Tendons are fibrous tissues that connect the body’s muscles and bones. They transmit force exerted by the muscles as well as store and release elastic energy, making them critical for musculoskeletal health.(1)
Tendinopathy refers to health conditions affecting the tendon tissue that cause pain or impaired functioning, including tendonitis and tendinosis. Tendonitis is a short-term tendon inflammation, while tendinosis is characterized by chronic degeneration of the tendon with little or no signs of inflammation. Many tendon conditions begin with inflammation before progressing into tendinosis.(1)(2)
Tendinopathy is often a result of injury from overuse and is commonly seen among athletes. However, genetics, certain health conditions, and hormonal changes during menopause may also play a role in its development.(1) Understanding the connection between menopause and tendinopathy can help women prevent, manage, and seek proper treatment for the condition.
The Connection Between Menopause and Tendinopathy
Aging of the musculoskeletal system accelerates after the age of 50.(3) For many, this coincides with the timing of menopause, which most women experience at the average age of 52.(4) Throughout the menopause transition, estrogen levels fluctuate, with marked shifts occurring during perimenopause. Along with many other functions, estrogen influences the health of the body’s muscles, ligaments, and tendons.
Tendons are largely made up of collagen. As tendon cells change with age, the rate at which the cells divide and grow decreases, which can impact collagen production, elasticity, and protein repair. Tendon cells also contain estrogen receptors. As estrogen levels decline during menopause, the tendon tissue can break down and lose strength.(5)
Shifts in estrogen levels have also been associated with an increased risk of tendon injuries and poorer healing. However, more research is needed regarding estrogen and its effects on the body’s tendons, as studies have produced mixed results. Other hormones may also influence the development of tendinopathy.(3)(5)
Common Types of Tendinopathy in Menopause
Women in their reproductive years are less likely to develop tendinopathy compared to men. However, the risk increases with age. The following are different types of tendinopathy women may be more susceptible to during the different stages of menopause:(1)(5)
Achilles Tendinopathy: The Achilles tendon runs along the back of the leg from the calf to the heel. Achilles tendinopathy may be influenced by estrogen levels, as one study found that hormone replacement therapy (HRT) improved tendon structure in physically active postmenopausal women.
Rotator Cuff Tendinopathy: The rotator cuff tendons, which support shoulder motility, are located around the upper arm bone. Increased rates of rotator cuff tendinopathy are often seen among middle-aged women.
Hamstring Tendinopathy: Cases of hamstring tendinopathy are common among athletes, but genetics and hormonal shifts during menopause may also influence its development.
Treatment and Management of Tendinopathy During and After Menopause
Recommended treatment methods for tendinopathy may differ based on what area of the body is affected as well as the severity and duration of symptoms. In addition to resting and icing the area, treatment methods typically include the following:(1)(2)(5)(6)
Physical Therapy: Eccentric exercise involves physical exercises that lengthen the muscles. This is the primary treatment method for most tendinopathies, as it helps reduce pain and improve tendon functioning. Eccentric exercise may also have protective effects against tendinopathy in postmenopausal women. A physical therapist may additionally implement deep friction massage to boost blood flow to the area.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs may be recommended for cases of tendonitis to reduce inflammation. However, they may not be recommended for degenerative cases of tendinosis, which do not involve inflammation. Some research suggests that NSAID treatment for degenerative tendinopathies may increase the risk of potentially serious adverse effects, such as a tendon rupture. Individuals should consult their doctor before taking any medications.
Surgical Intervention: Surgery may be recommended if other treatment methods are ineffective.
Preventing Tendon Issues During Menopause
Certain lifestyle adjustments may reduce the risk of tendon disorders as women age. The following preventative strategies can help support overall tendon health:(7)
Engaging in Regular Physical Activity: Getting 150 minutes of moderate-intensity exercise each week, along with two days of strength training exercise, can help build muscle and tendon strength.(8) Because repetitive motion can increase the risk of tendinopathy, it’s important to not overexert the body and to stop if exercise causes any physical discomfort.
Doing Balance Exercises: While more research is needed, results of one study published in The American Journal of Sports Medicine found that female soccer players who underwent long-term balance training developed fewer cases of Achilles tendinopathy and patellar tendinopathy (the tendon connecting the kneecap to the shinbone). However, these results were exclusive to professional athletes.
Keeping the Body Aligned: Maintaining proper spinal and shoulder alignment when doing repetitive tasks, such as typing, may help prevent rotator cuff tendinopathy. Taking regular movement breaks is also encouraged.
Wearing Shoe Insoles: Research findings vary, but wearing shock-absorbing shoe insoles may protect against Achilles tendinopathy by minimizing musculoskeletal strain on the lower limbs.
Supplying the Body with Nutrients: A nutrient-rich diet can help support tendon health. Supplements that promote collagen production or reduce inflammation, such as collagen peptides, arginine, or curcumin, may help reduce tendinopathy symptoms. Research findings regarding the health benefits of supplementation are inconclusive, and individuals should always talk with their doctor before using any new medications.(9)
Taking a Personalized Treatment Approach to Tendinopathy
While menopause is not considered a cause of tendinopathy, changes in hormone levels that occur during this stage of life may influence its development. There are preventive strategies that may help reduce the risk of tendon disorders. However, it’s crucial to seek treatment early if pain or stiffness develops to reduce the risk of complications. Healing may take between three and six months depending on the type of tendon condition.(6)
As there are different causes of tendinopathy, a personalized treatment approach is needed, factoring in a patient’s age, sex, menopause status, medication use, and health history. In cases where tendinopathy may be related to hormonal shifts during menopause, HRT may help relieve symptoms by supplementing the body’s hormone levels. Women should talk to their doctor about whether HRT may be recommended.
