Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

Chapter 14. Menopausal Arthritis and Bioidentical Hormones

Menopausal Arthritis Bioidentical HormonesChapter 14. 

Menopausal Arthritis and

Bioidentical Hormones

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 her menstrual cycles stopped, and she became post-menopausal. Since then, Joyce has visited a number of doctors with all the usual tests.  X-rays 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) NSAID tablets. (Non-Steroidal Anti-Inflammatory Drugs) Such as Aspirin, Acetaminophen (Tylenol™), Ibuprofen™, Naproxen™,  Celecoxib™, and Vioxx™.  Many of these are over-the counter drugs that so not require a prescription.  Some require a prescription.

2) Steroid Injections into the painful joint performed in the Doctor’s office.

3) Topical NSAID Creams for pain relief, available over the counter. 

4) Physical Therapy.

5) Wait for joint damage, and then offer prosthetic 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 noticed 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.  He doubted the association between low estrogen levels and arthritis. As surprising as this might seem, there are many "Denialist Doctors”, possibly a result of not keeping up with the medical literature.

Important Point:

Estrogen deficiency can be associated with an arthritis syndrome which is relieved by bioidentical estrogen.  This is well established in the medical literature.

Association Well Documented in the Rheumatology Literature

As it turns out, the association of arthritic aches and pains with low estrogen levels is well documented in the mainstream rheumatology literature.(7-10)  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.  (1)  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. (2)  The authors state:

"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."

Natural Treatments for Osteo-Arthritis

Although bio-identical hormone therapy seems to work for most post-menopausal women for arthritis relief, there are a few women that still have arthritis and arthralgias in spite of the estrogen cream.  It just doesn't work for them.  Well, here are a few natural therapies that can help.

Anti-Inflammatory Treatments

A Vegetable Juicing Diet is anti-inflammatory and can relieve arthritis: The vegetable juicing diet is an effective lifestyle modification that is very effective for arthritis.  I suspect the juicing diet works in part because of the elimination of wheat products, which tend to be pro-inflammatory.  In addition, fresh vegetables contain plant compounds which are anti-inflammatory.   Credit and thanks goes to Andrew Saul MD for bringing this to my attention in his book, "Doctor Yourself ", Page 36-38 which is devoted to arthritis and the vegetable juicing diet.(3)  This is certainly worth a try.

Weight Loss.

Weight loss is anti-inflammatory.  Fat in the "spare tire" of the abdomen produces inflammatory chemical mediators.  By reducing this fat depot, inflammation is reduced everywhere in the body.  This is certainly worth a try.

Anti-inflammatory Remedies

There are a number of anti-inflammatory herbs such as Boswellia, Ginger and Curcumin which can relieve the symptoms.  Omega 3 Fish Oil is anti-inflammatory and a number of studies reveal just as effective as NSAID anti-inflammatory medications for rheumatoid arthritis.(5)(12)

Nutritional Supplements to Rebuild Cartilage

Cartilage is an important cushion material in the joints that often wears thin as osteoarthritis progresses.  Once cartilage loss is severe enough to show up on an x-ray, this usually indicates irreversible damage to the joint. Cartilage nutrients such as glucosamine, chondroitin, and MSM (methyl sulfonyl methane) have been found to be effective at relieving arthritis.  Be patient, it takes about six weeks to get full relief.  In addition to cartilage, joints are made of bone material, so taking supplements to build strong bone makes sense.  Bone is made of collagen, so supplements that are required for strong collagen formation are ones we want here.   Vitamin C is a key vitamin for strong collagen.  Bio-available Silica  is a supplement that makes strong collagen.  Collagen is made from amino acids so, dietary amino acids such as lysine and proline are useful.  Collagen strength comes from the sulfur crosslinking, so a dietary source of sulfur such as MSM (Methyl Sulfonyl Methane) is useful as well.

For references and links, see my web site:

Articles with Related Interest:

Bioidentical Hormones Prevent Arthritis Part Two of a Series

Glucosamine for Arthritis

Arthritis and Nightshade Vegetables

References for
Chapter 14. Menopausal Arthritis and Bioidentical Hormones

(1)   Arthritis Rheum. 2005 Sep;52(9):2594-8. Aromatase inhibitors and the syndrome of arthralgias with estrogen deprivation. Felson DT, Cummings SR.

(2)  Lancet Oncol. 2008 Sep;9(9):866-72. Epub 2008 Aug 12.Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis.Sestak I, Cuzick J, Sapunar F, Eastell R, Forbes JF, Bianco AR, Buzdar AU; ATAC Trialists' Group.

(3)  Doctor Yourself: Natural Healing That Works by Andrew Saul, Basic Health Publications 2003

(4) Saul AW. William Kaufman, B-3, and arthritis. J Orthomolecular Med, 2001. Vol. 16, No. 3, Third Quarter, 2001, p 189.

(5)   Arthritis Rheum 1995 Aug;38(8):1107-14. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Kremer et al.

(6) Glucosamine and Chondroitin for Arthritis Pain by Jeffrey Dach M.D.

(7) "Menopausal Arthritis" May Develop in Women Receiving Estrogen-Depleting Treatments News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEd

(8) Women treated with aromatase inhibitors often experience joint pain and musculoskeletal aching: severe enough, in some cases, to make them stop the treatment.

(9) Anastrozole Associated With Joint Symptoms in Patients With Breast Cancer CME News Author: Roxanne Nelson   Author: Charles Vega, MD

Breast. 2007 Jun;16(3):223-34. 2007 Mar 21 Aromatase inhibitor-associated arthralgia syndrome. Burstein HJ.

Collateral Benefits of Fish Oil Therapy for Rheumatoid Arthritis by CHAK SING LAU, MD, FRCP,Professor of Medicine, Division of Rheumatology & Clinical Immunology, 

(12) James MJ, Cleland LG. Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum . 1997;27:85-97.

(13)  Volker D, Fitzgerald P, Major G, et al. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. J Rheumatol . 2000;27:2343-2346.

(14) Are There Any Vitamins Or Herbal Supplements That Can Be Used To Treat Pain Resulting From Osteoarthritis? Tieraona Low Dog, M.D., Director of Education, Program in Integrative Medicine, University of Arizona January 2, 2008

(14) Arthritis Foundation Statement on the Glucosamine/chondroitin Arthritis Intervention Trial 

(15) Even JAMA admits glucosamine is effective against osteoarthritic pain. McAlindon TE and others. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis JAMA 283:1469-1475, 2000.

(16)  Reginster JY and others. Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomized, placebo-controlled trial. Lancet 357:251-256, 2001.

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