It’s come to my attention that I write a low about menopause. And for good reason – many of my clients are within about 10 years of it (10 years before, or after). Besides the most common complaint that I get (weight gain) is another one: perimenopause aches and pains.
A number of my clients have reported that in their younger years, they were very active and athletic, but now, in their 40s, 50s and 60s, even a reduced level of activity/exercise causes:
- Fatigue that takes longer to recover from
- Minor injuries here and there – tendonitis, and others
- Exaggerated soreness – disproportional to the intensity of the workout.
What’s going on??? They want to know. And if my clients want to know, I want to know too. As you know from previous articles, like on exercise for osteoarthritis, and how to predict injuries before they happen, I have a researcher working for me, to research all these topics relevant to clients.
And there are a few rules/guidelines they have for their research:
- They can’t use mainstream sites – no Youtube videos, no blogs, no social media. Only scientific studies from Pubmed, Google Scholar, and Sci Hub.
- The studies have to match the population we’re applying it to. No sense in researching college-age women, when we’re talking about menopause, and generalizing research from one population to another.
- The studies have to be randomized controlled trials. Not just observations, which don’t infer causation.
And with that, my researcher did her research, and we came up with lots of interesting insights into why women experience more aches, pains, soreness and injuries in the 10 years before and after menopause. Although I have 13 pages of research, I’ll give you the “Cliff’s notes” in this article.
And hey, if you don’t want to hire your own researcher, and you want all the solutions simply handed to you, and personalized, you can see if you qualify to work with us by just filling out the application form on our home page.
How Do Estrogen Levels Impact Injury Risk in Women?
In one study, researchers removed the ovaries from rats (thereby really diminishing their estrogen levels), and assessed their recovery from a rat’s everyday life, along with injury risk.
What they found was:
- 14 days after ovary removal, the rats had a slower recovery.
- During days 7-14, the number of injured fibres they had increased.
- After 14 days, the rats were given estrogen, to bring their levels back to what they were before the removal of their ovaries, and the damaged fibres healed.
So why does estrogen reduce the risk of injuries? There are a few theories:
- Estrogen has an impact on muscle size and strength. Less estrogen, less muscle. If there’s less muscle, the stress from exercise that used to go into muscles now goes into tendons and ligaments.
- Estrogen stabilizes what’s called the “extracellular matrix” (or ECM). What is the ECM? It’s a group of “support structures” that help stabilize cells. What are those structures? Things like collagen, different minerals, and others. Different structures (bones, muscles, etc.) have different compositions of the ECM. Less estrogen means less “supporting structures” for muscles, tendons and ligaments.
- Estrogen can act as an antioxidant, and decrease the damage that muscles, tendons and ligaments sustain.
To test these theories, in one study, researchers gave postmenopausal women enough estrogen to bring them up to premenopausal levels. What they found was that:
- Collagen synthesis improved by 47%.
- Grip strength improved.
- Muscle mass increased a bit.
The effects on grip and muscle mass were fairly minor, but the effects on collagen synthesis at the tendons was quite significant. The researchers pointed out that muscle mass and strength improves a lot more with strength training than with estrogen replacement therapy.
Having sung the praises of estrogen replacement therapy, it is not without its risks. It may increase the risk of cancer in some women (not all), and other conditions. Every therapy (both natural and pharmaceutical) has advantages and disadvantages, so it’s ultimately up to you to speak to a medical professional, to evaluate the risks as they pertain to you. The one that I refer most of my clients to is Dr. John Dempster.
How do Progesterone Levels Impact Injury Risk in Women?
In the perimenopausal period, it’s not just estrogen that declines, but other hormones as well. Namely, progesterone and testosterone (and in some women, thyroid too).
So how does progesterone impact injury risk in women? While progesterone alone is not studied nearly as extensively as estrogen, this study found that progesterone really doesn’t have much of an impact on injury risk in postmenopausal women.
What did the researchers do in that one?
They divided the participants into 5 groups: 1 placebo group, 2 groups who received only estrogen (no progesterone), at 2 different doses, and 2 more groups who received both estrogen and progesterone (same progesterone dose, but different estrogen doses).
What they found, which is consistent with previous studies is that increasing estrogen after menopause does decrease injury risk. But when estrogen was raised, and progesterone was raised as well, there was no additional decrease in injury risk.
So in a nutshell: progesterone doesn’t appear to have much of an impact on injury risk in the postmenopausal years. Not to say it’s not important. It is. But just looking at it through the lens of its impact on tendons and ligaments, it doesn’t have much of an impact. It may impact other health parameters, like your heart, brain, skin, etc., but since this article is about injury risk, we’re really looking at muscles, tendons, and ligaments.
How Do Testosterone Levels Impact Injury Risk in Women?
Similar to progesterone, testosterone is not studied very well in postmenopausal women (at least when it comes to injury risk). However, there are a couple of studies to go by, though the ultimate conclusion is (as is so often in research): we don’t have the full picture, so more research is necessary.
With that disclaimer out of the way, let’s examine what the research has to say.
It’s been well-established that testosterone affects women’s muscle mass. We also know that it also affects women’s bone density. But how does testosterone affect women’s tendons and ligaments? That’s not as clear.
One study did show that women’s tendons have receptors for testosterone. What that means is that testosterone affects women’s tendons. It’s theorized that it improves tendon stiffness. Tendon stiffness is a good thing. A stiff tendon is a more injury-resistant tendon.
So we know that testosterone affects women’s tendons. What about their ligaments (side note: most people don’t know the difference between tendons and ligaments. So I’ll give you a quick lesson right now. Tendons connect muscle to bone. Ligaments connect bone to bone. You’re welcome.)? One study found that women with lower testosterone levels are more prone to ACL tears (that’s the ligament on the front of your knee). Another study found lower ACL stiffness in women with lower testosterone. Lower ACL stiffness typically means a higher rate of ACL tears.
In Conclusion
So we know that some hormones have a definite impact on injury and recovery in perimenopausal and postmenopausal women. Other hormones have no impact, and some hormones, we just don’t know.
However, there are of course non-hormonal ways to decrease injury risk, and speed up recovery from everyday life.
In another edition of “Igor’s Lab”, I wrote about how to predict injuries before they happen. This gives my team and I an idea of where you’re likely to get injured, and devise preventative strategies for it.
As for the injury risk, the non-hormonal factors that you may have been able to ignore before menopause, you can’t ignore anymore. The non-hormonal factors, being sleep, and protein. I’ve written extensively about sleep before, so I won’t rehash it here. As for protein, in my experience, most perimenopausal and menopausal women don’t get anywhere near what they should be getting. Here’s a great guide on how much protein you should be getting.
If you need help combining everything – exercise, nutrition, supplementation and sleep to improve your recovery, energy, decrease your injury risk, and get stronger/more toned, you can see if you qualify to work with us, by just filling out the application form on our home page.
