Ease the Transition: Tackling Joint Aches and Pains During Perimenopause

As women enter their mid-40s, many begin to notice subtle yet unmistakable changes in their bodies. Mornings might bring stiffness in the joints, a dull ache in the lower back, and muscles that feel perpetually sore despite regular exercise and a healthy diet. Activities that never caused problems before may now lead to puzzling injuries, particularly in tendons and connective tissue, with healing seeming to take forever. This marks the beginning of the journey through perimenopause.

Perimenopause is characterized by fluctuating hormones and a myriad of symptoms that can feel overwhelming and isolating. However, understanding the reasons behind these aches and pains can provide valuable insights into managing and improving them. One of the primary culprits behind many symptoms is fluctuating estrogen levels, and that is our focus today. Let’s explore how tissue repair is affected by estrogen and what steps we can take to mitigate problems as these levels naturally decline with age.

Inflammation often gets a bad reputation, but it is the first crucial step in the healing process. Signaling molecules called cytokines are released, stimulating the production of growth factors and other molecules that aid in healing. However, an excess of pro-inflammatory cytokines like TNF-α and Interleukin 6 can lead to systemic inflammation, which can hinder tissue repair. Estrogen helps balance the inflammatory response by reducing the production of TNF-α and Interleukin 6 while increasing the production of an anti-inflammatory cytokine called Interleukin-10 (Il-10). This prevents prolonged inflammation and allows the healing process to progress to the proliferation stage.

During the proliferation stage, the body works to regenerate damaged tissue. This involves activating fibroblasts, specialist cells primarily responsible for building the extracellular matrix that provides structural support to tissues. You can picture this matrix like the frame of a building that will eventually hold all the components of a house, with fibroblasts directing and overseeing the construction. They produce collagen, the most abundant protein in the extracellular matrix, which provides tensile strength and structural integrity, as well as elastin, the protein responsible for the elasticity and flexibility of tissues. Fibroblasts also synthesize proteoglycans and glycosaminoglycans like hyaluronic acid, which contribute to the hydration, elasticity, and structural support of the extracellular matrix.

Estrogen plays an important role in this process. It binds to specific sites on fibroblasts, activating internal processes that encourage these cells to divide and survive. Estrogen also affects the genes that control the cell cycle, promoting the production of proteins that help fibroblasts grow and multiply. Additionally, it increases the levels of certain growth factors like insulin-like growth factor (IGF-1), which act as powerful stimulants for fibroblasts, enhancing their activity and aiding in tissue repair.

In short, estrogen makes fibroblasts more active and efficient in repairing tissues by helping them grow, stay healthy, and work harder. Estrogen also directly influences collagen production by encouraging cells to produce more of this crucial protein, particularly types I and III, which are essential for wound healing. It does this by activating the genes responsible for collagen production. Once collagen is produced, it needs to be properly processed and stabilized to function effectively. Estrogen helps by enhancing the function of enzymes that ensure collagen fibers are correctly formed and strengthened. It also prevents the breakdown of collagen by reducing the activity of certain enzymes that would otherwise degrade it, maintaining the strength of the repaired tissue.

To help build the extracellular matrix, estrogen increases the production of fibronectin, a protein that provides a framework for collagen to adhere to, and promotes the creation of glycosaminoglycans like hyaluronic acid, which keep the structure hydrated and flexible. These glycosaminoglycans also facilitate cell movement and communication during repair. Estrogen also enhances the cross-linking of collagen fibers, making the extracellular matrix more durable and resilient.

Additionally, estrogen contributes to tissue repair indirectly by increasing the production of a protein called VEGF (vascular endothelial growth factor), which promotes the growth of new blood vessels, a process known as angiogenesis. This improves blood flow, bringing more oxygen and nutrients necessary for tissue rebuilding.

Now that we know how we repair tissue and which role estrogen plays, let’s see what we can do when our estrogen levels naturally decline as we age. What other ways are open to us to stimulate some of those key components of healing? Before we dive into this, I just want to say that there are plenty of medical and pharmaceutical interventions you can and should discuss with your healthcare provider, especially if symptoms are already severe. But if you are just noticing that it is taking you longer to heal and that you have more aches and pains than you used to, some of the following lifestyle changes might be of help.

Let’s dive into fibroblasts. These cells are significantly affected by stretching and compression, referred to as mechanical stress. When fibroblasts experience stretching, they change shape and ramp up their activity. This stretch encourages the cells to grow and multiply, as well as boosts their production of collagen and other proteins that support and fortify tissues. Conversely, when fibroblasts are compressed, they compact and activate different internal signals. This compression also leads to an increased production of collagen and other extracellular matrix components, which makes the tissue stiffer and stronger.

So if you tend to skip stretching after workouts, it’s time to make it a key part of your fitness routine. However, avoid overstretching to prevent muscle injuries — our goal is to promote healing, not cause harm. For compression, foam rolling is an effective and accessible method. The best approach is to foam roll both before and after your workout but be mindful not to overdo it. The pressure should be uncomfortable yet not painful. Excessive or prolonged mechanical stress can lead to tissue stiffening and scarring, a condition known as fibrosis.

If foam rolling isn’t sufficient, various massage balls can target areas foam rollers might miss. Just be cautious with these tools on the lower back or abdomen to avoid damaging underlying tissues. Additionally, deep tissue massages and compression garments can also help with fibroblast compression. Note that compression garments in this context are specialized products designed to aid recovery, not the slimming clothes you might be familiar with.

If you are unsure of how to stretch or use a foam roller, it is worthwhile investing in a few sessions with a qualified instructor. It will be cheaper and easier than having to seek out a physical therapist if you hurt yourself.

Next, let’s take a look at how exercise can help us in regards to our growth factors.

The most effective way to increase growth factors such as IGF-1 (Insulin-like Growth Factor 1) and VEGF (Vascular Endothelial Growth Factor) is high-intensity interval training (HIIT) and heavy resistance training.

A quick recap: IGF-1 is essential for tissue growth and repair. It helps in building new muscle fibers and other tissues, making it a critical component of the body’s regenerative processes. Exercise, especially HIIT and resistance training, stimulates the release of growth hormone from the pituitary gland. Growth hormone then prompts the liver and other tissues to produce more IGF-1. This cascade effect accelerates the repair and growth of tissues, ensuring that muscles and joints remain robust and resilient.

VEGF is crucial for angiogenesis, the formation of new blood vessels. These blood vessels are essential for delivering nutrients and oxygen to tissues, facilitating effective repair and regeneration. Intense exercise creates temporary hypoxia (low oxygen conditions) in muscle tissues. This hypoxic state triggers the production of Hypoxia-Inducible Factor (HIF), which in turn promotes the expression of VEGF. By enhancing blood vessel formation, VEGF ensures that tissues receive the necessary resources for optimal repair and maintenance.

To maximize the benefits of exercise on tissue repair, engage in high-intensity interval training sessions 2–3 times per week. These workouts should include short bursts of intense activity followed by periods of rest or low-intensity exercise. Prioritize heavy resistance training exercises, such as weight lifting, at least 2–3 times per week. Focus on compound movements like squats, deadlifts, and bench presses, which stimulate multiple muscle groups and promote overall strength. Allow sufficient time for recovery between intense workouts to prevent overtraining and facilitate optimal tissue repair. Incorporate rest days and light activities such as stretching or yoga.

Even with our best efforts, we can’t build new tissue without the right building blocks, which come from our food. So, let’s dive into nutrition and see what changes we can make to boost collagen production and activate fibroblasts.

First up is vitamin C, which is absolutely essential. Collagen synthesis involves several important steps, all needing vitamin C. This vitamin helps enzymes called prolyl and lysyl hydroxylases add hydroxyl groups to the amino acids proline and lysine in collagen molecules. This is crucial because it stabilizes and cross-links the collagen fibers, making them strong and resilient. Without enough vitamin C, this process falls apart, resulting in weaker collagen.

Collagen’s strong structure also relies on specific amino acids: glycine, proline, and hydroxyproline. Each has a unique role in making and stabilizing collagen. Glycine is the most common amino acid in collagen, making up about one-third of it. It stabilizes the collagen triple helix, a key structural element that gives collagen its strength and resilience. Without enough glycine, collagen fibers wouldn’t have the necessary structural integrity.

Proline also plays a big part in collagen’s structure. It’s crucial for forming hydroxyproline, an important component of mature collagen. The conversion of proline to hydroxyproline, with the help of vitamin C, ensures collagen fibers are stable and strong.

To give your body the amino acids needed for collagen production, a diet rich in high-quality protein is essential. Recent research shows that women need more protein than previously thought, and timing is important too. After exercise, there’s a small window to provide the body with the amino acids needed for recovery. Dr. Stacy Sims, an expert in women’s health, recommends 40 to 60 grams of protein within 45 minutes after exercise for people in perimenopause or menopause. Getting some of that protein from soy sources like tofu also provides phytoestrogens, which can help offset the loss of our own hormones a bit. Fatty fish is also a great option.

Omega-3 fatty acids found in fatty fish can be particularly beneficial when it comes to connective tissue repair. These essential fats have anti-inflammatory properties that help reduce inflammation, a common issue that can impede tissue healing and collagen production. Additionally, omega-3s support the structural integrity of cell membranes in connective tissues, promoting overall tissue health and repair.

For those who swear by alternative treatments, I have some good news. Over the past decade, acupuncture has firmly established itself as an evidence-based therapy. It works its magic on our fibroblasts, growth hormones, and inflammation. We began by discussing the crucial role of a balanced inflammatory response in tissue healing and how estrogen helps us achieve that balance. Acupuncture has some tricks that may help mitigate the effects of estrogen loss as we age.

Firstly, acupuncture has been shown to activate macrophages. These immune cells, whose name means “big eater,” clear away debris, pathogens, and apoptotic cells by engulfing and digesting them. Additionally, acupuncture stimulates the production of pro-resolution mediators, molecules derived from omega-3 precursors that help bring inflammation to a timely conclusion. They don’t prevent inflammation but ensure it fulfills its purpose and then stops before harming healthy tissue.

Acupuncture also supports collagen production and tissue repair. By stimulating specific acupuncture points, this therapy can enhance blood flow and activate the body’s natural healing processes, promoting the synthesis of collagen. The needles help trigger the release of growth factors and cytokines so crucial in tissue repair and regeneration.

If you have ever tried micro-needeling to improve your skin, those are the same mechanism.

Using a sauna can also significantly contribute to tissue healing, especially in perimenopausal people. The heat from the sauna increases blood circulation, delivering more oxygen and nutrients to tissues, which aids in their repair and regeneration. Additionally, the heat promotes the release of growth factors and heat shock proteins that help in repairing damaged cells and reducing inflammation. Regular sauna sessions can also alleviate muscle soreness and joint pain by relaxing muscles and improving flexibility. Integrating sauna therapy into your routine can thus be a powerful tool for enhancing tissue health and overall well-being during this transitional phase.

As you navigate the complexities of perimenopause, the changes in your body can feel both confusing and frustrating. Yet, by understanding the vital role estrogen plays in tissue repair, you can take proactive steps to support your health. Embracing regular stretching, foam rolling, and targeted exercises like HIIT and resistance training can stimulate our fibroblasts and boost growth factor production, essential for keeping your body strong and resilient. By nourishing yourself with a diet rich in proteins and omega-3 fatty acids, and exploring the benefits of alternative therapies such as acupuncture and sauna sessions, you can harness your body’s natural healing processes. This journey may be challenging, but with knowledge and intentional actions, you can manage these changes with grace and strength, reclaiming your well-being and thriving through this transformative phase of life.

Sybille Hazward