Menopause marks a significant chapter in life, and while everyone's experience is unique, there is a common thread in the discomfort and challenges the transition poses for many. Most of us will be impacted by menopause at some point in our lives, whether we are approaching it, currently in the midst of it, or supporting a loved one through their journey.
Here, we explore the potential benefits of chiropractic care as a holistic approach to helping those going through menopause. It's important to note that chiropractors can be part of your overall support network to help manage specific menopausal symptoms. They should work with other healthcare professionals, such as your GP, to provide comprehensive and well-rounded care.
Menopause
Menopause usually occurs between 45 and 55 years of age, with the average age in the UK being 51 (). Approximately 13 million people in the UK are peri- or menopausal, equating to one-third of the UK's female population ().
Menopause is defined as having no period for one year or more. The years leading up to that point are known as peri-menopause, which is separated into early peri-menopause when the pattern of the menstrual cycle changes by becoming slightly longer and infrequent. Late peri-menopause is when the menstrual cycles become less frequent, with periods a few months apart, and the symptoms worsen. The transition usually lasts about seven years but sometimes takes 14 years.
Up to 80-90% of the menopausal population will have some symptoms, with 25% describing them as severe and debilitating. As oestrogen fluctuations cause menopausal symptoms, these symptoms can also affect trans men and non-binary people. The most common symptoms are;
- Hot flushes and night sweats,
- Disturbed sleep and insomnia,
- Low energy levels,
- Low mood,
- Anxiety,
- Low libido and low sexual drive,
- Impaired memory and concentration,
- A sensation of 'brain fog',
- Joint aches,
- Headaches,
- Palpitations
- Vaginal dryness and urinary symptoms.
The Role of Oestrogen
Oestrogen is an essential hormone involved in reproductive health for all sexes. While it’s most known for its role in supporting the menstrual cycle and developing the female reproductive system, it also plays a part in other important bodily functions. These include supporting bone health, maintaining skin elasticity by boosting hyaluronic acid production, regulating cholesterol levels to promote heart health, and helping to regulate mood.
There are three types of oestrogen, each with distinct roles in the female reproductive system. Oestradiol (E2) is the most active form and is produced by the ovaries between puberty and menopause. Oestriol (E3) is produced by the placenta during pregnancy to help support a healthy pregnancy.
As we age, the production of E2 naturally declines due to a decrease in egg cells, which reduces the activity of ovarian follicles. During perimenopause, E2 levels can become erratic, leading to various symptoms. Once menstruation stops completely, E2 levels stabilise at a consistently low level. Oestrone (E1), on the other hand, becomes the primary form of oestrogen after menopause and is produced in body fat. While it is weaker than the other types, the body can store E1 and convert it to active oestrogen when needed.
Menopause & the Musculoskeletal System
Menopause can significantly impact musculoskeletal function, with increasing aches and pains reported. Bones, muscles, joints, cartilage, tendons, ligaments, and connective tissue comprise the musculoskeletal system. This system gives your body its structure and support, and it's where Chiropractors may be able to help.
Bone Health
Our bones rely on oestrogen to maintain their density and strength because it inhibits bone breakdown and promotes the activity of osteoblasts, special bone-building cells. When oestrogen declines, bone density decreases, leading to reduced bone strength and an increased risk of breaking bones. Changes can happen more rapidly in the decade after menstrual periods stop, and there will be a steady reduction in old age (Leyland, 2021). This gradual bone density loss affects men too.
In more severe cases, this can lead to a condition called Osteoporosis, where the bones become weaker so they can break with minimal force applied. The lifetime risk of sustaining an osteoporotic fracture after 50 years is close to 50% for women and 20% for men (Rizzoli, 2018).
If your Chiropractor suspects Osteoporosis, we will refer you back to your GP for a bone density known as a DEXA scan to establish how progressed it may be. Chiropractors can still support those diagnosed with Osteoporosis as they adapt their care as needed and focus on gentle joint mobilisations and soft tissue release, such as massage.
Muscular Health
There are receptors for oestrogen in all the skeletal muscles in the body. These are partially responsible for muscle regeneration and maintaining muscle health after stressors such as exercise (Leyland, 2021). Therefore, when oestrogen declines, there can be a decrease in muscle mass, strength and power, which is known as sarcopenia. Whilst muscle loss is expected as we age, with sarcopenia, this loss happens much faster (Walston, 2012).
Menopausal fatigue also contributes to muscle mass loss, as motivation to exercise is negatively impacted by coexisting symptoms such as hot flushes and poor sleep quality.
Fortunately, the risk of developing sarcopenia in postmenopausal women may be managed through healthy lifestyle changes, including diet (e.g., adequate protein intake, sufficient vitamin D intake, omega 3), and regular physical activity alongside hormone therapy, if applicable.
Connective Tissue Health
Ligaments and tendons function as connective tissue within the musculoskeletal system. Ligaments attach bone to bone, and tendons attach bone to muscle. Oestrogen reduces the collagen content of connective tissues, increasing the stiffness of the ligaments and tendons.
A stiffer ligament is preferable in the case of ligaments, as it helps maintain joint stability and prevent injury. However, a more inflexible tendon is not necessarily beneficial. A stiff tendon will not stretch, so the muscle attached to that tendon will experience more loading, often resulting in muscle injury and irritations/inflammation of the tendon (tendinopathies) (). In women, these commonly affect the gluteal, hamstring, Achilles, and rotator cuff tendons, resulting in aching in the hips, buttocks, heels, and shoulders.
Joint health
Joint pain is a commonly reported symptom of menopause. It can affect joints all over your body, making long standing injuries more painful. Osteoarthritis and rheumatoid arthritis can also develop or worsen in menopause; as oestrogen decreases, joints become more inflamed and painful. Osteoarthritis is a slow-progressing joint inflammation resulting from cartilage degeneration, and it is now recognised that this degeneration can occur due to oestrogen deficiency around menopause.
While joint pain and stiffness around menopause don't always indicate osteoarthritis, it can be a symptom.
Back pain, particularly lower back pain, can become a problem for many as they go through menopause. One survey of 5,325 women found that postmenopausal women were twice as likely to report lower back pain as premenopausal women (), with recommended treatments including physical exercise, massage, and manual therapy (), which is where your Chiropractor can help!
How can a Chiropractor help during the menopause?
Seeking Chiropractic care may not be the first thing you think of when going through menopause, but they can offer support wherever you are in your journey. Whilst there is an assumption that Chiropractors are mainly focused on conditions of the spine and adjusting the joints, we can also help with goal setting, maintaining physical activity and supporting changes to your lifestyle.
Remember, it's essential to consult with your healthcare provider for personalised advice and guidance tailored to your specific needs, but here are some lifestyle changes you can consider:
- Eat a healthy diet: Focus on a well-balanced diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats. Include foods rich in calcium and vitamin D to support bone health and manage weight.
- Stay hydrated: Drink plenty of water throughout the day. Avoid or limit caffeine and alcohol, as they can trigger hot flashes and contribute to dehydration.
- Maintain your sleep hygiene: Establish a consistent sleep schedule and create a relaxing bedtime routine. Ensure your sleep environment is cool, quiet, and comfortable. Limit caffeine and alcohol consumption, especially close to bedtime, as they can disrupt sleep patterns.
- Engage in regular exercise: Regular physical activity can reduce the severity of symptoms like hot flashes, mood swings, and sleep disturbances. Aim for 10-20 minutes of resistance training 2-3 times a week and 3-4 cardiovascular activities such as walking, swimming or an exercise class. Incorporating strength/resistance training exercises can also help maintain muscle mass and support bone health.
- Manage stress and prioritise self-care: Practise stress-reduction techniques like deep breathing exercises, meditation, yoga, spending time in nature or any activity that brings you joy. Chronic stress can worsen menopausal symptoms, so finding effective stress management strategies is essential.
- Seek support: Talk to friends, family, or a support group about your experiences. Sharing your concerns and hearing others' stories can provide valuable emotional support.
- Manage your musculoskeletal pain: While chiropractic care does not directly address hormonal changes, it can help manage some of the symptoms women may experience.
Remember, every woman's experience with menopause is unique, so it's important to find the support and resources that work best for you. Feel free to contact multiple sources to gather information and seek guidance that suits your specific needs. Recommended resources include , , or the .
Chiropractic care offers women going through menopause a holistic and supportive approach to managing the physical and emotional changes during this phase by focusing on musculoskeletal health and overall well-being. If you are navigating menopause and seeking natural support, consider booking an appointment with a Chiropractor as a complementary option to enhance your overall wellness.
Further References:
Hertility (no date) Oestrogen 101: Everything you need to know, Hertility Health. Available at:
Geraci, A., Calvani, R., Ferri, E., Marzetti, E., Arosio, B. and Cesari, M. (2021). Sarcopenia and Menopause: The Role of Estradiol. Frontiers in Endocrinology, 12. doi:
Khadilkar, S.S. (2019). Musculoskeletal Disorders and Menopause. The Journal of Obstetrics and Gynecology of India, [online] 69(2), pp.99–103. doi: .
Mahajan, A. and Patni, R. (2018). Menopause and Osteoarthritis: Any Association ? Journal of Mid-Life Health, [online] 9(4), pp.171–172. doi: .
Xu, X., Li, X., Liang, Y., Ou, Y., Huang, J., Xiong, J., Duan, L. and Wang, D. (2019). Estrogen Modulates Cartilage and Subchondral Bone Remodeling in an Ovariectomized Rat Model of Postmenopausal Osteoarthritis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, [online] 25, pp.3146–3153. doi: .