Surviving Menopause With Arthritis

Released Jan. 28, 2025

 

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MUSIC BRIDGE

 

Stacy Courtnay:

Welcome to the Live Yes! With Arthritis podcast. I'm Stacy Courtnay, your guest host today, and I'm very excited about our topic: going through menopause with arthritis. This subject is very relevant and pertinent to me as I am nearing 47, and I've had rheumatoid arthritis for about 22 years. And as we all know, living with arthritis is hard enough, but women have the added challenges of menopause bringing hot flashes, which we can talk about that shortly, pain and sometimes worsening your arthritis symptoms.

 

Menopause also comes with increased risk of developing osteoporosis and osteoarthritis, among other conditions. So, I'm excited to introduce our guest expert today, Dr. Anne Ford, from the Duke School of Medicine. Welcome, Dr. Ford.

 

Dr. Anne Ford:

Thank you. Happy to be here.

 

Stacy Courtnay:

Thank you. So, tell us a little bit about yourself and your profession.

 

Dr. Anne Ford:

I've been at Duke for more than 25 years. I'm an OB-GYN generalist, meaning that I'm not sub-specialized. I run a generalist division in Wake County, but I have a special interest in menopause and have for about 20 years.

 

I am a certified menopause practitioner through the Menopause Society. I have a large menopausal practice, and I'm very passionate about promoting menopause as a natural part of aging, but something that we don't necessarily have to suffer with, the symptoms of menopause. There are great treatment options, both hormonal and non-hormonal, and I really want people to know that there are things we can do to make this transition much smoother. Maybe for you, too.

 

Stacy Courtnay:

(laughs) Yes, yes, definitely. What types of symptoms do you see in women with arthritis, like starting to go through menopause or post-menopause?

 

Dr. Anne Ford:

I think it's important to distinguish between perimenopause and menopause. You don't really know that you're menopausal until you haven't had a menstrual period for a year. So, the three years or so before your final menstrual period is considered the perimenopausal years where your hormone levels can be fluctuating wildly and fluctuations are really hard. Because you may feel good for two months, then you may not feel so good for two months.

 

The most common symptoms in the perimenopause are some type of a change in your menstrual cycle and hot flashes. Hot flashes during the day are just that, just a sensation of warmth that kind of swoops up your body and usually down to up. It can make you have sweating, and you can become red and flushed. And then, I don't know, 30 seconds to several minutes later, you get cool and you can be sweaty.

 

If that occurs at night, it's considered a night sweat. and night sweats can be very bothersome and disruptive to sleep. So, I think one of the biggest challenges in both perimenopause and menopause is negotiating sleep issues. Sleep impacts everything. It can impact pain, it can impact cognition, it can impact mood. So, if you're not sleeping, it can really exacerbate your symptoms.

 

Stacy Courtnay:

Do you see, you know, more joint pain or increased levels of fatigue or increased challenges with sleeping with somebody who has arthritis?

 

Dr. Anne Ford:

I think women with arthritis do have additional challenges with menopause. In my personal practice, I've seen a lot of patients with arthritis whose symptoms exacerbate with loss of estrogen. That's what happens with menopause.

 

Whether hormone replacement therapy will kind of make a huge difference in women with arthritis or not is a little bit controversial. There are several studies that do show that menopausal hormone therapy, systemic hormone therapy, can help joint pain, arthritis specifically. Whether or not you decide that hormone therapy is the thing that you want to pursue for your arthritis or for your menopausal symptoms, I think it depends on how much worse your symptoms have gotten. What other treatments are you using? And are you really taking care of yourself?

 

Like, are you exercising? Are you eating healthfully? If you're not sleeping, and you're not sleeping because you're having a lot of hot flashes and night sweats, all of those other aspects of your life that are for health and wellness are going to be difficult. So that, in and of itself, would be a reason, especially for people with arthritis who are dealing with additional pain, discomfort and movement issues, may want to consider hormone therapy, especially if their menopausal symptoms, not so much their arthritis symptoms, are worsening. You're trying to tease out what's menopause and what's arthritis. It's kind of like this question is: Are joint symptoms caused by menopause? I don't know if anybody knows the answer to that, but I do think they can definitely be exacerbated by menopause.

 

Stacy Courtnay:

And do you see a difference in a woman with say, osteoarthritis or an inflammatory arthritis, such as rheumatoid?

 

 

Dr. Anne Ford:

I'm not a rheumatologist. What we do know is: As your estrogen levels go down, your inflammatory issues may get worse. I have seen several patients with both rheumatoid and osteoarthritis who have been helped tremendously by hormone therapy. And now I'm talking about systemic hormone therapy. It would be helpful for both types of arthritis.

 

Stacy Courtnay:

And when you say systemic hormone therapy, can you explain a little bit what that means?

 

Dr. Anne Ford:

Yeah. I think hormone therapy can be used as a catch-all term, but systemic hormone therapy is a way to take hormones so that the level of, if we want to say estradiol or estrogen, in your blood increases. So, I think you have to kind of compare that to local therapy, local estrogen therapy, which would be a therapy that you would use if you had vaginal dryness. Like there are creams and rings and tablets that you can put in your vagina that are very low dose that won't do anything for your arthritis or your joint pain, but they'll take away your local symptoms. As opposed to systemic interventions or therapies, which also could be pills, creams, patches, gels, that will raise your systemic estrogen levels high enough to change your symptoms, your vasomotor symptoms, your hot flash symptoms.

 

Another thing is brain fog. A lot of people complain about brain fog. I don't know if that's... I don't necessarily think that's specific to arthritis, but the local therapy would not affect that, but systemic therapy would. So, for women with a uterus, systemic therapy would include an estrogen, an estrogenic component, and a progestational component. The estrogen component is the piece of the therapy that really affects the hot flashes, the night sweats, the brain fog. The progestational component is really there mostly to protect the uterus. Because if you take unopposed estrogen, it can stimulate the uterus and cause endometrial cancer. So, you have to take two hormones if you're going to be a user of systemic therapy and you still have a uterus.

 

Stacy Courtnay:

OK. And do you know if any of the hormone replacements have any impact on, say... Like, for instance, I take a biologic. Is there any interaction between the biologics and the hormones? Or it's safe to take both at the same time?

 

Dr. Anne Ford:

In my practice, I don't discriminate based on your biologics. And as long as you don't have other reasons why you would not really be a candidate for systemic hormone therapy, a biologic should not be a reason why you couldn't take it.

 

Stacy Courtnay:

OK.

 

Dr. Anne Ford:

So, other reasons why we don't recommend systemic hormone therapy for women: If you've had a history of breast cancer, especially estrogen receptor positive breast cancer, if you have active liver disease, if you have a history of pulmonary embolus or a blood clotting disorder, you wouldn't want to use systemic hormone therapy. If you have significant cardiovascular disease, like you've have stents, so you have angina, you probably don't want to use systemic hormone therapy either. Those are just a few examples.

 

PROMO:

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Stacy Courtnay:

Dr. Ford, can you tell us a little bit about some research you’re doing with regards to menopause and arthritis?

 

Dr. Anne Ford:

It's interesting that joint health and menopause is a very understudied subject in menopause research realms. We do know from the Women's Health Initiative that when women stopped their systemic hormone therapy, their joint pain issues tended to get worse. I have a friend who's an orthopedic surgeon, Jocelyn Wittstein, and we were actually talking about frozen shoulder and how we both had noticed that issues with frozen shoulder seemed to exacerbate in the perimenopause and the menopause. So, we did a retrospective study. What we found was the women who used systemic hormone therapy were much less likely to have problems with frozen shoulder than women who didn't use systemic hormone therapy.

 

Dr. Wittstein and I, we've started a registry, and we are looking at women aged 45 and older, and we're asking them to tell us about their menopausal symptoms and their joint issues. So, it's not specific to arthritis and osteoarthritis or rheumatoid arthritis, but it's all joint pains. We're going to follow those women over time and see how their menopause, and where they are in their menopausal transition, and whether or not they're using hormone therapy affects their joints and how it affects their joints. So, that's where we are now.

 

Stacy Courtnay:

Very fascinating. And so, a lot of women seem to develop conditions like rheumatoid arthritis around the same age as menopause. Is there a connection? Have you seen a connection?

 

Dr. Anne Ford:

I don't think anybody knows that for sure. And I don't think anybody... Because nobody knows what makes you get rheumatoid arthritis. Why did it happen to you? Osteoarthritis is maybe a little bit easier because you can kind of think of it as wear and tear on joints and breakdown of cartilage and inflammation. But what I would say is: If you have an arthritis condition prior to menopause, it would be reasonable to expect that with decreasing estrogen levels and potentially increasing inflammatory markers, your symptoms might get worse.

 

But I think this raises another very important point in menopausal care now: That treatment really needs to be individualized to that particular woman, and she needs to be able to have a conversation with her provider about what's really bothering her and what treatment options may potentially help, even if it's not an FDA approved indication.

 

Stacy Courtnay:

Why is it, after menopause, that women are at a higher risk for osteoporosis or osteoarthritis? Is it because of the lack of estrogen?

 

Dr. Anne Ford:

Yeah. So, estrogen is great for your bones, your joints and your connective tissue. And when your estrogen levels drop... Same thing happens actually for your cardiovascular system, too; estrogen is great for your cardiovascular system. So, post-menopausally, when your estrogen levels drop, at least in your bones, you are at higher risk for bone turnover and for bone loss. The highest rate of loss is the first two years after your last menstrual period, and then the rate of loss tends to decrease a little bit more slowly after that.

 

But if you take systemic hormone therapy, you can prevent that initial loss. Your bone density doesn't decrease like you would if you didn't take hormone therapy. The interesting thing about that is, though, once you stop your hormone therapy, then you'll very quickly lose your bone mass and catch up to your age-adjusted peers if you stop the systemic hormone therapy.

 

So, it kind of can delay the loss of bone, but it won't prevent it forever, unless you stay on your hormone therapy long term. Several years ago, we were saying to people, "Oh, you should only stay on hormone therapy for five years. Don't stay on it for more than five years." But now the pendulum is kind of swinging a little bit on that as well, and the idea is, "Oh, well, there may be benefits to a lot of people to continue on their hormone therapy for bone protection. And if you continue to have hot flashes and if you have very incapacitating arthritis and you stop your medication and your symptoms get worse."

 

If your hormone therapy dramatically increases and improves your quality of life for you, and now, Stacy, you're 70, and you've been on hormone therapy and your doctor talks to you about coming off your hormone therapy because, as you age, your stroke risk increases, so you decide you're going to try to do that, but then your arthritis gets really bad and you were functioning and exercising, and then all of a sudden it’s just awful for you to get out of bed again, I think you might decide, “Oh, I want to stay on my therapy.”

 

Stacy Courtnay:

Well, absolutely, it's quality of life. And it's the risk versus the reward, and that's how I feel with the biologics. They can be very scary sometimes, but my quality of life is changed tremendously, like tenfold, since biologics have been available.

 

PROMO:

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Stacy Courtnay:

You mentioned the reasons why you should not take hormone therapy if you have a history of breast cancer and liver disease. But what are the long-term risks?

 

Dr. Anne Ford:

So, if you use systemic hormone therapy for longer than five years, you may increase... MAY… the important piece to that is you MAY increase your risk for breast cancer. So, in my population of patients that I treat, that's the symptom that most everybody is most worried about, probably because everybody knows somebody who's had breast cancer.

 

And your mother may have had breast cancer, and so that would impact your risk. Your mother having breast cancer is not an absolute contraindication to you taking hormone therapy. But it should be a discussion that you have with your provider, because your mother's risk of breast cancer may increase your risk of breast cancer or your sister's risk of breast cancer. But again, it's all about risk, reward, and balancing the benefits and the risks. So, breast cancer is one thing.

 

If you take systemic hormone therapy, you are also at higher risk for a blood clot. So, clotting issues. If you take the estrogen through your skin, either with a patch or a gel, or you use it through your vagina — there are several rings that you can wear in your vagina that will give you systemic estrogen levels — and you don't ingest it, you can avoid first pass clearance through your liver. So, if you avoid that first pass clearance through your liver, your clotting enzymes are not increased. So, if you're at all at high risk for any kind of clotting issues, and you are thinking about taking systemic hormone therapy, my advice would be to use your skin or a non-oral delivery system. And then as you age, as we all age, our stroke risk increases, but if you take systemic hormone therapy in addition as you age, it will increase your stroke risk as well.

 

If you're a person who can't or desires not to use estrogen, but you have very bad hot flashes and night sweats, there are some treatment options that have FDA approval for hot flashes. One of them is an SSRI medication, so a selective estrogen receptor medication called Brisdelle.

Other SSRI, SNRI medications, which people are oftentimes taking for other symptoms, like depression and anxiety, can also help with hot flashes and night sweats. Gabapentin can be used for hot flashes and night sweats. Oxybutynin, or a medication that's approved for overactive bladder, can also help with hot flashes and night sweats. Those are off-label uses of those medications.

 

There are other, newer medications that regulate the receptors in your hypothalamus, and there's one of them that's FDA approved and one of them that's probably coming down the pipeline. You have to be a little bit more careful with those medications because they can interact and have problems with liver functions, but they actually are great in terms of reducing hot flashes and night sweats. So, yeah, there are options.

 

Stacy Courtnay:

Have you found that those non-hormonal options help eliminate the symptoms of arthritis?

 

Dr. Anne Ford:

In my experience, those other medications mitigate the vasomotor symptoms, the hot flashes and the night sweats. If you're sleeping better and you're not waking up 10 times at night, your arthritis might feel better. But in my experience, the hormonal, the... It's really the estrogen component of hormone therapy helps with the joint pain better than the other treatment options.

 

Stacy Courtnay:

OK. And so, other than systemic or local hormone replacement therapy, are there any other ways to reduce symptoms that are maybe more, like supplements or dietary changes or other measures, that women could take? And we joked earlier, before we started recording, I think I am in the throes of menopause and the hot flashes, and I joke that I'm throwing layers off all over the house, I have a sweater or, you know, and I'm just... I'm burning up. I have not had any increase in my rheumatoid symptoms so far, knock on wood, but anything else that we all could be doing, you know, with not traditional hormone replacement?

 

Dr. Anne Ford:

I don't think hormone replacement therapy is for everybody, and I don't think everybody needs hormone replacement therapy, so your question is great. We'll talk about non-pharmacologic. We'll say like non-drug things that you can do. You can dress in layers. You can keep your room very cool. You can avoid triggers, and for some people, caffeine is a trigger; for some people, alcohol is a trigger. You can keep yourself fit, you can exercise. You can eat healthfully and avoid processed foods. And be more concerned about nutrition.

 

As far as supplements go, the supplement literature is very confusing at times because the placebo effect really can make a huge difference in whether or not people seem to get benefit from supplements. And I don't espouse one supplement over another. When I talk to patients about supplements, I just want to make sure that they're not ingesting products that could potentially be tainted with substances that could hurt them, especially if you're buying them over the internet. And that there aren't going to be other side effects with such supplements that might adversely affect your health overall.

 

I think phytoestrogens have gotten a lot of attention in the lay literature in terms of helping with vasomotor symptoms, like soy supplements. I do think everybody should make sure that they are doing as much as they can in terms of protecting their bones by exercising regularly with regular weight-bearing exercise, walking, jogging, bands, light weights, heavy weights if you want to do heavy weights, and making sure that you're getting adequate calcium in your diet. I would encourage calcium in your diet over supplements first and then just making sure you're either getting enough sunlight to make sure your vitamin D levels are normal or taking a supplement for vitamin D.

 

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Stacy Courtnay:

For this podcast episode, we asked followers on social media what they found most helpful for coping with both arthritis and menopause at the same time. So, I'm going to read a couple of the comments, and then feel free to jump in, Dr. Ford, with any feedback that you have on them.

 

Dr. Anne Ford:

Sure.

 

Stacy Courtnay:

So, handbags36, she said, "My inflammatory arthritis journey started the same month I went into menopause. I have found that reducing my stress, sorting out my sleep, taking magnesium, following a low-sugar, gluten-free diet when I can and no alcohol has helped with my symptoms, and I truly believe it reduced my flares. I've started swimming and using the steam room. It's really helped with my night sweats and my up and down moods. And lastly, being kind to myself is very helpful."

 

Dr. Anne Ford:

Oh my gosh, she's doing everything that I would recommend that she do. (laughter)

 

Stacy Courtnay:

That's right.

 

Dr. Anne Ford:

You know, when you have an inflammatory condition that we don't really know what causes it, the things that she was saying about eating, especially eating a healthy diet, avoiding processed sugars and keeping herself mobile and moving and swimming and saunaing and being kind to herself are so important. And if all of those things help her sleep as well, even better, because she's going to have more energy to kind of keep going, doing those things if she's sleeping well.

Stacy Courtnay:

Sleep is, yes, so, so important. It affects all aspects of your life.

 

Dr. Anne Ford:

Yes. She didn't mention meditation. Or mindfulness. And I would encourage people to think about that along those same lines as well.

 

Stacy Courtnay:

Yes. Meditation, mindfulness. Also, I have just started Pilates, which has been very, very helpful for my joints and my mood and everything, so I highly recommend Pilates.

 

But the next user, so Denise Graff Fitness, she says, "I've had RA for over 40 years. I've learned through pregnancies, peri- and post-menopause, that my hormone fluctuations had an impact on inflammation and joint pain. I've learned to pace myself. I've learned the importance of movement. And I've learned that the brain and body work together and not independently. I talk with a trusted individual when I feel overwhelmed, anxious or stressed. And after all these years, I'm still learning, but I feel so thankful for the support and progress and research over the years."

 

Yes, a hundred percent can relate. And agree with her on all of that and... She referenced pregnancy. So, my doctor joked that when you... When most women get pregnant, their rheumatoid goes into remission, but my doctor joked that my body did not get that memo because...

 

Dr. Anne Ford:

Oh, no. (laughs)

 

Stacy Courtnay:

... I had a really rough pregnancy and major flare-ups and all of that, so I can attest to the fact that hormones definitely, you know, can affect the arthritis and the fluctuations in your body, but I like what she said here. "After all these years, I'm still learning, but thankful for the support and progress of research." And that is, as a volunteer for the Arthritis Foundation, that is what I've always said, why I'm involved and why I champion the Foundation.

 

And because we fundraise, we put a lot of resources into finding better, safer, more effective treatments for all. And when I'm in the infusion lab, and I'm getting my infusion, I see, you know, people in their seventies or eighties who are crippled, and they're deformed, and they did not have the biologics or the advances in medications that we have. So, I like her point that we're all learning, and we're all growing, and every year that goes by, we're finding, you know, more treatments to help all of us, whether it's arthritis or menopause, so…

 

Dr. Anne Ford:

I liked what she said about brain-body connection, too. I think that's huge.

 

Stacy Courtnay:

Absolutely. And I had not read this comment beforehand, but this goes back to what I just said about Pilates. So, Eden of England, she said, "Osteoarthritis in my hips brought on in part by hypermobility. Pilates and strength training has helped reduce the pain to the point that walking is less painful, and I feel more stable. Cold water therapy and swimming has also helped, as well as improving my mood and sleep."

 

I definitely, I think, movement, no matter what type of movement you're getting is going to be helpful for your joints, for your mood, your emotions. And she also referenced taking some supplements. Chondroitin, MSM, glucosamine and turmeric also help.

 

Dr. Anne Ford:

I would echo her comments there, especially about balance. Balance is so important as we age. Because as we age, falls become much more dangerous. So, if you are doing Pilates now, and you have good balance, and you continue as you age, and you can keep your balance good, I mean, that's just huge for your overall health and wellness.

 

Stacy Courtnay:

We wrap up each episode by sharing our top three takeaways, and so, Dr. Ford, I'm going to ask you: What are your three top points that you would like the listeners to take away from our discussion today?

 

Dr. Anne Ford:

So, I would like everybody to kind of think of menopause as a natural part of aging. And different people experience the symptoms and signs of menopause in different ways. And we live in an age where we are lucky enough to have treatment options that can help everybody if you need them. Some people don't need them. So, if you're one of those people that's just sailing through and doing great, wonderful. If not, I don't think people need to suffer. And there's no one size fits all. Everybody needs to kind of figure out what they need to make their quality of life the best it can be.

 

My second point would be along those lines. Treatment options exist for menopausal symptoms that are both pharmaceutical or medication, and they can be hormonal or non-hormonal. So, if you're suffering from hot flashes, but you really don't want to use systemic hormone therapy, don't be afraid to ask a provider about other non-hormonal options that could work for you.

 

And my third point would be: I really am a big proponent of overall health and wellness. In terms of diet, exercise and mind-body health and wellness, we all need to do as much as we can to keep ourselves healthy and fit and eating well and aging gracefully. I am a believer we're all going to get old and we're all going to die. But if we, as a society, could just accept that, I think we would be so much better off. But it doesn't mean that we have to just say, "Oh, throw in the towel." We can age gracefully and enjoy the time that we have up until until we can’t. So, yes, those are my points.

 

Stacy Courtnay:

Oh, I like it. So, I would say my three takeaways from this conversation... Number one is movement. Any type of movement for your arthritis is going to be helpful. I just feel that any type of exercise is great for the mind, the body, the soul, the emotions, the hormones, all of that, so I encourage everybody to exercise.

 

Also, you know, the risk versus reward with the hormone therapy, I think it's a matter of personal choice. And if your quality of life is really impacted by the symptoms of menopause, there are options out there, hormonal or non-hormonal options, so thank you for explaining all of that to me.

 

And also, I love what you said: Menopause is part of life. We're all going to get old, you know. It's just a matter of aging gracefully. We're very lucky to live in this time where there's always new medications and new therapies coming out to help us all live our best life. So…

 

Dr. Anne Ford:

Yeah.

 

Stacy Courtnay:

I really enjoyed this conversation. And I appreciate all of our listeners. Again, this is our going through menopause with arthritis podcast with our guest expert, Dr. Anne Ford, from the Duke School of Medicine. So, really appreciate your time. Enjoyed the conversation. So, thank you so much.

 

Dr. Anne Ford:

Thank you for having me. I enjoyed talking to you, too.

 

PODCAST CLOSING:

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. For a transcript and show notes, go to arthritis.org/podcast. Subscribe, rate and review us wherever you get your podcasts. If you subscribe through Spotify, leave a comment on their platform, letting us know what you think about this episode. And stay in touch!