Menopausal arthralgia: Fact or fiction

Arthralgia is experienced by more then half of the women around the time of menopause. The causes of joint pain in postmenopausal women can be difficult to determine as the period of menopause coincides with rising incidence of chronic rheumatic conditions such as osteoarthritis. Nevertheless, prevalence of arthralgia does appear to increase in women with menopausal transition and is thought to result from reduction in oestrogen levels. Similar syndrome occurs following sudden withdrawal of hormone replacement therapy or treatment with aromatase inhibitors. Various interactions between sex hormones and pain processing pathways, immune cells and chondrocytes have been demonstrated but undoubtedly require further research. Whilst, at present, no specific treatment exists for menopausal arthralgia, a number of conservative measures may be effective. Hormone replacement therapy (HRT) has been shown to have some benefit in alleviating arthralgia associated with menopausal transition, and can be considered in women who report distressing vasomotor symptoms. Simple analgesia, weight loss and physical exercise should be encouraged particularly in women with underlying osteoarthritis. Finally, other factors commonly associated with chronic pain and menopausal transition such as fatigue, poor sleep, sexual dysfunction and depression need to be addressed.