Menopause Matters Forum
Menopause Discussion => Postmenopause => Topic started by: Wrensong on August 07, 2024, 06:15:04 PM
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Persistent joint pain & stiffness past 5 months, affecting flexibility, limiting activities. Neck, lower back, hips, elbow, shoulder, thumbs. Back pain/stiffness is the most limiting, worse after immobility e.g. rising from bed/chair & can be fleetingly excruciating on shifting weight after standing for a while. Prior to this, always had v good flexibility, now feels like joints have rusted. MRI 2 yrs ago showed disc degeneration in C-spine, but only to a degree common for my age (62). Also have osteopenia.
Physical fatigue disproportionate to effort has ramped up to a level I remember from peri 12+ yrs ago (pre-HRT), as if every muscle fibre is burnt out by early afternoon. I do sleep v poorly for various reasons inc horrrible night sweats, but that’s nothing new. Ferritin only 20 post-hysterectomy summer 2023, 62 last test, on iron bisglycinate (ongoing). On Vit D many years but result hovers around insufficiency as side effects preclude a higher dose. Muscle bulk, always minimal, declined further with enforced abstention from exercise for 3 months post-op last year & haven’t regained it.
No obvious inflammation in joints, no soft tissue swelling, redness, heat, though some finger joints look enlarged/misshapen. Inflammatory markers always low, but not tested recently. Diet good, weight low. Exercise: walking, static bike (when energy permits), light weights & recently started yoga stretches.
On HRT 7+ yrs, now oestrogen only. Serum E2 <200 on 2 tests this year, but lower in past without significant joint probs. Don’t fare well on higher oestrogen at this age. Had BSO 2018 & find testosterone helps with muscle strength, stamina & more but frustratingly off it due to hair loss of uncertain cause. Also hypothyroid 30 yrs, with chronically low T3, on T4-T3 fine-tuned to tolerance.
Does this degree of joint pain, stiffness & fatigue sound par for the course at 60+? Perhaps naively, I hadn’t expected it! Mentally I‘m at my best when busy/active, so this debility is frustrating & demoralising. Sorry so long, but hope detail will help.
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Mis-shapen finger joints can be due to oestro-arthritis - wear and tear - or rheumatiod arthitis when joints can be suddenly extremely hot, swollen and painful. The latter is an auto-immune condition - years ago gold injections were given successfully into swollen joints but it became too expensive for the NHS to continue with. Apparently. Even though patients had good benefit.
VitD - I need to get my levels checked as I've been exceptionally weary in the last 6-8 months: when I wake my head doesn't want to get out of bed ..... as well as needing to sit after any gardening activities.
I'm known for dropping off to sleep mid-afternoon and apparently: I snore :o :o :-X Moi?
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Hi Wrensong
Well I'm 57 and ( I think ) still in peri. I naively assumed that hrt would help with debilitating joint pain but it just got worse despite me upping my oestrogen dose.
After many blood tests, x-rays and scans, I was found to have osteoarthritis in hips, knees and fingers, fibromyalgia and inflammatory arthritis which mostly affects me in hands and wrists. I too have misshapen fingers and await physio. The fibro has it's own symptoms but likes to intensify angry pains... That's fun...
I would definitely ask your gp for more testing. It may well be linked to thyroid ( I have underactive too ) or vitamins deficiencies as you are aware. Do seem gp advice.
CLKD is right in rheumatoid arthritis being auto immune, but their are several types of inflammatory arthritis - and ( as in my case ) a small minority do not have the RA markers show in their bloods,so are considered seronegative. These days newer drugs are used to try to slow the progress of the condition.
Osteoarthritis is very common as we age, to varying degrees but I would still get checked out.
I would suggest you look at the Versus Arthritis site, which is extremely informative. Or NRAS which is geared to the inflammatory types of arthritis. Extreme fatigue is often seen in these types of arthritis. Just to see if anything on these ring further bells.
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Does this degree of joint pain, stiffness & fatigue sound par for the course at 60+? Perhaps naively, I hadn’t expected it! Mentally I‘m at my best when busy/active, so this debility is frustrating & demoralising. Sorry so long, but hope detail will help.
No, its definitely not the usual aches and pains that one gets with the aging process in what you are experiencing. I would say SarahT is spot on in her post and you should seek further advice.
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Thank you CLKD, SarahT & Ayesha, that's all really helpful.
SarahT I'm sorry you have arthritis, fibromyalgia & hypothyroidism to contend with, it sounds like a horribly debilitating combination. I hope the physio will help you. Do you know how long you'll have to wait? You'll know we can have joint issues with hypothyroidism but it's not one of the more widely recognised consequences & neither my Endocrinologist nor the spinal surgeon I saw for the neck issues suggested a link.
I did briefly mention the joint & muscle pain to my GP when seeing her about another issue a few weeks ago. There wasn't time for her to go into it in depth but she suggested osteoarthritis on basis of appearance of my hands & the prior findings of arthritis in C-spine on MRI. I got the impression she thought it all pretty much to be expected at my age, but never having been 62 before(!) I wanted to know other women's experiences & thoughts on it.
I've had some pain in various joints in the past on & off for quite a few years but it's only lasted for a week or two each time & never in all these joints together. The widespread nature this time, persistence & degree of lower back pain & stiffness mean I tend to agree with you Sarah & Ayesha that it seems more than I'd imagine to be normal for age. I self-referrred for physio a few weeks ago so will see what they think when the appt comes. I did also have physio for the cervical spondylosis & core strength a couple of years ago but it only made matters worse! Thank you for the website pointers Sarah, I have done some reading around since the neck issue was diagnosed but not sure whether I looked at those sites specifically so it's helpful to know trustworthy sources of info :).
Wx
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Morning. It's important to have good solid footwear as the spine will compensate all the way down if feet aren't comfy.
Let us know how you get on.
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Morning CLKD. Good point about the footwear. I had orthotic insoles a few years ago but had forgotten there can be adverse consequences for spinal alignment if footwear isn't right. I'll see what the physio says as they usually analyse gait.
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I would see your gp before the physio. Some are great and will check there are no underlying problems first but others don't and can make things worse. And then there's the 20 something who dismisses all joint pain because 'everyone over 40 has arthritic changes'. Which just happen to show themselves at the exact moment a bl#£%# sheep ran full tilt into my knee >:(
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Ouch Sheila. How frustrating to be fobbed off like that. Are you OK now?
I'd wanted to avoid bothering my GP again just now given how busy they are but that was good advice, thank you. I'd been thinking that a good physio would anyway probably not want to treat me without further imaging or specialist opinion. They set imaging in motion for OH after he self-referred for a leg problem so I'm expecting they might do similar for me. I'll think about it though & may go back to a GP before the physio appt comes through as you suggest.
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Hello Wrensong.
I'm sorry that you are suffering with so much joint pain.
I don't have any answers unfortunately but I wonder if it's worth asking for another blood test to check inflammatory markers? You say that it's been a while since this was looked at and it may be that there has been a change recently. I find that GPs are happy to arrange blood tests, probably because it is a job for the nurses! If your C Reactive Protein has increased you may find a non steroidal anti inflammatory is enough to calm things down.
I hope you get this sorted soon and sending hugs.
Take care.
K.
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Definitely ask your GP for a blood test to check for rheumatoid arthritis.
My mum, aunt and nana have/had this.
Similar presentation to what you describe.
Don't try to get it addressed on the end of an appointment for something else - they have 8 minutes and are not likely to give it the attention it deserves if you do that.
Blood tests are not 100 percent conclusive but a good place to start.
Regarding the testosterone, this can also be extremely helpful with musculoskeletal issues. Debatable whether it contributes to hair loss but there's a case for putting your health and quality of life before what others MIGHT think (but probably don't) about your hair.
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Hello Kathleen, lovely to hear from you & thank you for posting. It's so helpful to know other women's thoughts as we age, given all manner of unexpected things seem to occur without any obvious cause :o.
Yes, that's a good point, asking to test again for inflammatory markers as it's 3 or 4 years since it was last done I think. Another thing for the list . . !
Hug back to you.
Wx
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Hi bombsh3ll. Yes, I have found T helpful over the years & the hair loss could be down to several causes. It's more how I'd feel about it if I lost much more than about others' opinions, but I've also given myself the health is more important talking to, so I hear you on that. I haven't given up on T, just trying to tune in to what's going on for now.
Thank you for posting.
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I'm approaching 70 and this year I seem to have begun to fall apart (despite over a decade on HRT!). Really horrible neck pain which has been diagnosed as spondylosis (age related arthritis) and trochanteric bursitis (pain at the top of the leg when walking any distance, when getting up from being seated etc. - again mostly age related). I have tried a steroid injection for the leg pain which was great for about three months but apart from that its either a case of taking painkillers or low dose amitryptyline every day which I don't want to do unless it gets unbearable. All I can say is getting old ain't for cissies!
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Agreed Jillyboo - I thought that I had sciatica but turns out, diagnosed by a physio who gave me exercises: which I forget about : bursitis. Which wakes me in the early hours and is no problem in the day.
If I don't kneel when loading dishwasher etc. I get low back pain which seizes me up :-\. Humans should not have evolved upright! When I see myself in a shop window I notice that I am beginning to bed forwards = risk of osteoporosis so Note To Self!
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Hi Jillyboo, I'm sorry to hear that. Have you had physio for the cervical spondylosis? I did, but found the exercises aggravated the pain which made my insomnia worse. Can I ask does the spondylosis pain radiate to your arms or is it confined to the neck & is it a burning pain? Also, is it more problematic at night, interfering with your sleep? Sorry, rather a lot of questions & please don't feel obliged to answer if you prefer not to.
Thank you for sharing :hug:
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Hi - yes I'm doing physio exercises for both leg and neck. Unfortunately the pains are on different sides of my body so sleep is often pretty elusive! It's more of a sharp pain in my neck to be honest - as in a nerve being pinched. It doesn't radiate down my arm. Like you I sometimes feel the physio aggravates it! The amitryptyline at night was supposed to resolve the pain - which it did to a large extent but it also left me feeling like a zombie next morning which I hated. I must have spent hundreds of pounds trying different types of pillow to no avail - have you had any success in that respect?
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Oh, thanks for the detail about the neck pain. Interesting that the pain doesn't affect your arms. No numbness in arms/hands either? What a nuisance about the amitryptiline. Imagine you took as low a dose as poss to minimise side effects. I've been prescribed it 3 or 4 times for pain over many years but each time have had to discontinue due to problematic effects on GI tract, dryness & thyroid interaction. I don't take any prescription meds for pain, just paracetamol occcasionally. More often recently due to the back pain.
Like you, I've long been on a mission to find a suitable pillow & we now have quite a collection of abandoned styles, together with a mountain of nearly new, too hot bedding, mattress toppers etc acquired over 2 decades. I need a flattish pillow, but I'm also waiting for a new mattress to come into the showroom in hope that might improve neck, back, night sweats & insomnia. A big ask, but better sleep is the holy grail for me. We have a newish, good quality mattress in one of the bedrooms but I need to use 2 different bedrooms & the mattress we're now hoping to replace is too insulating for me & I suspect may not be giving enough support.
I've just checked an old thread of mine on insomnia where Buffy26 kindly recommended the Simba pillow. You may like to google that if you haven't tried it.
Wx
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Ahh! I can relate to your experience with persistent joint pain and stiffness, particularly in the neck and lower back. I dealt with similar issues for months, feeling like my flexibility had vanished and struggling with fatigue. I tried various treatments, but mostly over-the-counter pain relievers. Obviously, they didn’t provide lasting relief. Eventually, I discovered this acupuncture clinic kitchener (https://strivept.ca/services/acupuncture-kitchener/), which transformed my approach to managing pain. The combination of procedures significantly improved my flexibility and energy levels!! Pls find the right specialists though...
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Hi Minicat. Thanks for posting.
How are you now? Any progress?
Wx
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Hi Wrensong!
A B12 deficiency can cause drenching night sweats. Have you ruled that out as a cause? Vit D deficiency is also associated with hot flashes and night sweats.
You're hypothyroid with low D and low ferritin. Low vitamin D levels are associated with autoimmune hypothyroidism. You said, "On Vit D many years but result hovers around insufficiency as side effects preclude a higher dose." What forms of vit D have you tried and what side effects do you experience?
Wondering if the vit D deficiency is preventing your body from properly absorbing calcium and phosphorus, resulting in muscle pain and weakness. It could also cause hair loss.
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Hi Ana21, good to hear from you & with some helpful suggestions :), thank you.
Night sweats are v longstanding, nearly 2 decades, every night & continue to wreck my sleep, with frustrating effects on fatigue & stamina.
Lower back pain has thankfully improved somewhat in recent weeks, but neck's not likely to with spondylosis & various other joints & muscles/tendons/ligaments seem increasingly fragile.
No B12 deficiency whenever tested, whether on or off supplements & try to keep levels up as per Endocrinologist advice.
I take D3 tabs, but at only 200 iu as I find they consistently worsen slow gut transit at 400 iu or higher, though research (fairly recent from memory), found good D levels were important for normalising gut transit. Probably didn't include thyroidectomised patients, or those who don't adequately convert thyroxine, so also have to take T3.
Calcium always fine when tested & phosphorus never flagged as abnormal.
Awaiting recent blood test results, with Endocrinology, Physiotherapy & Orthopaedics appts coming up, all within a few weeks. If that lot doesn't throw any light I'll think again. May need to go back to Rheumatology.
Thanks for posting. I hope you're OK?
Wx
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Hi Wrensong!
You have a number of conditions linked to low vit D. You've tried D3 cholecalciferol and that doesn't work for you.
I was wondering whether you had tried calcifediol. It might be a better option. Different absorption mechanism. It's used to treat people with malabsorption issues. Here's some info:
Calcifediol is superior to cholecalciferol in improving vitamin D status in postmenopausal women: a randomized trial
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597097/
Calcifediol: Why, When, How Much?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10222038/
Wondering if raising your D level might help.
I'm doing well. Thanks for asking! I hope things are OK at your end.
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Ana21, thank you for taking the time to post those interesting links. I have scanned & bookmarked them this morning, plus a few more I turned up. I don't think I have probs absorbing from standard D3 tabs, just problematic side effects from higher doses, so not sure about increasing levels further via a different/more potent form. I'll see whether I can turn up anything on side effects specific to calcifediol & it's probably worth asking my Endocrinologist about. There is also a FH of renal disease so I need to be careful.
Thank you again :).
Wx
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Hi Wrensong,
Some of the studies refer to Hidroferol (calcifediol 0.266 mg). In the UK, Domnisol appears to be an equivalent drug:
https://flynnpharma.com/wp-content/uploads/2023/11/Calcifediol-PI-final_03-Aug-2023-final-1.pdf
If you decide to speak to your endocrinologist about it, please let me know his thoughts.
I hope your tests and upcoming appointments shed some light on your sudden increase in symptoms. I hope you get answers soon.
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Ana21 :thankyou:
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Quick update. Turns out my estradiol is <120 pmol/L & at its lowest for 5 years, way lower than before the onset of all this joint pain earlier this year. The third lowish E2 result I've had since then & no surprise this time around. Levels all over the place in last 2+ years, so v erratic absorption from patches that were reliably consistent for me when younger. My T is also close to bottom range & lower than on any previous test post-BSO. Together these seem to make sense of quite a few symptoms. Time for yet another rethink.
Thank you to everyone who posted with suggestions & support.
Wx