Menopause Symptoms Beyond Hot Flashes: Muscle Loss, Frozen Shoulder, and Digestive Issues
Over 80% of women experience menopause symptoms, with vasomotor issues like hot flashes, night sweats, and palpitations being the most common (1). However, menopause can impact various organ systems in unexpected ways. There are many more symptoms, including joint pain, changes in body odor, oral health problems, and migraines.
This article will cover other symptoms linked to menopause and their potential treatments. Menopause can affect women in surprising ways, so it’s essential to talk to your healthcare provider about your symptoms for personalized care.
Muscle Loss:
Starting at age 30, the body naturally loses 3–5% of muscle mass every ten years (2). Age-related decline in muscle mass and function, or sarcopenia, is associated with menopause, says Terri DeNeui, DNP, APRN, ACNP-BC, a nurse practitioner and founder of EVEXIAS Medical Centers specializing in hormonal health and wellness. Testosterone decline in both men and women directly affects muscles. Interestingly, estrogen loss in women also has a big impact, notes DeNeui. Estradiol, the strongest estrogen hormone, controls menstrual cycles and helps with muscle growth and repairing damaged muscles. It also helps control inflammation, which can affect sarcopenia (3).
Strength training, exercises that contract the muscles, is the most promising prevention for sarcopenia (2). You can rebuild muscle and strength with easy exercises at home, like squats, using resistance bands for bicep curls, and doing push-ups against the wall (4).
A nutritious diet with adequate protein intake is also important, says DeNeui. Healthy protein options include lean cuts of meat, poultry, fish, eggs, legumes, low-fat dairy, nuts, and seeds (5). Specifically, consuming 20-35 grams of protein per meal can help prevent muscle loss as you age (6). Research also shows that eating more fruits and vegetables can preserve muscle mass and function (2, 7). Work with a registered dietitian for personalized dietary advice.
Additionally, hormone replacement therapy (HRT) that includes estrogen, testosterone, and progesterone can help improve muscle and bone mass and reduce muscle loss in middle age, says DeNeui. Talk to your healthcare provider about your menopause symptoms and treatment options, including the risks and benefits. They can help you decide if HRT is right for you.
Frozen Shoulder:
Frozen shoulder, or adhesive capsulitis, causes pain and stiffness in the shoulder, making it hard to move. It typically affects adults aged 40 to 60 and is more common in women than men. (8)
As estrogen levels drop, you may experience stiffness and inflammation in your shoulder due to its role in maintaining collagen and connective tissues, says Tahir Saifullah, MD, D.ABA, MS, a pain management doctor and founder of Spine & Pain Institute Los Angeles. While the exact connection between menopause and frozen shoulder isn’t fully clear, hormonal changes are a likely factor, adds Dr. Saifullah.
The cause of frozen shoulder is complex and involves inflammation (9). People with diabetes and thyroid problems have a higher risk because these conditions are linked to inflammation (9). Also, poor sleep, fatigue, depression, and sexual dysfunction, which can happen during menopause, can contribute to frozen shoulder. (10)
Dr. Saifullah says that physical therapy can be highly effective for improving shoulder mobility and strength, while pain relief may come from NSAIDs or corticosteroid injections. He recommends consulting an orthopedic specialist for personalized treatment.
According to the American Academy of Orthopaedic Surgeons, symptoms usually improve over time without surgery, but it can take up to 3 years. They also suggest managing any health conditions that may contribute to frozen shoulder. For example, if you have diabetes, work with your healthcare provider to control your blood sugars.(8)
Dr. Saifullah says that while hormone therapy might not directly relieve frozen shoulder, it could improve joint health by enhancing cartilage and connective tissue, though more research is needed.
Gastrointestinal Issues:
The menopause transition can provoke symptoms such as bloating, constipation, diarrhea, and acid reflux (11). Multiple factors, including stress, poor sleep, diet, and physical inactivity, may contribute to gastrointestinal symptoms in midlife women, says DeNeui.
Research shows that changes in the makeup and function of gut bacteria influence reproductive aging (12). The gut microbiome is a collection of tiny living things in your stomach and intestines, like bacteria. It plays a role in digestion, metabolism, and inflammation (13). Significant shifts in the gut microbiome during perimenopause and post-menopause highlight the influence of hormones as women transition through this stage of life, notes DeNeui.
To manage digestive issues during menopause, start with these lifestyle changes (11):
● Exercise regularly to help reduce gas and bloating.
● Eat more high-fiber foods to keep bowel movements regular. Fiber also feeds the good bacteria in your gut, supporting a healthy gut microbiome.
● Chew food slowly to make digestion easier.
● Drink plenty of water to help stools pass easily and support digestion.
According to DeNeui, HRT and probiotics can be helpful. It’s crucial to discuss your symptoms, medical history, and the risks versus benefits with your healthcare provider to ensure a personalized approach that suits your health needs.
Menopause is associated with symptoms beyond hot flashes, such as muscle loss, frozen shoulder, and digestive issues. Since each woman's experience is unique, what unexpected symptoms have you faced, and what remedies have helped you? Let’s talk about it.
Resources:
Peacock K, Carlson K, Ketvertis KM. Menopause. [Updated 2023 Dec 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/
Geraci A, Calvani R, Ferri E, Marzetti E, Arosio B, Cesari M. Sarcopenia and Menopause: The Role of Estradiol. Front Endocrinol (Lausanne). 2021 May 19;12:682012. doi: 10.3389/fendo.2021.682012.
OASH: Office of Women’s Health. Stronger than Sarcopenia: Strength Training at Home
OASH: Office of Women’s Health. Stronger than Sarcopenia: Addressing Sarcopenia with Nutrition.
Ardeljan AD, Hurezeanu R. Sarcopenia. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560813/
Ganapathy A, Nieves JW. Nutrition and Sarcopenia-What Do We Know? Nutrients. 2020 Jun 11;12(6):1755. doi: 10.3390/nu12061755.
American Academy of Orthopaedic Surgeons: Orthoinfo. Diseases and Conditions: Frozen Shoulder.
Kraal T, Lübbers J, van den Bekerom MPJ, Alessie J, van Kooyk Y, Eygendaal D, Koorevaar RCT. The puzzling pathophysiology of frozen shoulders - a scoping review. J Exp Orthop. 2020 Nov 18;7(1):91. doi: 10.1186/s40634-020-00307-w.
Medical News Today. The link between frozen shoulder and menopause.
MenopauseNow. Understanding Digestive Problems in Menopause.
Huang F, Cao Y, Liang J, Tang R, Wu S, Zhang P, Chen R. The influence of the gut microbiome on ovarian aging. Gut Microbes. 2024 Jan-Dec;16(1):2295394. doi: 10.1080/19490976.2023.2295394.
Cleaveland Clinic: healthessentials. How Your Gut Microbiome Impacts Your Health.