One medical condition that half of the population will experience personally, while the other half will encounter indirectly, is the menopause transition. This inevitable part of life has long been shrouded in mystery, confusion, misconception, and stigma.
Given that dentistry is a field predominantly composed of women, understanding the menopause transition is particularly crucial for those in the dental profession. Recent research has shown numerous health effects associated with menopause, particularly its significant impact on musculoskeletal health.
Menopause and the dental clinician
Musculoskeletal disorders are a leading cause of disability among dental clinicians, and understanding the role hormones can play in them is crucial. Clinicians must grasp what the menopause transition entails and how it can affect their daily well-being, especially considering the physical toll that a career in dentistry already imposes.
Defining menopause and the menopause transition
Let’s start with some definitions and benchmarks. Menopause refers to the day after one hasn’t had a menstrual period for 12 consecutive months.1 The menopause transition, also known as perimenopause, is the period leading up to menopause, which can last for years depending on the person. The time after perimenopause is called postmenopause, and this lasts for the rest of a woman’s life. The average age at menopause is 52, and women can be experiencing symptoms of perimenopause as early as 10 years before menopause.2 However, some women experience perimenopause symptoms as early as their late 30s or early 40s if they experience menopause early. Several factors affect when a woman experiences perimenopause and menopause, and it’s crucial to understand the wide range of ages.
Menopause is a natural process and is marked by ceasing ovary function, fluctuating hormone levels characterized mainly by declining estrogen, stopping menstrual periods, and the inability to become pregnant.1 For some, this comes as a relief; they don’t have to worry about birth control or tampons anymore! Although associated with aging, which typically comes with a negative connotation in our society, it’s also a period of beauty, growth, and acceptance. By this time, many women are comfortable with themselves, confident in who they are, and have experienced enough of life to give them knowledge, wisdom, and perspective. However, if one doesn’t know what to expect, this period can be summed up in one word: chaos.
Mental and physical effects
Since estrogen receptors are present not just in the female reproductive system, but also in the brain, liver, bone, skin, colon, and salivary glands, the effects of declining estrogen may cause changes from head to toe.3 More than 35 symptoms are attributed to perimenopause, including hot flashes, night sweats, sleep disturbances, anxiety and depression, weight gain, loss of libido, and hair loss, just to name a few. Musculoskeletal issues are a lesser-known symptom, but especially important to women in dentistry, as practicing itself is hard on the body. When menopause is added into the mix, clinicians may experience more discomfort and not know why.
Musculoskeletal pain affects about 71% of perimenopausal women, which is significantly more than their premenopausal peers. Perimenopausal women experience a reduction in bone density and muscle mass each year, and both are attributed to the loss of estradiol, the most biologically active form of estrogen.4 Estradiol impacts every part of the musculoskeletal system, from cartilage and ligaments to muscle and bone.
Estrogen’s role in inflammation and pain
Estrogen is also naturally anti-inflammatory, so when levels dramatically decrease, like what’s seen during perimenopause, women begin to experience increased joint and muscle pain. This can be a confusing time, as women may seek out medical help due to their pain, but there are no clinical findings on imaging, which can lead to misdiagnosis or dismissal of symptoms from their medical provider.
The decline in estrogen can contribute to sarcopenia, which is defined as both the loss of muscle mass and strength.5 This loss of muscle not only contributes to pain and loss of function, but since muscle mass helps maintain bone density, those with sarcopenia are more prone to bone breaks and fractures, functional decline, and loss of independence in their later years.
A time for knowledge, not fear
The menopause transition isn’t something to dread or fear, but women of all ages must recognize the signs and symptoms. Different treatment modalities are available, from hormone replacement therapy and supplements to lifestyle changes, including diet, sleep, and exercise. Only you know your body, and you know when it starts feeling different. Many women report being dismissed by health-care providers, hearing phrases like, “Your labs are normal,” or “Let’s start you on antidepressants.” Women must be persistent in seeking adequate treatment. While menopause is a natural part of life, women shouldn’t have to endure substandard mental, physical, or emotional health. For dental clinicians, understanding menopause and taking the necessary actions to maintain both their health and career longevity is crucial.
Editor's note: This article appeared in the January/February 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
1. What is menopause? National Institute on Aging. US Department of Health and Human Services. Updated October 16, 2024. https://www.nia.nih.gov/health/menopause/what-menopause
2. Menopause basics. Office on Women’s Health. US Department of Health and Human Services. Updated October 17, 2024. https://www.womenshealth.gov/menopause/menopause-basics
3. Eyster KM. The estrogen receptors: an overview from different perspectives. Methods Mol Biol. 2016;1366:1-10. doi:10.1007/978-1-4939-3127-9_1
4. Wright, VJ, Schwartzman, JD, Itinoche, R, Wittstein, J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466–472. doi:10.1080/13697137.2024.2380363
5. Walston JD. Sarcopenia in older adults. Curr Opin Rheumatol. 2012;24(6):623-627. doi:10.1097/BOR.0b013e328358d59b
