Joyce is a 52 years old, post menopausal typist who came to see me in the office because of joint pain in her hands which keeps her up at night with aching, and interferes with her job as a typist. She was fine until about three years ago when she went into menopause and stopped her menstrual cycles. Since then, Joyce has made the rounds with a number of doctors and all the usual tests. Xrays of the hands were normal and blood tests for rheumatoid arthritis were negative. Her doctors told her she had early osteoarthritis and recommended the standard treatments listed here:
Conventional Treatment of Osteoarthritis:
1) NSAIDs. Over-the-Counter Aspirin, Acetaminophen (Tylenol), ibuprofen and naproxen, COX-2 inhibitors such as celecoxib.
2) Steroid Injections.
3) Topical Creams for pain relief available over the counter.
4) Physical therapy.
6) Wait for joint damage and then do a joint replacement.
Menopausal Arthritis
I explained to Joyce that she had fairly classical Menopausal Arthritis caused by an inflammatory response associated with declining estrogen levels. I have noted this in many of my patients. The inflammatory process is usually relieved by bio-identical estrogen as a topical cream. Joyce’s lab panel showed low estrogen levels, and Joyce was started on her bio-identical hormone program. Six weeks later, Joyce reports complete relief of symptoms. Her arthritis pains have gone. In addition, Joyce reports that she went off the bio-identical hormone cream for a week to see what would happen, and sure enough, the arthritis came back, only to be relieved again by resuming the hormone cream. This is a fairly typical story that I have seen over and over again.
Doubts From A Colleague
In casual conversation with a rheumatologist friend of mine, I mentioned Joyce’s story and the association of arthritis with declining estrogen levels relieved by bioidentical estrogen. To my surprise, my rheumatologist friend merely laughed and scoffed at the idea, saying he never heard of it and doubted the association between low estrogen levels and arthritis. As surprising as this might seem, there are many “denialists” doctors, possibly a result of not keeping up with the medical literature.
As it turns out, the association of arthritic aches and pains with low estrogen levels is well documented in the mainstream rheumatology literature. For example, an article published in Sept 2005 in Arthritis & Rheumatism by Felson and Cummings entitled,”Aromatase Inhibitors and the Syndrome of Arthralgias With Estrogen Deprivation”, showed that menopausal women treated with estrogen depleting medications tend to develop aches and pains in their joints. Another report in The Lancet Oncology,September 2008 by Sestak and Cuzick showed the same finding that estrogen depletion is associated with joint aches and pains. They say “Joint symptoms (eg, arthralgia and arthritis) are a well-known side-effect of certain drugs that reduce estrogen levels. Low estrogen levels and postmenopausal status are associated with the development of symptoms of arthralgias and arthritis.”
In Part Two Dr Dach will look at natural Treatments for Osteo-Arthritis for women – Coming out Friday 22nd October 2010.
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