Does sudden withdrawal of Estrogen cause a “aromatase inhibitor pain syndrome” leading to increased musculoskeletal pain? One author thinks so.
Marcel-Francis Kahn
Joint Bone Spine 73 (2006) 488–489
Does hormone replacement therapy discontinuation cause musculoskeletal pain?
Aromatase inhibitors are sometimes used to shut down non-ovarian estrogen production in post-menopausal breast cancer patients. They have a somewhat higher musculoskeletal pain problem.
(Anastrazole, Arimidex®), the aromatase inhibitor -27.8%
tamoxifen group – 21.3% (P < 0.0001).
Replicated results:
35% of women taking anastrazole
29.4% of those taking tamoxifen (P < 0.0001).
Apparently mice with aromatase deficency develop “a lymphoproliferative disorder reminiscent of Sjögren syndrome.”
He refers to it as “menopausal arthritis” and relates how osteoarthritis, rheumatoid arthritis and carpal tunnel syndrome relate to post-menopausal period. He also calls it : “estrogen deprivation musculoskeletal pain syndrome”
My note – – He mentions there is no claim that estrogen replacement helps pains. A sex change study presented at the IASP conference 2006 Australia found the opposite:
1/3 of men on estrogens developed pain
1/3 of women on androgens got rid of their pains.
Migraine relief is one of the things that postmenopausal women enjoy, yet it seems the fluctuations in hormone levels cause the biggest problems. There are test studies suppressing estrogen production and then giving steady levels with an estrogen patch; these patients had fewer headaches. It could be that rapid withdrawal of estrogens is not a good idea and the author suggests gradual withdrawal.
Sleep deprivation (like sleep apnea) and sometimes opioids can suppress testosterone production. I have found men on testosterone shots seemed to have less chronic pain. I have been using small doses on androgens for chronic pain in women (Andriol 40 mg one every 1-2 days) and feel it helps. Now if we could only get drug plan coverage.
Anyone else have experiences with this?
Your write up is very interesting. I have chronic pain from bulging discs and degenerating discs. But the pain has been really chronic since I have been going thru menopause. My estrogen levels have been way off, so it is interesting that you said how much worse your pain was since you were lacking estrogen. I wonder what the doctors think of this! I just know that I have a ruined body because of all the drugs that the doctors have put me on. They think they are helping us with our pain but they are killing us with the medications just to keep us quiet.
I am not a doctor, I am a woman who began experiencing musculoskeletal pain after discontinuing HRT about six months ago. I’ve been trying to research this on my own because my primary care physician has never heard of a relationship between estrogen deficiencies and fibromyalgia-type pain.
Two good resources: the work of Elizabeth Vliet, MD, PC who is based in Texas. Also, the Fibromyalgia & Fatigue Center of Philadelphia and Steven Lipschutz, MD.
I am so sorry for your pain and have tried to put together some rational responses.
1) There are reasons why women have more pain than men – noted by sex change operation results:
IN: Surging hormones blamed for pain- Study of sex-change patients reveals role of oestrogen.
Carina Dennis
Nature 25 August 2005
Two references mentioned:
“Men taking female hormones often start to experience chronic pain, says Anna Maria Aloisi, a physiologist from the University of Siena in Italy. In a study of 54 men taking oestrogen and anti-androgens as treatment to become women, 30% reported developing pains, primarily chronic headaches, during their treatment.”
“In another study of women taking testosterone to become men, says Aloisi, more than half found their aches and pains improved. “They seemed to feel better generally,” she adds.”
I measure testosterone levels in women and if low use Andriol 40 one EOD. I think it helps.
Another more recent article suggested restless leg syndrome might be more common after a to female sex change:
Stephany Fulda et al
Prevalence of the restless legs syndrome in transsexual patients: the hormonal hypothesis revisited
J Neurol November 2007
2) With menopause, for some unknown reason, about 1/4 of women develop a subtle form of sleep apnea called periodic breathing.
http://www.greenjournal.org/cgi/reprint/102/1/68?ck=nck
This can lead to frequent arousals and a “fibromyalgia” like picture. My daughter and I presented a poster on Commonly missed problems in chronic pain at the 2006 Canadian Pain Society Meeting – and nocturnal desaturations was one of them. I would suggest and post menopausal woman with pain should have at least have a Noctural Oximetry study done. In Regina, VitalAire will do a simple Nocturnal oximetry study for ?$60-70 while Prairie Oxygen will do the cadillac version with measurement of upper airway resistence and well for ? $150.00. People with sleep apnea often develop low testosterone levels which takes us back to #1. It has been suggested that 1/4 people on opioids will get sleep apnea. Which makes me wonder just how much I am helping people with painkillers.
3) Women are smaller –
– they develop more small painful disc bulge protrusions that are likely to maintain a chronic sciatica condition.
Natural Course of Disc Morphology in Patients With Sciatica – An MRI Study Using a Standardized Qualitative Classification System Tue S. Jensen et al
SPINE Volume 31, Number 14, pp 1605–1612
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16778696
– They are more likely to develop sublte cervical stenosis (narrowing of the neck canal) which may cause a Fibromylagia like illness.
Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: Outcomes and implications
Heffez, D et al
European Spine Journal
Volume 16, Issue 9, September 2007, Pages 1423-1433
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=17426987
– They can be injured at lower speeds in car accidents. Insurers like to think people need to have a speed change of 8 km/hr, to be injured but a new study including women suggest this could happen at 6.3 km/hr change
– at least 1/2 of chronic neck pains are of facet origin for which there is no imaging findings or clinical/physical signs that have stood up to vigourous study ( last one by N. Bogduk showed a physio identification technique did not work). This problem will NEVER be diagnosed without selective duration facet anesthetic blocks and these are NOT routinely done here. So an neck injury will not be adequately diagnosed or treated – some even told it is all in their head… One gentleman who worked for one of the police forces in Regina has a wife (not my patient) that was injured at work. She was told because the MRI was negative it must be in her head and cut her off WCB. I think this gentleman should arrest someone for fraud here :) Even if the neck is fine, Thoracic Outlet syndromes are common in unresolved cases and can be debilitating after motor vehicle accidents.
4) A German epidemiological study found neck pain in women increased 15% in women since the introduction of computers. Recent studies suggest correlation of neck pains and cell phone use. I suspect the technological age is not all that user friendly.
5) If I remember correctly, it has been suggested that a person will develop at least one health problem by the age 55 – perhaps age is a favor as well.
I would invite any comments and other suggested post-menopausal pain causes.
M. Montbriand MD