Its highest content is recorded during menstruation.
It has been observed that the more severe the menstrual symptoms
(especially mood swings and pain), the higher the content
SRP ¹² .

Osteoporosis

Articular and, consequently, muscle pain, may manifest
osteoporosis. Against the background of estrogen deficiency, bone metabolism is disturbed:
the process of its formation slows down, and its destruction is activated. In
Osteoporosis is more common during menopause than during other
life periods. Bone tissue is a storehouse of minerals, for example:
calcium, magnesium, phosphorus. Deficiency of these minerals can manifest
painful cramps in the calf muscles ¹¹ .

Premenstrual syndrome and body pain

PMS may present with muscle pain in combination with other symptoms.
The prevalence of PMS varies from 18% to 92%, and the age of the highest
vulnerability varies between 25 and 35 years ⁷ . As intended by nature,
for its optimal functioning, a mature female body must be under
well-coordinated and rather monotonous effect of sex hormones. This means,
that a woman from the beginning of menstruation to menopause must be either pregnant,
either by a nursing mother, and hormone fluctuations are allowed only for
conception ³ .

At present, such a large number
pregnancies are rare, so menstrual cycles are accompanied
sharp hormonal fluctuations ³ . premenstrual syndrome and
dysmenorrhea often coexist. Perhaps they are combined
general mechanisms of development, including the role of prostaglandins. Besides,
they are linked by psychosocial factors: dysmenorrhea pain
provokes negative thoughts that make them even more pronounced
manifestations of PMS ¹ .

PMS is more likely to develop in
women engaged in mental work, suffering from vegetative
dystonia, 4 times more often – with a lack of body weight ⁷ .

Classification
syndrome

Painful periods are not the norm, but a disease that is called
“dysmenorrhea”. Especially severe dysmenorrhea can occur accompanied by
premenstrual syndrome, when a set of painful, painful symptoms
expands. In addition, dysmenorrhea can act as a bright
a sign of other pathological processes in the body that are aggravated
during menstruation.

Dysmenorrhea occurs

² :

• Primary. Considered a functional disorder because
  no damage to the structure of the reproductive organs can be identified.
  May begin as early as adolescence, 1–3 years after the first
  menses.
• Secondary. Symptoms often appear several years after onset
  monthly. Secondary dysmenorrhea always has an organic cause –
  changes in the pelvic organs: inflammation, endometriosis, adhesions.
  The influence of external factors is not excluded, for example, the use
  intrauterine device, etc. ¹

Also manifestations of dysmenorrhea vary in severity

² :

• Mild — pain is mild, daily activity is not reduced.
• Moderate Significant pain, decreased daily activities,
  which can be maintained by taking painkillers.
• Severe – in addition to severe pain, there are other symptoms (headache
  pain, nausea, vomiting, diarrhea, etc.). Painkillers are ineffective.

Treatment of dysmenorrhea

Treatment of dysmenorrhea using drugs in combination with non-drug
methods. Non-drug therapy should begin with lifestyle changes.
It is recommended to exclude psycho-emotional and physical overloads,
long (7-8 hours) night sleep, moderate physical activity is required
load. A good result is walking, jogging, cycling.
You can choose an activity according to your interests – dancing, step aerobics, yoga ^4,
7.14 .

Foods that contribute to fluid retention should be removed from the menu.
body (salt, sugar, alcohol), and to improve digestion it is worth
add complex carbohydrates (cereals, nuts, cereals) and fiber (vegetables,
fruit) ^{4, 7} :

Is it possible to self-medicate?

In most cases, without pharmacotherapy aimed at normalization
menstrual cycle and a decrease in the level of prostaglandins, bypass
not possible ¹² . For treatment to be effective, it is important
to establish the cause of pain, their nature and other features of the body.
Therefore, there is no need to postpone the visit to the doctor until later.

Drug treatment

Several groups are used to treat dysmenorrhea
preparations ^3.9 :

• multivitamins;
• preparations of magnesium;
• nonsteroidal analgesics;
• antispasmodics;
• hormonal preparations (combined oral contraceptives,
  gestagens) and others.

Although the treatment of muscle soreness should be individualized in
each case, it usually starts with painkillers. As
non-narcotic pain reliever (analgesic)
paracetamol has proven itself: it was effective as an emergency
to relieve acute pain, as well as in the long-term treatment of chronic
pain syndromes. According to scientific studies, paracetamol is not
inferior in analgesic effect to non-steroidal anti-inflammatory
drugs, but, unlike them, has a low risk of complications with
aspects of the cardiovascular and digestive systems ¹⁹ .

The combination of the antispasmodic drotaverine and the non-narcotic analgesic paracetamol acts selectively for spasm and specifically for pain ¹³ .

Read more

The main goal of dysmenorrhea care is to reduce or eliminate pain
lower abdomen. Paracetamol is considered the drug of choice for the treatment of pain in
menstruation ²⁰ Paracetamol blocks the formation of prostaglandins and
thus reduces the severity of pain sensations ¹³ .

As an adjunct to the treatment of dysmenorrhea to control pain caused by
spasm of smooth muscles, antispasmodics may be prescribed. Antispasmodic
drotaverine blocks excessive uterine contractions, improves blood circulation
organ, which may contribute to pain relief in dysmenorrhea ⁹ .

No-shpa® Duo contains
paracetamol and drotaverine, and therefore has a dual effect of an analgesic and
antispasmodic. No-shpa® Duo
Helps relieve symptoms of mild to moderate dysmenorrhea
gravity ¹³ .

Find out more about
No-shpa® Duo

find out

Show
sources

MAT-EN-2103226 – 3.0 – 03/2022

PMS – premenstrual syndrome.

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