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:
Treatment of Osteoarthritis:
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.
Steroid Injections into the painful joint performed in the Doctor’s office.
Topical NSAID Creams for pain relief, available over the counter.
Wait for joint damage, and then offer prosthetic joint replacement.
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.
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.
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."
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
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 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.
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)
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: www.bioidenticalhormones101.com
Articles with Related Interest:
Bioidentical Hormones Prevent Arthritis Part Two of a Series
Glucosamine for Arthritis
Arthritis and Nightshade Vegetables
14. Menopausal Arthritis and Bioidentical Hormones
(1) http://www.ncbi.nlm.nih.gov/pubmed/16142740 Arthritis
Rheum. 2005 Sep;52(9):2594-8. Aromatase inhibitors and the syndrome of
arthralgias with estrogen deprivation. Felson DT, Cummings SR.
(2) http://www.ncbi.nlm.nih.gov/pubmed/18703382 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) http://www.doctoryourself.com/arthritis.html Doctor Yourself: Natural Healing That Works by
Andrew Saul, Basic Health Publications 2003
(4) http://www.doctoryourself.com/JOM1.html Saul AW. William Kaufman, B-3,
and arthritis. J Orthomolecular Med, 2001. Vol. 16, No. 3, Third Quarter,
2001, p 189.
(5) http://www.ncbi.nlm.nih.gov/pubmed/7639807 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) http://jeffreydach.com/2007/05/22/glucosamine-and-chondroitin-for-arthritis-pain-by-jeffrey-dach-md.aspx Glucosamine and Chondroitin for Arthritis Pain by Jeffrey Dach M.D.
(7) http://cme.medscape.com/viewarticle/512093 "Menopausal Arthritis"
May Develop in Women Receiving Estrogen-Depleting Treatments News Author:
Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEd
(8) http://www.emaxhealth.com/70/3606.html Women treated with aromatase
inhibitors often experience joint pain and musculoskeletal aching: severe
enough, in some cases, to make them stop the treatment.
(9) http://cme.medscape.com/viewarticle/579250 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
(12) http://www.ncbi.nlm.nih.gov/pubmed/9355207 James MJ, Cleland LG. Dietary
n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum .
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) http://abcnews.go.com/Health/PainArthritis/story?id=4566412 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) http://www.arthritis.org/media/newsroom/statements/GAIT_Statement_FINAL_2_21_06.pdf Arthritis Foundation Statement
on the Glucosamine/chondroitin Arthritis Intervention Trial
(15) http://www.healingdaily.com/conditions/glucosamine.htm 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.
Reginster JY and others. Long-term effects of glucosamine sulfate on
osteoarthritis progression: a randomized, placebo-controlled trial. Lancet