Knee pain during periods

Joint Pain and Women

Women’s Bodies and Joint Pain

Hormones are only part of the picture, however. Female brains may be wired for pain. It’s thought that endorphins, the body’s natural painkillers, work more effectively in men than in women. “Studies have found that females release less of the brain chemical dopamine in response to painful stimulation. Without dopamine, endorphins can’t function effectively,” says Patrick Wood, MD, a pain researcher at Louisiana State University, in Shreveport, and medical advisor to the National Fibromyalgia Association.

Female structural differences may contribute to some kinds of joint pain, too. For example, women are more prone to osteoarthritis of the knee. One possible explanation: “Women tend to be more limber and loose-jointed than men, so there’s more movement in that area, increasing the risk that the kneecap will rub on the bones below it,” notes Bruce Solitar, MD, a rheumatologist at the NYU Hospital for Joint Diseases, in New York City. This may lead to osteoarthritis symptoms in the knee area.

Joint Pain Medication and Women

Women react differently than men to some medications for relieving joint pain. For example, fluctuating hormone levels can reduce the amount of medicine circulating in the bloodstream, which means that women may need more of the standard dose. Plus, female digestive systems are slower, causing certain medications (like pain relievers) to take more time to pass through the digestive tract where they’re absorbed more fully. And because pain sensitivity increases right before a woman’s period, more pain-relieving medicine may be required at this time of the month. “Women need to be aware of these factors, ask the right questions, and be persistent about getting an accurate diagnosis and proper treatment,” says Dr. Tucker. By becoming educated about how joint pain affects them, women can increase the odds of finding relief and getting the best health care possible.

Is it normal for my legs to ache during my period? I always find it really hard to walk since my legs hurt so much while I’m menstruating!

I feel so bad for you! Unfortunately, some women will have bad cramps even in their upper legs when they have their period, so this is normal. Just because it’s normal doesn’t mean that you have to put up with it! If you can predict a day or two ahead of when your period usually starts, you can lessen or prevent these leg cramps by taking ibuprofen. The cramps are due to prostaglandins that are being released by your body to help shed the lining in your uterus and bring about your period. Unfortunately, prostaglandins don’t just affect the uterine muscles, but can cause cramps in other muscles too. By taking the ibuprofen before you even have cramps, you prevent the prostaglandins from having a place to attach to the muscle and cause cramps. Most women over 110 pounds can take 600mg every 8 hours or so for the day or two before their period and for the first day and end up a lot more comfortable. Good luck!

Periods and aching joints and muscles

An introduction to aching muscles

Around your ‘time of the month’ you are particularly vulnerable to a whole list of ailments. Believe it or not, the list of menstrual period symptoms isn’t short and muscle and joint aches and pains definitely make an appearance. Very slight niggles can become exacerbated as a result of a barrage of hormones and chemicals (and sometimes a lack of!) circulating around your body.

On this page I discuss some of the reasons why your menstrual cycle can give rise to muscle and joint pain. Understanding what is going on inside your body means you have a better chance of tackling your issues. I then go on to discuss some useful home, herbal and conventional remedies that can help.

How can your period cause aching muscles and joints?

There are several reasons why you might find your muscles and joints are particularly sensitive around the time of your period as I discuss below.

  • Hormones – You might find the effects hormones can have on muscles and joints surprising and these are often overlooked. Between ovulation and your period, the hormone progesterone is dominant compared to oestrogen. There is some evidence to suggest that progesterone may have some suppressing action on the immune system. Research has suggested that women who are on progesterone-only contraceptives may be more susceptible to viral infections. This means your immune system has to work harder to fight off invading pathogens and your joints can suffer as a result. Aching muscles and joints are a common symptom of the flu virus; as your immune cells have to put so much energy into fighting the invaders, your muscles and joints are abandoned and they can become uncomfortable. As you approach your period it is also important to take into the account the big drop in oestrogen you experience. Oestrogen is important for lubricating your joints and low levels can mean they can easily become dehydrated – this makes them more susceptible to irritation
  • Prostaglandins – It is likely prostaglandins have a big part to play in muscle and joint aches and pains too. Prostaglandins are released from your womb in order to initiate contractions which ultimately give you your period. In excess, prostaglandins can diffuse past the womb into surrounding areas and also into your blood stream. As they diffuse into nearby areas, this is possibly why many women feel that their period pains can radiate into their backs and down their legs. If these hormone-like chemicals make it into your blood, they can exert a more widespread inflammatory response and many women experience aches and pains elsewhere as well as headaches
  • Other inflammatory mediators – As well as prostaglandins, research has suggested that other inflammatory mediators such as C-reactive protein (CRP) may also have a part to play in some of the symptoms of periods including back, joint and muscle pain

  • Magnesium – As your levels of important hormones drop, so can your levels (or efficiency) of certain minerals. Oestrogen can affect the uptake and utilisation of magnesium and sufficient levels are crucial for healthy muscles – low levels can result in aches, pains and cramps.

Federation of American Societies for Experimental Biology. (2013) Progesterone may be why pregnant women are more vulnerable to certain infections. .

Diet, lifestyle and home remedies

If aching joints or muscles are particularly troublesome there are some home remedies and dietary and lifestyle factors that could help.

  • Follow an anti-inflammatory diet rich in magnesium – Certain foods promote inflammation in the body whilst others have anti-inflammatory properties such as antioxidants which are particularly good for joints. Try to eat less saturated animal fats, processed foods, refined carbohydrates and sugar, caffeine and alcohol. Instead fill up on plenty of water, fresh fruit and vegetables including lots of green leafy veg, seeds, nuts, beans and oily fish in order to get a good amount of magnesium and anti-inflammatory omega-3
  • Gentle exercise – Exercise helps to increase your blood flow which means oxygen can be efficiently delivered to your joints and muscles and waste materials can be swiftly taken away. Exercise also helps to increase levels of chemicals called endorphins. It is likely a lack of endorphins can affect your sensitivity to pain
  • Apply some heat – Although often only a short term solution, heat can help to reduce pain in many cases. Applying heat helps local blood vessels dilate which allows more nutrients to be delivered to the affected area. Also, it is possible that activated heat receptors could temporarily block pain receptors
  • Massage or acupuncture – Some alternative treatments may help to alleviate muscle or joint pain if they are particularly troublesome month after month. It might be worth your while contacting a good masseuse or acupuncturist.

Herbal remedies to help

There are some herbal remedies which can help you aching muscles and joints:

  • Soy isoflavones – If your joint pain is cyclical it could be down to low levels of oestrogen. Soy isoflavones can help to gently restore the hormone balance. Other symptoms of low oestrogen include mood swings in particular feeling irritable and angry, water retention and painful, heavy periods
  • Devil’s claw – For muscles and joints or back ache, Devil’s claw is a licensed herbal remedy to help relieve the pain. Arnica is a nice topical alternative which is particularly soothing if you store it in the fridge before use.

Please note, if you are taking hormonal contraceptives such as the pill, hormone-balancing herbal remedies may not be suitable for you.

How can my doctor help?

If your muscle and joint pain is getting you down it might be time to pay your doctor a visit.

If your issue is related to hormones a form of hormonal contraception might be an option. In addition to, or instead of this, anti-inflammatory medication might prove useful. Always make sure you are aware of side effects though (especially if you plan to use this longer-term) as many can cause digestive upset for example.

7 Signs You Have Too Much Inflammation During Your Period

Menstrual symptoms are already painful enough as they are, but when your body is inflamed, everything can feel much worse. It can be hard to pinpoint the source of your period woes, but sometimes the root of these issues is excess inflammation. There are a number of signs that indicate you have too much inflammation during your period, and recognizing these symptoms can help you make the right choices to help make your period a bit more comfortable.

“Inflammation can make menstrual cycle symptoms seem much more significant and more severe,” gynecologist Jessica Vaught, MD of the Winnie Palmer Hospital for Women & Babies, tells Bustle. “If PMS becomes severe, it can have many effects on a women’s life. Pain can impact her ability to work, ability to take care of her family responsibilities, and ability to take care of herself.”

Inflammation can occur for a number of reasons, including diet, lack of sleep, stress, etc., so managing your habits may be able to help bring down inflammation and alleviate some of your unwanted symptoms. Engaging in stress-reducing habits and managing your blood sugar are just two ways you can help combat inflammation, and make your period — and the time before your period — less painful and distressing. Here are seven signs you might have too much inflammation during your period, according to experts.

1. Breakouts

Ashley Batz/Bustle

Frequent breakouts are often a telltale sign your body is inflamed. Acne can indicate gut inflammation, as a result of nutrient deficiencies or diet, gynecologist Felice Gersh, MD, tells Bustle. “We know that hormones have a great impact on the gut microbiome, and of course the hormones are shifting throughout the cycle,” she says. “Estrogen is especially beneficial to the gut microbiome, and the levels are lowest during the second half of the cycle (the luteal phase) and during the period itself. Acne breakouts tend to occur at those times, more than at ovulation or just prior, when estrogen levels are peaking.”

2. Heavy Flow

Andrew Zaeh for Bustle

Heavy bleeding is another sign that something is amiss. “There is no absolute way for the average woman to measure blood loss,” says Dr. Gersh. “That said, how many pads or tampons are soaked during the day is a good guide. If changing a soaked pad or tampon more often then every two hours is needed, there is excessive blood loss. If the heaviest days of a period last more than two days, that is excessive bleeding.”

3. Muscle & Joint Pain

Andrew Zaeh for Bustle

“Oftentimes this symptom is experienced by women who are suffering underlying pain caused by arthritis or previous injuries,” gynecologist Roohi Jeelani, MD, FACOG, tells Bustle. “Most days they can tolerate this, but during and right before their period, the inflammatory markers which help release the menstrual blood may cause a flare in these symptoms.”

4. Diarrhea Or Nausea

Aaron Amat/

Another common marker of too much inflammation is digestive issues. Since our gastrointestinal organs are anatomically close to our reproductive organs, they can be affected by our cycle changes. “The most common way an excess amount of inflammation manifests itself in our GI system is usually diarrhea and possibly nausea,” Dr. Vaught says.

5. Pelvic Pain

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Pain that extends beyond your typical cramps can also be an indication of inflammation — and possibly endometriosis. “Women may have pain that feels different than menstrual cramps,” Dr. Vaught says. “If a woman has a condition called endometriosis, she can feel pain that is exaggerated during her cycle. Endometriosis is a very inflammatory condition where there are implants of endometrial tissue within the pelvis.” If your period cramps are severe and debilitating, be sure to speak to your doctor.

6. Mood Swings

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Inflammation can even affect your mental state. “When our hormonal levels shift to allow our body to have our menstrual cycle, women can experience mood swings,” Dr. Vaught says. “Sometimes, these mood swings are subtle and can be controlled, but in other patients, they can be very pronounced and might even require intervention if a women feels she cannot control her behavior during this time.”

7. Dizziness and Headaches

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If you have a tendency to feel lightheaded and faint during your period, inflammation may be to blame. “Inflammation can lead to increased cortisol levels that can give a woman a variety of symptoms, including sugar cravings, headache, dizziness, and fatigue,” Dr. Vaught says.

To help with inflammation during your period, try to maintain healthy habits such as eating a balanced diet, staying active, and managing stress. And if symptoms still persist, talk to your doctor about them.

You wake up and get out of bed to start your day. You swing your feet onto the ground and stand up, only to realize an aching tension pulling at your knee. You figure it’s just stiffness, but as you continue your day you notice the subtle pulsating of pain radiating across your knees.

Knee pain can be connected to a variety of different health problems. Muscle and joint aches are typically related to injuries sustained during exercise or joint-impacting conditions such as arthritis. But there may be a completely logical explanation for your knee pain that is just as likely: your period.

Why?

Your aching knees may in fact be a result of your menstrual cycle. A woman’s period affects her body in many ways at different points throughout the regular cycle. And your knees are no exception. At different times during your cycle, the muscles in your knees react differently. The fluctuating function in your knee muscles then destabilizes the joints, making for some serious achiness.

Progesterone and estrogen are both common hormones that affect your body during your period cycle. These hormones also affect how the nervous system works, which can affect your muscles and joints. Ovulation can also play a factor. When the ovary releases its egg, they body’s reactions might manifest in pain. The prostaglandin, a hormone-like chemicals, released at the time of ovulation, can cause inflammation and joint aches.

Another reason for the increase in knee pain due to menstruation is simply the fact that women are more susceptible to pain than men. It is thought that endorphins work more effectively in men than in women. As a result, the changes in hormones may make the achiness in your knees more palpable.

Premenstrual tension is a common symptom of premenstrual syndrome caused by the imbalance of the progesterone and estrogen hormone levels in the body. Women who experience this symptom can have pain manifest in a variety of areas on the body, including knee joint and muscle pain. Most of the time, these symptoms let up with the onset of your periods, although they may resurface during the later phase of the cycle.

A research study conducted at the University of North Carolina-Chapel Hill measured the link between women’s menstrual cycles and the activity of their knee muscles. They found the firing rate of the muscle fibers in women to be significantly higher later in their menstrual cycle and right before their cycles.

Increasing joint pains are also common during perimenopause and menopausal phases due to the significant drop in estrogen levels.

While the link between muscle pain and specific phases of the menstrual cycle is still being studied, there is no denying that our menstrual cycles affect our muscles and can cause our knees to ache. There are several factors that can contribute to knee pain during your menstrual cycle, and symptoms can be worsened by PMS, stress, hormone changes, emotional problems, and chemical changes in the brain. All of these factors combined with each individual woman’s cycle and how they react to it can determine the severity of their knee pain.

What to do if your knees ache?

Muscle and joint pain is a common period-related symptom that women experience, just like cramps, bloating, and back pain. Just like these other symptoms, there are ways to mitigate the pain and treat your knee discomfort.

Vitamin D: Your aching joints and muscles could be an indication that you have a vitamin D deficiency. Integrating a higher intake of vitamin D into your daily diet can possibly help reduce that muscle pain around your time of the month.

Magnesium: It is also thought that low magnesium levels can cause aching joints and muscles as a result of inflammation. Eating your greens, taking magnesium supplements, and spreading magnesium gel onto your joints can help ease the pain.

Ibuprofen: If you’re feeling a little achier than usual during your period, try taking some ibuprofen. The pain-relieving medication can help reduce inflammation and provide some relief, also helping with other period symptoms such as cramps and headaches.

Massaging and heating pads are also helpful.

Overall, a combination of good nutrition and dietary supplements can help reduce your knee pain symptoms. Some non-organic dairy products may interact and disrupt your natural hormone cycle, contributing to hormonal imbalances. Eating a more organic diet can help reduce the severity of the symptoms during your menstrual cycle, and making it less painful to walk.

There are some hypotheses that women have more complaints of knee pain because of wider pelvis, but that has yet to be proven by appropriate research.

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  • Menstrual Periods & Arthritis

    Medical Author: William C. Shiel Jr., MD, FACP, FACR

    Why do many women with arthritis feel worsening symptoms before and during their monthly menstrual periods? During the course of any day in caring for women with arthritis, it is not uncommon for a number of them to complain of a monthly regular worsening of their joint pain, stiffness, and swelling. This is not just a coincidence.

    Many forms of arthritis and rheumatic diseases are known to occur more frequently in women than in men. Moreover, it is not unusual for the initial presentation of these conditions to occur following a pregnancy. Why?

    Researchers are finding that the immune system is influenced by signals from the female reproductive hormones. It seems that the levels of hormones, such as estrogen and testosterone, as well as changes in these levels can promote autoimmunity. “Autoimmunity” is a condition whereby the immune system (which normally wards off foreign invaders of the body, such as infections) turns and attacks the body’s own tissues, such as skin, joints, liver, lungs, etc. Autoimmune diseases typically feature inflammation of various tissues of the body.

    Autoimmune diseases are also characterized by a disorder of the immune system with the abnormal production of antibodies (autoantibodies) that are directed against the tissues of the body. Examples of autoimmune diseases include not only those that feature inflammation in the joints, such as systemic lupus erythematosus, Sjogren’s syndrome, and rheumatoid arthritis, but also disease of other organs, such as occurs in Hashimoto’s thyroiditis and juvenile diabetes mellitus.

    When women report only having symptoms or having increased symptoms at monthly intervals that coincide with their menstrual periods, many doctors will recommend adjusting or adding medication to reduce inflammation selectively just before and during the period. The rationale for this short-term adjustment is that the immune system may be temporarily more active as women’s hormone levels change during their periods. The additional medication can frequently help to avoid the symptom roller coaster that affects many women with arthritis.

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    Study suggests that inflammation is behind period pain

    “Scientists have finally discovered why periods hurt so much, following a ground-breaking study into menstrual pain,” The Independent reports.

    A new study suggests that the pain is caused by acute inflammation, as measured by the C-reactive protein (CRP). CRP is a protein produced by the liver; its levels rise when there is inflammation present in the body.

    In this latest research, scientists wanted to see if raised levels of CRP were associated with the often reported feelings of dull painful cramping many women feel before their period. This symptom is a common occurrence in what is known as premenstrual syndrome (PMS).

    PMS is the name given to the pattern of physical, psychological and behavioural symptoms that can occur two weeks before a woman’s monthly period.

    Overall, the study found that middle-aged women with raised CRP levels had about a 26-41% increase in risk of the various PMS symptoms. However, it is difficult to prove direct cause and effect between these two things and exclude the influence of other factors. The findings may also not apply to girls and younger women with PMS.

    The authors hope that these results will pave the way for future research into therapeutic treatments for PMS. While not life-threatening, PMS can cause a considerable negative impact on quality of life.

    Taking steps to avoid factors associated with increased inflammation – such as smoking, overweight and obesity – may also help.

    Where did the story come from?

    The US study was carried out by researchers from the University of California, Davis, and was funded by grants from the National Institutes of Health (NIH), the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH).

    The study was published in the peer-reviewed medical publication Journal of Women’s Health. It is available on an open-access basis and can be read for free online.

    The Independent was slightly pre-emptive when reporting that, “a ground-breaking study has found a link between inflammation and PMS”. This alleged link cannot be confirmed from the methodology used in this research, which was a cross-sectional analysis. However, the main body of the article was accurate.

    What kind of research was this?

    This was a cross-sectional analysis of data taken from a long-running cohort study being carried out in the US. It aimed to investigate whether CRP levels (C-Reactive Protein – a blood inflammatory marker) were associated with premenstrual symptoms.

    Around 80% of women suffer from PMS and 50% seek medical advice for them, placing a sizeable burden on the healthcare system.

    Cross-sectional studies like this are useful in assessing the incidence and prevalence of medical conditions or health indicators, but they are unable to prove causation, and say, for example, that raised inflammatory markers/inflammation cause the symptoms. It’s probably more of a complex relationship that could involve other factors. A prospective cohort study would be one of the best ways to validate these findings.

    What did the research involve?

    The data for this analysis was obtained from the Study of Women’s Health Across the Nation (SWAN), which is a longitudinal study of midlife women in the US. SWAN is currently following a cohort of 3,302 women from five ethnic groups at seven clinical institutions across the nation – it continues to collect data on reproductive health, plus demographic and lifestyle factors, through self-reported questionnaires.

    As part of the initial questionnaire, participants were asked about their periods and to indicate a yes/no response to eight commonly reported premenstrual symptoms:

    • abdominal cramps/pain
    • breast pain/tenderness
    • weight gain/bloating
    • mood changes/suddenly sad
    • increase in appetite or craving
    • feeling anxious/jittery/nervous
    • back/joint/muscle pain
    • severe headaches

    Blood CRP levels were also measured.

    This cross-sectional analysis used the data from the baseline visit (in 1996/97) to assess whether CRP levels were associated with pre-menstrual symptoms. Participants were included in the analysis if they were aged 42-52 before or around the time of the menopause, had not undergone a hysterectomy or had both ovaries removed, were not pregnant, and were not using hormone replacement therapy or oral contraceptives at baseline. CRP-levels were categorised into “elevated” (>3mg/L) and “non-elevated” (≤3mg/L) for the analysis.

    Other potential risk factors were controlled for to assess the true effect of CRP levels on PMS symptoms. This study included 2,939 women from the original cohort with full data available.

    What were the basic results?

    Overall, elevated CRP levels (>3mg/L) were significantly related to a 26-41% increased odds of reporting PMS symptoms. However, this relationship varied between different symptoms, suggesting that other mechanisms may be responsible for the occurrence of different symptoms.

    The analysis also found that symptoms were reported more by Hispanic women and those around the time of the menopause, and significantly less in Chinese and Japanese individuals, compared to Caucasian or premenopausal women. A higher education (more than high school) and higher annual income were associated with fewer PMS symptoms.

    Most symptoms were reported significantly more by obese women, those with active or passive smoke exposure, and women with elevated depressive symptoms.

    How did the researchers interpret the results?

    The researchers concluded: “These results suggest that inflammation may play a mechanistic role in most PMS symptoms, although further longitudinal study of these relationships is needed. However, recommending to women to avoid behaviours that are associated with inflammation may be helpful for prevention, and anti-inflammatory agents may be useful for treatment of these symptoms.”

    Conclusion

    This study found that middle-aged women with elevated CRP levels were more likely to report symptoms of PMS.

    The study had a good sample size, and represented a racially diverse and community-based sample of women who could be generalised to the US population of middle-aged women.

    However, there are a few points to bear in mind:

    • It is unclear whether CRP levels were measured two weeks before a woman’s period, so the results may differ, depending on the stage of the menstrual cycle.
    • As the researchers acknowledge, some of the associations observed may have resulted from other exposures, such as anti-inflammatory medications, physical activity and depressive symptoms.
    • It is difficult to imply the direction of effect/causation. A longitudinal study would be needed to better assess whether a rise in CRP levels preceded the onset of PMS, or vice versa.
    • No information was collected on the presence of infection in participants, which could have influenced the increased levels of inflammation.
    • Lastly, the findings cannot be applied to girls or younger women. It is also possible that PMS prevalence and associations could differ between women of different cultures and ethnicities than the US population sampled in this study.

    The researchers hope that these results will pave the way for future research, as well as potential therapeutic treatments for PMS symptoms through advice about avoidable factors associated with increased inflammation, such as smoking, overweight and obesity.

    Usually, a step-wise approach is recommended for PMS. Women with mild symptoms can usually relieve symptoms using over-the-counter painkillers and self-care techniques, such as eating smaller meals more frequently to help reduce bloating.

    Women with more severe symptoms should see their GP, as they may benefit from the use of prescription medication.

    Read about the treatment options for PMS symptoms.

    Analysis by Bazian
    Edited by NHS Website

    Links to the headlines

    Period pain: Scientists finally work out why menstruation hurts so much

    The Independent, 21 June 2016

    Links to the science

    Gold EB, Wells C, Rasor MO.

    The Association of Inflammation with Premenstrual Symptoms

    The Journal of Women’s Health. Published online May 2016

    PMC

    • Latman NS. Relation of menstrual cycle phase to symptoms of rheumatoid arthritis. Am J Med. 1983 Jun;74(6):957–960.
    • Rudge SR, Kowanko IC, Drury PL. Menstrual cyclicity of finger joint size and grip strength in patients with rheumatoid arthritis. Ann Rheum Dis. 1983 Aug;42(4):425–430.
    • Goldstein R, Duff S, Karsh J. Functional assessment and symptoms of rheumatoid arthritis in relation to menstrual cycle phase. J Rheumatol. 1987 Apr;14(2):395–397.
    • Mathur S, Mathur RS, Goust JM, Williamson HO, Fudenberg HH. Cyclic variations in white cell subpopulations in the human menstrual cycle: correlations with progesterone and estradiol. Clin Immunol Immunopathol. 1979 Jul;13(3):246–253.
    • Larsson P, Holmdahl R. Oestrogen-induced suppression of collagen arthritis. II. Treatment of rats suppresses development of arthritis but does not affect the anti-type II collagen humoral response. Scand J Immunol. 1987 Nov;26(5):579–583.
    • Vernon-Roberts B. The effects of steroid hormones on macrophage activity. Int Rev Cytol. 1969;25:131–159.
    • Sapolsky R, Rivier C, Yamamoto G, Plotsky P, Vale W. Interleukin-1 stimulates the secretion of hypothalamic corticotropin-releasing factor. Science. 1987 Oct 23;238(4826):522–524.
    • Roby KF, Terranova PF. Tumor necrosis factor alpha alters follicular steroidogenesis in vitro. Endocrinology. 1988 Dec;123(6):2952–2954.
    • Da Silva JA, Hall GM. The effects of gender and sex hormones on outcome in rheumatoid arthritis. Baillieres Clin Rheumatol. 1992 Feb;6(1):196–219.
    • Kamat BR, Isaacson PG. The immunocytochemical distribution of leukocytic subpopulations in human endometrium. Am J Pathol. 1987 Apr;127(1):66–73.
    • Halme J, Hammond MG, Hulka JF, Raj SG, Talbert LM. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol. 1984 Aug;64(2):151–154.
    • Halme J, Becker S, Haskill S. Altered maturation and function of peritoneal macrophages: possible role in pathogenesis of endometriosis. Am J Obstet Gynecol. 1987 Apr;156(4):783–789.
    • Fakih H, Baggett B, Holtz G, Tsang KY, Lee JC, Williamson HO. Interleukin-1: a possible role in the infertility associated with endometriosis. Fertil Steril. 1987 Feb;47(2):213–217.
    • Tabibzadeh SS, Santhanam U, Sehgal PB, May LT. Cytokine-induced production of IFN-beta 2/IL-6 by freshly explanted human endometrial stromal cells. Modulation by estradiol-17 beta. J Immunol. 1989 May 1;142(9):3134–3139.

    Women’s Rehabilitation Medicine for Pelvic and Sacroiliac Joint Pain

    Pelvic pain and sacroiliac joint pain in women are frequently misdiagnosed as originating from spinal structures or abdominal or pelvic organs.

    The physiatrists at the Department of Physical Medicine and Rehabilitation (PM&R) diagnose and treat these difficult musculoskeletal conditions using a holistic, multidisciplinary approach.

    What Is Pelvic Pain?

    Pelvic pain is common during pregnancy and postpartum. You may experience pelvic pain in your lower abdomen, though sometimes it spreads to the back and upper thighs. Pelvic pain can range from mild to severe, often varying in consistency.

    In many cases, pelvic pain arises due to an underlying issue in the pelvic muscles or your urinary, digestive, or reproductive system. Various causes of pelvic pain include:

    • Pregnancy-related problems
    • Gynecological issues (such as endometriosis, painful menstrual cramps, ovarian cysts)
    • Bladder issues (such as IBS)
    • Muscular and bone structural issues

    Your physiatrist will help determine the cause of your pelvic pain by performing a comprehensive evaluation that may include other tests such an ultrasound, abdominal x-ray, urine sample, and blood tests.

    When gynecologic dysfunction has been ruled out, myofascial pain, or chronic and severe pelvic pain, can often be attributed to sacroiliac dysfunction. Learn more about treatment for pelvic pain and other women’s health issues at the UPMC Centers for Rehab Services.

    What Is Sacroiliac Joint Pain?

    The sacroiliac joint lies next to the bottom of the spine and acts as a shock-absorbing structure. It may cause pain and dysfunction in cases where the symphysis pubis joint separates after delivery. Your symphysis pubis joint refers to ligaments that help keep your pelvic bone in place, especially important during pregnancy.

    Sacroiliac joint pain causes

    Sacroiliac joint dysfunction occurs due to:

    • A change in your typical gait or joint motion
    • Trauma or injury to your lower back area
    • Pregnancy and childbirth complications
    • Cartilage degeneration over the bone (degenerative arthritis)

    Sacroiliac joint pain symptoms

    Symptoms of sacroiliac pain commonly include pain in your lower back, made worse by movement directly affecting the area such as sitting or standing for long periods of time. Similar to pelvic pain, sacroiliac joint pain can spread to other areas of the body and increase in intensity.

    Sacroiliac dysfunction and pain are often misdiagnosed as they imitate other conditions, including underlying causes of pelvic pain.

    A few reasons it is important to accurately diagnose and treat sacroiliac pain include:

    • Misdiagnosis frequently results in unnecessary surgery.
    • Left untreated, symptoms of myofascial pain can lead to persistent impairment and disability.
    • Early referral can prevent dysfunction and chronic pain.

    Treating Pelvic and Sacroiliac Joint Pain

    Once the cause of pain has been determined, our physiatrists will work with you to effectively manage your type of pain. Treatment for both pelvic pain and sacroiliac joint dysfunction include similar types of rehabilitation.

    Physical therapy exercises and other forms of treatment for these muscular imbalances include:

    • Bracing, in the form of a wide belt (specific to sacroiliac dysfunction)
    • Medications to treat both pain and inflammation
    • Joint manipulation, including properly directed muscle energy techniques and strengthening

    Joint injections, such as cortisone shots which reduce inflammation and provide pain relief, may be necessary for some patients to reduce severe pain levels before beginning other treatment.

    Those suffering specifically from pelvic pain may benefit from pelvic floor therapy. Your pelvic floor includes the muscles and nerves near your lower back and abdomen, especially those with reproductive function. Pelvic floor physical therapy treats the pain through techniques such as deep tissue massage, and exercises to tighten and relax specific muscles.

    Physiatrists at the Department of Physical Medicine and Rehabilitation are specifically trained in areas relating to women’s health and wellness, including the ability to:

    • Address biomechanical issues
    • Treat pain
    • Perform interventional procedures, when indicated
    • Coordinate care with physical therapists and other professionals to address contributing factors, like mood disturbances and life situations

    For more information about conditions associated with pregnancy and postpartum care, visit UPMC Magee-Women’s Hospital.

    Multisite joint pain in older Australian women is associated with poorer psychosocial health and greater medication use

    1. 1.

      Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1545–602.

      • Article
      • Google Scholar
    2. 2.

      Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–67.

      • Article
      • Google Scholar
    3. 3.

      Hartvigsen J, Davidsen M, Hestbaek L, Sogaard K, Roos EM. Patterns of musculoskeletal pain in the population: a latent class analysis using a nationally representative interviewer-based survey of 4817 Danes. Eur J Pain. 2013;17(3):452–60.

      • CAS
      • Article
      • Google Scholar
    4. 4.

      Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D. Change in the number of musculoskeletal pain sites. A 14-year prospective study PAIN®. 2009;141(1–2):25–30.

    5. 5.

      Peat G, Thomas E, Wilkie R, Croft P. Multiple joint pain and lower extremity disability in middle and old age. Disabil Rehabil. 2006;28(24):1543–9.

      • Article
      • Google Scholar
    6. 6.

      Leveille SG, Bean J, Ngo L, McMullen W, Guralnik JM. The pathway from musculoskeletal pain to mobility difficulty in older disabled women. Pain. 2007;128(1):69–77.

      • Article
      • Google Scholar
    7. 7.

      Scudds RJ, Robertson JM. Pain factors associated with physical disability in a sample of community-dwelling senior citizens. J Gerontol A. 2000;55(7):M393–M9.

      • CAS
      • Article
      • Google Scholar
    8. 8.

      Natvig B, Bruusgaard D, Eriksen W. Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study. J Rehabil Med. 2001;33(1):21–5.

      • CAS
      • Article
      • Google Scholar
    9. 9.

      de Fernandes RCP, Burdorf A. Associations of multisite pain with healthcare utilization, sickness absence and restrictions at work. Int Arch Occup Environ Health. 2016;89(7):1039–46.

      • Article
      • Google Scholar
    10. 10.

      Miranda H, Kaila-Kangas L, Heliövaara M, Leino-Arjas P, Haukka E, Liira J, et al. Musculoskeletal pain at multiple sites and its effects on work ability in a general working population. Occup Environ Med. 2010;67(7):449–55.

      • Article
      • Google Scholar
    11. 11.

      IJzelenberg W, Burdorf A. Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain. Occup Environ Med. 2004;61(10):806–10.

      • CAS
      • Article
      • Google Scholar
    12. 12.

      Carnes D, Parsons S, Ashby D, Breen A, Foster NE, Pincus T, et al. Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study. Rheumatology (Oxford). 2007;46(7):1168–70.

      • CAS
      • Article
      • Google Scholar
    13. 13.

      Kamaleri Y, Natvig B, Ihlebaek CM, Bruusgaard D. Localized or widespread musculoskeletal pain: does it matter? Pain. 2008;138(1):41–6.

      • Article
      • Google Scholar
    14. 14.

      Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D. Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population. Eur J Pain. 2008;12(6):742–8.

      • Article
      • Google Scholar
    15. 15.

      Haukka E, Leino-Arjas P, Solovieva S, Ranta R, Viikari-Juntura E, Riihimäki H. Co-occurrence of musculoskeletal pain among female kitchen workers. Int Arch Occup Environ Health. 2006;80(2):141–8.

      • Article
      • Google Scholar
    16. 16.

      Von Korff M, Dworkin SF, Le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32(2):173–83.

      • Article
      • Google Scholar
    17. 17.

      Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing. 2006;35(3):229–34.

      • Article
      • Google Scholar
    18. 18.

      Tamcan O, Mannion AF, Eisenring C, Horisberger B, Elfering A, Muller U. The course of chronic and recurrent low back pain in the general population. Pain. 2010;150(3):451–7.

      • Article
      • Google Scholar
    19. 19.

      Patel KV, Guralnik JM, Dansie EJ, Turk DC. Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and aging trends study. Pain. 2013;154(12):2649–57.

      • Article
      • Google Scholar
    20. 20.

      Lee C. Cohort profile: the Australian longitudinal study on Women’s Health. Int J Epidemiol. 2005;34(5):987–91.

      • Article
      • Google Scholar
    21. 21.

      Brown WJ, Bryson L, Byles JE, Dobson AJ, Lee C, Mishra G, et al. Women’s Health Australia: recruitment for a national longitudinal cohort study. Women Health. 1998;28(1):23–40.

      • CAS
      • Article
      • Google Scholar
    22. 22.

      de Luca K, Parkinson L, Byles J. A study protocol for the profile of pain in older women: assessing the multi dimensional nature of the experience of pain in arthritis. Chiropractic Man Ther. 2014;22(28).

    23. 23.

      von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9.

      • Article
      • Google Scholar
    24. 24.

      Pan F, Laslett L, Blizzard L, Cicuttini F, Winzenberg T, Ding C, et al. Associations between fat mass and multisite pain: a five-year longitudinal study. Arthritis Care Res (Hoboken). 2017;69(4):509–16.

      • Article
      • Google Scholar
    25. 25.

      Thomas E, Peat G, Harris L, Wilkie R, Croft PR. The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the north Staffordshire osteoarthritis project (NorStOP). Pain. 2004;110(1–2):361–8.

      • Article
      • Google Scholar
    26. 26.

      Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191–7.

      • CAS
      • Article
      • Google Scholar
    27. 27.

      Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23(1 Suppl):S1–43.

      • Article
      • Google Scholar
    28. 28.

      Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630–5.

      • CAS
      • Article
      • Google Scholar
    29. 29.

      Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–20.

      • Article
      • Google Scholar
    30. 30.

      Hochman JR, Davis AM, Elkayam J, Gagliese L, Hawker GA. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1236–42.

      • CAS
      • Article
      • Google Scholar
    31. 31.

      Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011;19(6):647–54.

      • CAS
      • Article
      • Google Scholar
    32. 32.

      Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res. 2010;62(7):1019–23.

      • Article
      • Google Scholar
    33. 33.

      Ware J, Snow K, Kosinski M, Gandek B. SF-36 Health Survey. Manual and interpretation guide. Boston: The Health institute, New England Medical Center; 1993.

      • Google Scholar
    34. 34.

      Ware JE Jr. SF-36 health survey update. Spine. 2000;25(24):3130–9.

      • Article
      • Google Scholar
    35. 35.

      Energy. DoPIa. Rural, remote and metropolitan areas classification: 1991 census edition. Canberra: Australian Government Publishing Service; 1994.

      • Google Scholar
    36. 36.

      AIHW. National Health Data Dictionary. Version 6.0. Standard questions on the use of tobacco among adults. Canberra: Australian institute of Health and Welfare; 1997.

      • Google Scholar
    37. 37.

      NHMRC. Australian alcohol guidelines: health risks and benefits. In: Council NHaMR, editor. Canberra: Commonwealth of Australia; 2001.

      • Google Scholar
    38. 38.

      WHO. WHO consultation on obesity. Obesity: Report to WHO consultation. Geneva: World Health Organization; 1999.

      • Google Scholar
    39. 39.

      Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993;9(3):174–82.

    40. 40.

      Shmagel A, Foley R, Ibrahim H. Epidemiology of chronic low Back pain in US adults: data from the 2009-2010 National Health and nutrition examination survey. Arthritis Care Res (Hoboken). 2016;68(11):1688–94.

      • Article
      • Google Scholar
    41. 41.

      Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Do psychological states associate with pain and disability in chronic neck pain patients? J Back Musculoskelet Rehabil. 2015;28(4):797–802.

      • Article
      • Google Scholar
    42. 42.

      Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011;29(6 Suppl 69):S92–6.

      • CAS
      • PubMed
      • Google Scholar
    43. 43.

      Stamm TA, Pieber K, Crevenna R, Dorner TE. Impairment in the activities of daily living in older adults with and without osteoporosis, osteoarthritis and chronic back pain: a secondary analysis of population-based health survey data. BMC Musculoskelet Disord. 2016;17:139.

      • Article
      • Google Scholar
    44. 44.

      Raja R, Dube B, Hensor EM, Hogg SF, Conaghan PG, Kingsbury SR. The clinical characteristics of older people with chronic multiple-site joint pains and their utilisation of therapeutic interventions: data from a prospective cohort study. BMC Musculoskelet Disord. 2016;17:194.

      • Article
      • Google Scholar
    45. 45.

      Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83.

      • Article
      • Google Scholar
    46. 46.

      Gandhi R, Zywiel MG, Mahomed NN, Perruccio AV. Depression and the overall burden of painful joints: an examination among individuals undergoing hip and knee replacement for osteoarthritis. Arthritis. 2015;2015:327161.

      • Article
      • Google Scholar
    47. 47.

      Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol. 2016;8:103–13.

      • Article
      • Google Scholar
    48. 48.

      Louie GH, Tektonidou MG, Caban-Martinez AJ, Ward MM. Sleep disturbances in adults with arthritis: prevalence, mediators, and subgroups at greatest risk. Data from the 2007 National Health Interview Survey. Arthritis Care Res (Hoboken). 2011;63(2):247–60.

      • Article
      • Google Scholar
    49. 49.

      Generaal E, Vogelzangs N, Penninx BW, Dekker J. Insomnia, Sleep Duration, Depressive Symptoms, and The onset of chronic multisite musculoskeletal pain. Sleep. 2017;40(1).

    50. 50.

      de Luca K, Parkinson L, Haldeman S, Byles J, Blyth F. The relationship between spinal pain and comorbidity: a cross-sectional analysis of 579 community-dwelling, older, Australian women. J Manip Physiol Ther. 2017;40(7):459–66.

      • Article
      • Google Scholar
    51. 51.

      Macfarlane GJ, Beasley M, Jones EA, Prescott GJ, Docking R, Keeley P, et al. The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study). Pain. 2012;153(1):27–32.

      • Article
      • Google Scholar
    52. 52.

      Wong AY, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord. 2017;12:14.

      • Article
      • Google Scholar
    53. 53.

      van Laar M, Pergolizzi JV Jr, Mellinghoff HU, Merchante IM, Nalamachu S, O’Brien J, et al. Pain treatment in arthritis-related pain: beyond NSAIDs. Open Rheumatol J. 2012;6:320–30.

      • Article
      • Google Scholar
    54. 54.

      Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288(5472):1765–9.

      • CAS
      • Article
      • Google Scholar
    55. 55.

      de Luca K, Parkinson L, Byles J, Lo TK, Pollard H, Blyth F. The prevalence and cross-sectional associations of neuropathic-like pain among older, community-dwelling women with arthritis. Pain Med. 2016.

    56. 56.

      Wilkie R, Hay EM, Croft P, Pransky G. Exploring how pain leads to productivity loss in primary care consulters for osteoarthritis: a prospective cohort study. PLoS One. 2015;10(4):e0120042.

      • Article
      • Google Scholar
    57. 57.

      Wilkie R, Blagojevic-Bucknall M, Jordan KP, Pransky G. Onset of work restriction in employed adults with lower limb joint pain: individual factors and area-level socioeconomic conditions. J Occup Rehabil. 2013;23(2):180–8.

      • Article
      • Google Scholar
    58. 58.

      Peeters G, Parkinson L, Badley E, Jones M, Brown WJ, Dobson AJ, et al. Contemporaneous severity of symptoms and functioning reflected by variations in reporting doctor-diagnosed osteoarthritis. Arthritis Care Res (Hoboken). 2013;65(6):945–53.

      • Article
      • Google Scholar
    59. 59.

      de Luca K, Parkinson L, Pollard H, Byles J, Blyth F. How is the experience of pain measured in older, community-dwelling people with osteoarthritis? A systematic review of the literature. Rheumatol Int. 2015;35(9):1461–72.

    Aching knees? Don’t blame the weather–check your cycle instead. The muscles in your knees work differently at different points in your menstrual cycle, according to a study presented at the Integrative Biology of Exercise Conference. This changing muscle function destabilizes your joints and can set you up for serious pain.

    Since women tend to suffer more ACL tears and generalized knee pain than men, researchers have long wondered if part of the reason has to do with hormonal changes from the menstrual cycle. “We know that progesterone and estrogen affect how the nervous system functions, so we theorized that the menstrual cycle might be affecting how women use their muscles,” says study author Matthew Tenan, certified athletic trainer and doctorate candidate.

    Tenan and his research team at the University of North Carolina-Chapel Hill tracked the menstrual cycles of seven female volunteers with natural cycles (no hormonal contraception was used). Then they measured the activity of muscles in their knees during a knee extension exercise. They found that the firing rates of the muscle fibers were significantly higher later in the women’s cycles, about a week before their next period, compared to earlier in the menstrual cycle.

    Blame it on hormones and the brain: “The way the brain activates the neurons that cause the muscle to move are altered specifically at the latter part of the cycle right before start of next period, when the progesterone is decreasing and estrogen levels are maintained,” says Tenan.

    But don’t let the stages of your cycle influence your gym patterns, at least not yet.

    “We can’t say for sure that there is the time in a woman’s cycle that she’s more likely to be injured, but the fact that the patterns of muscle firings change through the cycle could mean that there is less stability in the joint due to the muscles being activated in a different way,” says Tenan.

    Understanding how the menstrual cycle influences women’s muscles can help trainers better treat knee pain in their patients in the future. “Some say women have more knee pain because they have wider hips,” says Tenan “But you can’t change the width of someone’s hips. Our findings are good news because people change their hormones all the time.”

    Your knees aren’t the only body part affected by your period. Learn when your female hormones can help (and hurt!) you at the gym, so you know when you push harder, and when you can back off without guilt.

    Image: Photodisc/Thinkstock

    More from WH:
    How to Avoid Sprains, Strains, and Tears
    The Best Yoga Poses for Your Knees
    Common Fixes for Fitness Class Injuries

    Look Better Naked: Buy the book to learn how to look (and feel!) your very best.

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