Peri-Menopause Aching-the study that’s never been done

“When I have to go to the bathroom in the middle of the night, I walk like an 80 year old woman. Dr. Nieder, I am only 48. There is something seriously wrong!” Lately, this complaint comes one or two times a week from peri-menopausal women. (Peri=around so peri-menopause is defined as around the time of menopause). Similar to my recent Hot Flash post, I started thinking about their complaints from my own experience. It hit me–I don’t ache like I used to. Yes, I exercise more now than in my mid-40’s but not as much as three years ago yet I don’t ache as badly as then. Why?  Research reveals the likely cause of the aches is estrogen deprivation but I cannot find studies that have been done on younger women. And most of the studies are more anecdotal comments about the “anti-estrogen” effect of medications given to women with breast cancer. Many of those patients are unable to tolerate the therapy because their joints hurt too badly[1]. In addition, all the studies on joint pain and estrogen loss have been done on post-menopausal women.[2]

What dawned on me is that the reduction in pain occurred about the same time I started sleeping again and the hot flashes were reduced. An “AH HA” moment indeed. But I’m an “N of one” which means my experience is unique to me and not statistically significant. I am only surmising that my patients will also improve based on my experience and the fact that my older patients are not complaining as much as my peri-menopausal patients are. Let’s hope these studies get done so I can give my patients facts instead of just life experience.

In the meantime, keep walking and staying optimistic. It will get better.


1. Qamar J. Khan, Anne P. O’Dea, and Priyanka Sharma, “Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors,” Journal of Oncology, vol. 2010, Article ID 654348, 8 pages, 2010. doi:10.1155/2010/654348

2.Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial. Chlebowski RT, et al. Menopause. 2013 Jun;20(6):600-8. doi: 10.1097/GME.0b013e31828392c4.

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HOT Flash

This short post is mainly directed at my menopausal patients. It came to me last night about 3 am. As it happened that was the second time I’d awakened for no obvious reason until a few moments later it seemed the room temperature had risen 10 degrees. No wait, MY temperature had done that. FlameV1Having nothing better to do until my temperature normalized (besides kicking off all my covers much to my husband’s dismay) it occurred to me, “this’ll make a great blog post!”

For those women struggling through the peri-menopausal period, better known as the meno-fuzzies, I have good news and bad news. Your cognition issues are real[1]. That’s the bad news. The good news is that this too shall pass and most of your brain function will return. You will also have fewer hot flashes and there will come a time when you will once again sleep through the night. Now that I’ve made it to the other side I can state with assurance that walking into rooms in my house only to discover that I have NO idea why I’m there are fewer now. No longer do I fear bursting into flame in the middle of my office. The bad news? Even though I’m in my late 50’s I still awaken in a sweat two or three times a week. And I have 80 year-old patients that assure me that they too still occasionally flash.

Are your fears about your memory well-grounded? Yes, but it will come back.
Is your insomnia as bad as you think it is? Yes, but you will sleep again.
Are you as irritable as your family says you are? Maybe, but exercise helps.[2]
Are you gaining weight because of the menopause? No, that’s more of the aging process.
Should you take hormones? That’s a very individual question and best discussed with your doctor in the office. Every woman needs to make that choice with her own needs and risk factors in mind.


1. Cognition and mood in perimenopause: A systematic review and meta-analysis. Weber MT, Maki PM, McDermott MPJ Steroid Biochem Mol Biol. 2013 Jun 14. pii: S0960-0760(13)00111-8.

2. Physical Activity, Menopause, and Quality of Life: The Role of Affect and Self-Worth across Time. Steriani Elavsky, Ph.D. Menopause. 2009; 16(2): 265–271.

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