It is interesting to consider a fundamental difference for women and men – the experience of menopause. Given the proportion of podiatry clients who are older women, it is important for practitioners to understand the impact of menopausal hormone changes on foot structure and function.
As we age our foot structure and function is influenced by individual physiology, foot and limb mechanics, systemic pathology, and familial traits; but it is only women who are impacted by a natural change in hormone levels in mid-life.
In this article I will focus on:
- Menopause as a three-stage process and the associated hormonal changes
- The impact of menopause for women
- The effect of oestrogen on musculoskeletal tissues
- Quality of life and foot health related to menopause
- A ‘new beginning’ for hormone replacement therapy (HRT).
More on menopause
Menopause is commonly referred to as ‘the change of life’. It might be considered as an ‘end’ in relation to reproductive life but currently the focus is on menopause as a ‘new beginning’. The average age of menopause is 51 but the age range for naturally occurring menopause is 45-55 years, with some women experiencing menopause in their 60s. There are exceptions to this, such as premature menopause or premature ovarian insufficiency which may occur before the age of 40 due to natural ovarian function ceasing, following surgery to remove the ovaries, or as a result of cancer treatments.
Menopause is considered to be a three-stage process, marked by a decline in sex hormone levels:
- Perimenopause refers to the eight to ten years before menopause when oestrogen levels generally decline in an irregular fashion.
- Menopause refers to the time when menstrual periods have stopped for at least a year - progesterone production ceases after the final menstrual period.
- Postmenopause begins 12 months after menstrual periods have ceased - testosterone production declines with ageing but continues after menopause.
The impact of menopause
The impact of menopause for women varies widely but it is understood to be an inevitable part of the ageing process. Symptoms which women commonly associate with menopause are hot flushes, sweats, mood changes, disrupted sleep, lack of energy, loss of libido, menstrual irregularity and weight gain.
The longer-term impacts of menopause, however, appear to be less well understood by women for example, osteoporosis and cardiovascular disease.1 This is important to understand because the two leading causes of ‘non-fatal burden of disease’ for women aged 45-64 years are ‘other musculoskeletal’ (11%); and ‘back pain and problems’ (9.3%).