These Boots Are Made For Walkin'

Body aches, injuries, and pain in perimenopause

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Look around. Do you notice what I notice? Middle-aged women everywhere are wearing boots - and not the stylish kinds. They are wearing medical boots.

If you haven’t noticed it yet, you will now that I’ve brought it to your attention. Maybe you’ve even had your own story about an encounter with a curb that left you hobbling for weeks. Or maybe it was from something more fun, like skiing.

Orthopedic medical boots stabilize and protect broken bones and other injuries in the lower leg, ankle, and foot. They prevent more damage and help the area heal. They are usually worn for 1 - 6 weeks, depending on the severity of your injury.

Perimenopause women are more at risk for injury than when we were younger. Like everything in health, there are several reasons for this, which I’ll review in this article.

The Musculoskeletal System

Let’s chat about what the musculoskeletal system is and how the biology of perimenopause can make us more injury-prone. These physical changes increase our risk factors of sprains, fractures, and strains from slips, trips, and falls.

The musculoskeletal system includes:

• Bones

• Muscles

• Connective tissue

• Ligaments

• Tendons

• Cartilage

These are all places in your body that help you move and keep you upright. Pain in these areas can be mild to severe and may make you think there’s something wrong with an organ or two, especially if you’ve never dealt with any major pain in your torso area.

Common places to develop pain are the rib cage, back (lower, middle, upper), hips, knees, neck, and jaw. Joints are also a primary place of pain.  

Musculoskeletal Issues in Perimenopause

Perimenopause should be called SHED Syndrome - Something Hurts Every Day.

Although falling estrogen may be to blame, especially in menopause, I don’t think that’s the complete picture. Many perimenopause women develop musculoskeletal issues even though during perimenopause our estrogen can spike 2 – 3x higher than usual. That leads me to think that there is something else going on, at least in perimenopause. More research is needed. I added it to the list.

The information we have now to go on is that lowered estrogen levels cause 5 leading changes:

1. Increase in inflammation

2. A decrease in bone mineral density

3. Increased risk of osteoarthritis

4. A decrease in muscle mass

5. Changes in muscular stem cells, which affect our muscle power and muscle repair.¹

A recent article in the journal of the International Menopause Society by Dr. Vonda Wright, an orthopedic sports medicine surgeon, suggests that we name this collection of body changes “The Musculoskeletal Syndrome of Menopause,” much like the naming convention for The Genitourinary Syndrome of Menopause (which already had been adopted as a medical term back in 2014).

In Singapore, musculoskeletal pain and issues are the number one complaint of menopausal women², whereas in North America and Europe, it’s hot flashes. However, a scientific systemic review and meta-analysis reports that an estimated 71% of all midlife women will experience musculoskeletal pain and included this statement, “Perimenopause is a state during which women are particularly predisposed to develop musculoskeletal pain.”³

It seems the majority of problems start in the perimenopausal phase.

This isn’t “just” about pain, as we’ll see below.

Some common musculoskeletal issues are:

• Frozen shoulder

• Joint pain

• Loss of muscle mass (sarcopenia)

• Back pain

• Joint stiffness

• Hip pain

• Knee pain

• Decrease in strength and stamina

• Bone density issues (Osteopenia, the start of osteoporosis and Osteoporosis)

• Pickleball injuries

• Foot and ankle injuries

• Carpel Tunnel Syndrome

• Broken bones

• Tendonitis

• Bursitis

• Slipping Rib Syndrome (when your rib pops out of your place, usually one of the lower ribs that “float.”)

• Muscle pain or wide-spread pain that feels like what fibromyalgia would feel like

Additional Considerations

In addition to the physical changes happening, there are other things to consider as a cause of injuries.

Let’s leave out the Captain Obvious ones that aren’t related to perimenopause, such as slippery surfaces, icy stairs, inadequate lighting, or cracks in sidewalks.

• I don’t know about you, but I sometimes forget I even have a body. I’m thinking, thinking, thinking, so I’m often unaware of the space around me. Being distracted can play a role in injury when you’re moving at the same time. Us and multi-tasking don’t mix well. I tell my twins not to walk and be on their phones at the same time. It’s not good for them and it’s really not good for us.

• When we’re in a heightened state of anxiety, like what can happen in perimenopause, it narrows your vision and focus. It’s supposed to do this to help us escape from a threat, however it also means we can’t take in the entire environment and see danger outside of our narrowed field of vision.

• Our years of poor posture and shallow breathing finally catch up with us. Poor posture puts more wear and tear on our bodies causing things to break down faster. Shallow breathing doesn’t oxygenate our cells for regeneration as much as proper breathing.

• If you haven’t been sleeping, being tired can increase your chance of injury.

• Your body weight is distributed differently from the hips and thighs to the abdomen and can throw your balance off.

• You may be dealing with vertigo/dizzyness so your balance may be off.

• Loss of bone strength and losing muscle can make you weak.

• Overuse (Pickleballers, I’m talkin’ to you!)

• Are you klutzy or trip over your own two feet often? That can be an issue with your proprioception. Proprioception is your bodily ability to judge where you are in relation to the things around you. It’s the sense that lets you know someone is standing behind you or when the plane starts to land before the Captain comes on, for example. Our proprioception is affected during perimenopause for the same reasons as everything else we experience. If you aren’t able to judge that the trashcan is in the way, you’ll walk right into it especially if you’re da, da, da, da distracted.

Here’s What Becomes Important As We Age

• Building muscles

• Keeping as much bone density as possible

• Movement (motion is lotion to your body)

It’s less about being thin and more about body composition. You want the weight of muscles and bone on your frame.

Even in our 40s and 50s (and beyond), we can still do miraculous things for our bodies that have a big impact. Yes, we may be past our peak bone density years, but there’s always something we can do to help ourselves.

And it’s still possible to build muscle at any age, although it may take a bit slower. It’s not all doom and gloom. We have to be smart about it, and hey, WATCH OUT for that curb.

Sing it, Nancy!

For us “Peripausies,” I especially liked these lyrics!

You’ve been a’messin’ where you shouldn’t’ve been a’messin’

You keep samin’ when you oughta be a’changin’

And you keep thinkin’ that you’ll never get burnt (ha)

Are you ready boots? Start walkin’

As always, thank you for reading The Periprofessional! I appreciate that you’re here with me!

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Be well, stay cool…

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1. Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024 Oct;27(5):466-472. doi: 10.1080/13697137.2024.2380363. Epub 2024 Jul 30. PMID: 39077777.

2. Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women's Health Programme (IWHP). Maturitas. 2023 Dec;178:107853. doi: 10.1016/j.maturitas.2023.107853. Epub 2023 Oct 6. PMID: 37806008.

3. Lu CB, Liu PF, Zhou YS, Meng FC, Qiao TY, Yang XJ, Li XY, Xue Q, Xu H, Liu Y, Han Y, Zhang Y. Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis. Neural Plast. 2020 Nov 25;2020:8842110. doi: 10.1155/2020/8842110. PMID: 33299396; PMCID: PMC7710408.