Issn Print: 1556-6803

Publication Date: 2006/12/01


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Menopause is not a Disease

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Excerpt

Shortly after turning 50, and after I realized I was asking rather frequently, “Is it hot in here or is it me?” I became acutely interested in the topic of menopause. Since I am an admirer of Dr. Susan Love, my first source to read was a book she co-authored with Karen Lindsey that is titled, Dr. Susan Love's Hormone Book.1 In the introduction to the book, the authors wrote something that has stayed on my mind since I read the words. They wrote, “… menopause is not a disease; it's a natural stage in a woman's life.” They continued with another statement, “Menopause is a change. Not “the” change, but “a” change—and your body, in the midst of that change, is in a process of flux for a few years.” One of those changes required wardrobe modifications in that I found that I was dressing in layers year-round. Since I am from Maine, that often brought curious glances from patients when I was in a t-shirt and they were shivering in Down jackets. However, I always thought that my female patients completely understood and we shared some “Mona Lisa” smiles.
Much to my dismay, in 2005 I began to have some shoulder pain. There had been no trauma or repetitive motions. My determination to selfdiagnose led me first to an article by Newport in which she listed several musculoskeletal diagnoses that preferentially affect women.2 Two of these include impingement/rotator cuff and adhesive capsulitis. My differential diagnoses led me to believe I might be heading toward the latter. Next I found an article in which the authors reported that the incidence of adhesive capsulitis is 70% women and that it was more common after the age of 40.3 One sentence they wrote caught my attention. They wrote, “Do fluctuations in female hormones play a role in the development of adhesive capsulitis or is there a subtle, unrecognized autoimmune component of this syndrome?” Now my curiosity was piqued. I continued to look for reasons for the increased incidence of specific musculoskeletal diagnoses in women. I found no definitive findings; what I found was several onesentence wonderings.
“Significant hormonal and physical attributes specific to women render them more susceptible but the specific causation is not clear.”2
“The association between oestrogen status and the collagen content of various structures is poorly defined at present. It is recognized that oestrogen deficiency causes a loss of collagen from the skin which results in skin thinning. Loss of collagen from around the urethra and within the trigone of the bladder may predispose to urinary dysfunction. The musculoskeletal aches and pains of which many postmenopausal women complain may be related to a loss of collagen from ligaments and other soft tissues.”4
“Menopause in the absence of hormone therapy is associated with a decrease in the quantity of collagen I in the ATFP (arcus tendineus fascia pelvis) in premenopausal or postmenopausal women…This may compromise tensile strength and an increased susceptibility to anterior vaginal wall prolapse.”5
“Decreasing levels of anabolic hormones may be associated with musculoskeletal atrophy and decrease in function that is observed in older women…”6
“Cartilage contains estrogen receptors, and estrogen influences many inflammatory diseases by altering cell turnover, metabolism, and cytokine release.”7
Once again, something I read in Dr. Love's book flashed (pun intended) into my mind. She and her co-author discussed the “Medicalization of Menopause” and how in the 1960s menopause was portrayed as an “estrogen-deficiency disease.

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