My PT journey, Musculoskeletal Syndrome of Menopause, and lowering dementia risk
August midlife roundup [2024]
I’m just coming off a week in New York. I went with my daughter who attended a musical theatre masterclass as she kicks off her college search. There were a lot of parental events, too.
It’s going to be quite a year!
I used to live in New York, so it’s always nice to go back. I even caught up with a few old friends who still live there. And saw some shows. And did some writing and a podcast interview.
As I make progress on my book, I need more stories! Specifically, nutrition-related stories–gut health, protein, nutrient deficiencies, plant-based eating etc. Anything you want to share go here or email me at maryann@maryannjacobsen.com.
If I use the story for the book, you will get a free 15 minutes phone consultation with me. I will change names and some details to protect privacy if I use the story for the book.
Now to the roundup. I have a quick update on my hamstring injury, a few studies that caught my eye, and what I’ve been reading and listening to.
My PT journey
In my last roundup, I shared with you about my hamstring injury and how I started PT. I’ve been doing exercises about 5 days per week, strengthening the muscles in my glutes and hamstrings. And I’m happy to say it’s much better.
My physical therapist emphasizes not stopping activity like running. Of course, if the pain increases to a certain level, I should stop. And now I’m able to run, barely feeling it.
The thinking behind this is that if you completely stop activity, healing will happen, but the muscles weaken and you're more prone to re-injuring it. This may not be true for every injury so be sure to check with your PT.
I really trust my PT. He used to work out of my old gym, and I’ve gotten to know him. He’s a PhD and stays up to date on the latest research, which I love.
It has truly made me realize the importance of diversifying my exercise routine. Not only focusing on hamstrings and glutes, but overall mobility. Mobility is the combination of strength and flexibility and a key to reducing injury risk.
I’m going to be digging into exercise, so feel free ask questions about anything that confuses you or that you’d like to know more about.
Musculoskeletal Syndrome of Menopause
Dr. Vonda Wright, an orthopedic surgeon, has coined the term Musculoskeletal Syndrome of Menopause in a review study in Climacteric. This is used to describe a cluster of symptoms that occur during the menopause transition, including:
Arthralgia (joint pain)
Loss of muscle mass
Loss of bone density
Increased risk of fracture
Higher risk of tendon and ligament injury
Adhesive capsulitis (frozen shoulder)
Rapid increase in arthritis
According to this paper, 70% of women will experience Musculoskeletal Syndrome of Menopause, with 25% being severely affected. Also, 40% will show no structural abnormalities with testing.
According to Wright, the decline in estrogen impacts tissues like tendon, bone, muscle, cartilage, and ligaments, leading to these issues. She does briefly mention aging as a factor.
From what I’ve read, joint pain during the menopause transition can be transient or a risk factor for osteoarthritis, the most common form of arthritis. Frozen shoulder is also a common complaint in midlife women.
As for solutions, Wright discusses MHT as the primary target and she also mentions the importance of vitamin D, vitamin K2 and resistance training.
Although MHT can help decrease joint pain and prevent bone loss, its relationship with arthritis is controversial. A recent meta analysis linked it with higher rates of knee replacement surgery. So, I think we need to look deeper here.
I get so curious about uric acid levels, which increase during menopause in women. It’s been linked with joint pain, osteoarthritis, and other metabolic issues, as noted below.
Could it be one of the missing links?
Uric Acid study
I ran across this 2023 study linking uric acid levels with metabolic syndrome in postmenopausal women.
A quick review. Uric acid is a byproduct of purine metabolism and, when at normal levels, has beneficial effects in the body. When levels rise, it can form crystals in the joints and kidneys, increase inflammation/decrease nitric oxide, and cause gout.
Estrogen promotes uric acid clearance in the kidneys, so when levels decline, it often rises. Research suggests women are more sensitive to elevated uric acid levels than men.
The study involved 600+ women aged 40-65 who underwent measurements of uric acid, biomarkers, blood pressure, and anthropometric data.
The mean uric acid levels were 4.9 mg/dl and ranged from 2.0 to 11.6 mg/dl. Uric acid levels above 4.8 mg/dl were associated with adverse metabolic parameters such as insulin, fasting blood glucose, and blood pressure. Women with higher levels were more likely to be on diabetes and blood pressure medications.
Now remember that 6 mg/dl is high, but research shows negative effects at lower levels, 4.8 in this study. If you haven’t already, consider starting a conversation with your doctor about checking your levels. I’ll be checking mine again soon.
I plan to post on ways to decrease uric acid levels if it’s high. The researchers of the study conclude:
Women with UA levels greater than 4.8 mg/dl should be closely monitored, highlighting the importance of lifestyle changes, such as improvements in diet and physical activity and urate-lowering therapy in specific cases. We recommend conducting further longitudinal studies to confirm our findings, especially since UA is a modifiable risk factor that can be easily assessed during routine clinical visits.
Dementia news
The Lancet Commissions published the 2024 update on dementia prevention and intervention. Risk factors for dementia are listed for both midlife and older age.
These risk factors include less education, hearing loss, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol, traumatic brain injury, air pollution, and social isolation. Recent additions include untreated vision loss and high LDL cholesterol.
Ann Marie from HotFlash Inc provides an excellent summary of this on her Substack. It’s important to note that hormone therapy did not make the cut, even though it’s often touted to prevent issues.
The report’s lead author, Professor Gill Livingston at University College London, told MSN: "We could not find any evidence that HRT reduces the risk of dementia."
I must add that researchers have found high homocysteine to be a predictor of dementia risk, and it often goes under the radar. A 2011 study that followed midlife women over 35 years found high levels of homocysteine at midlife increased risk for later life dementia. It’s on my biomarker guide, so be sure to talk to your healthcare provider about it.
Also in dementia news, researchers are homing in on blood tests for earlier and more accurate diagnosis. In addition, there was a correlation between Alzheimer's blood biomarkers in late midlife and late-life dementia. Diabetes and high blood pressure were linked to these higher levels.
There’s so much research in this area, I’m hopeful things will look much different in the next 10 to 20 years.
What caught my eye
This article from the Midst touches on eating disorders in midlife, a growing problem. Meno-rexia: why women in peri/menopause are developing eating disorders.
I really enjoyed Hotflash Inc interview with Red School Co-founders and authors of Wise Power. They touch on adapting to changes in our 40s, along with connecting with you true self at midlife.
A balanced conversation about whether or not we all need to be menopausal hormone therapy on the Hit Play not Pause podcast.
And on the topic of dementia, Jen Gunter does a review of studies to date on MHT and dementia risk on the Vajenda. It’s behind a paywall, but you can claim one free post.
Well that’s it for now. Have a great week and leave a comment with any questions or thoughts.
Thanks so much for including us in the roundup! And it sounds like New York was a fun time!