Menopausian Journey, Part 4
by Leslie Shalduha
In other words, this ain’t nothin’.
Random lightning strikes of pain on the back right side of my neck, disappearing as soon as they arrive, causing me to release a short scream of pain, became normal about midway through my 16 year perimenopause journey. I came to understand that sitting caused the pain to come more often, morphing into a constant state of tension pain going across the top of my shoulders, sometimes moving down into my shoulder blades and upper back. I initiated use of a stand-up desk to minimize pain and tension. I followed the endless path of doctor, x-ray, weeks of physical therapy before approval of a magnetic resonance imaging (MRI - a procedure that creates detailed images of the inside of the body with radio waves and a strong magnet) culminating in a visit with a surgeon in Boise. He assured me that though I do have a bone spur in my cervical vertebrae, my neck looked to be in better shape than “most of the people who live in my small town.” Oh boy, was I happy to hear that. I wondered aloud how was I to manage the pain that I did feel? His response was to simply live my best life and have a good day.
Since I started hormone replacement therapy, my body has had an abnormal response. I am unable now to sit in a normal position for longer than ten minutes at a time without experiencing constant, intense pain. I am fortunate, I suppose, in that I can sit in a slouch position, such as on a soft couch or chair with a foot stool. I start my day in that position as I write and catch up on reading, then transition to standing activities for most of the day. By early evening, I am exhausted from standing and in my “normal” amount of pain, which is the constant sharp pain that now exists at the base of my neck, on my spine. At this point I make dinner and collapse on the couch, turn on the tv and the heating pad that offers some relief before making my way to bed. Once again, I am fortunate that lying down only causes me mild discomfort, usually. With the exception of tossing and turning to adjust my position frequently, I sleep well.
In those first few weeks, the anxiety that the medicals* want to blame for everything did increase, causing difficulty in catching my breath, increased heart palpitations, raised blood pressure and pulse rate, and also made me, shall we say, a little less pleasant to be around. I broke into tears easily, unable to handle “normal” life pressure as the pain weakened my resiliency, too. Not one to take medications very often, I found myself eating ibuprofen and acetaminophen daily for a couple of weeks, to no avail. At first, I chalked the pain up to nasty withdrawal from cannabis, the stress of having to unexpectedly replace my water main line two days before Thanksgiving or when I realized my business social media pages disappeared, forgetting for that first 24 hours of panic that I had deactivated it myself in a moment of crisis. Or perhaps when I returned to work after missing two weeks for health reasons and my boss let me know I no longer had a job - I mean, at thosetimes it makes sense that I would have tension pain.
Now unemployed, I had nothing but time to practice my breathing, up my yoga and meditation, hoping to outwit the “anxiety.” As an herbalist, I make a lovely muscle rub that has given me some relief from the tension pain, though not the epicenter – placebo or no, I care not. Mostly I feel calm and resilient – I go to acupuncture, massage and physical therapy, learning how to move my body in ways that will not contribute to the pain.
When I am sitting with my girls, flapping our lips about what brings us joy, sharing family stories, reading astrology and tarot, discussing our futures and possibilities, when we cook together and share meals, watch shows that make us belly laugh or attend local music performances or a friend’s holiday craft party – those times should not result in extreme pain, which in turn leads me to unwillingly return to being Mean as a Snake.
Three years ago, my friend Jean invited me to help her train her llamas for mountain pack trips; an interesting offer as I had never really spent any time with llamas! The training included harnessing and saddling the animals then walking them with lead ropes, exposing them to unexpected situations. We helped the llamas to remain calm when a cat crossed our path, a vehicle drove near us or a cow looked at us sideways. I was inexperienced myself, of course, so when my llama startled for the first time, I held tight to the lead rope rather than giving it slack, an unfortunate reaction. Not long after this, I began to have shoulder pain and limited range of use. I set out on the monotonous path of doctor, x-ray and physical therapy for weeks before approval for a MRI. All of which again culminated in the final medical opinion that everything was just fine. In other words, I should simply live my best life and have a good day.
In this last year, I happened upon Frozen Shoulder in my menopause research. This condition is much more common in women, age 40 to 60, than any other group. There is no official link to menopause so no doubt this is simply a coincidence. This condition progresses through several stages, often beginning with an injury, or inflammation, in the soft tissue of the shoulder. The pain and stiffness cause a loss in range of motion, leading to thickening of the fibrous sheath of the joint which then prohibits the joint from working properly, causing intense pain. Over time, usually about two years, the frozen shoulder does get better in most cases. It was about a year before my pain subsided and I regained full use of my shoulder. Thank goodness, then, that this is only a temporary inconvenience, yes?
My mom has suffered with hip pain for years. The pain comes and goes; when it comes, she suffers greatly. The pain shoots down her thigh, emanating from her hip and lower back, limiting her ability to walk very far and causing her to limp painfully. When she joined me in Oregon, I introduced her to a naturopathic chiropractor who had been helping me with musculoskeletal pain and tension. This incredibly skilled woman gave my mom the most relief she has ever had, before or since, with Cranial Sachal (CS) work. CS is not often covered by traditional health insurance nor is it widely practiced in the areas where she resides now. Mom has been to multiple medicals seeking help, none of whom have ever mentioned this tendon disorder as a possibility. Rather they tell her she should simply live her best life and have a good day.
When I started to experience pain in my butt cheek and shooting down my leg, I did not recognize then the similarities to Mom’s pain. The pain comes and goes for me, too, sometimes shooting down the side or back of my thigh, causing me to limp for a few moments after coming to a standing position from either sitting or lying down. The pain is worse when I am sitting, making it difficult to find a good position. Luckily, I am unable to sit much now anyway. Perhaps I will head on down that familiar path of doctor, x-ray and physical therapy for weeks before approval for a MRI. Alas, I have no happy ending to this painful symptom; at least I have a name for it now.
Gluteal Tendinopathy (GT) is a tendon disorder that breaks down tendons, causing severe pain in the hips, thigh and butt muscles in particular. It happens particularly to women after the age of 40. Once again, there is no official link to menopause so no doubt this is simply a coincidence. After months of a predatory facebook ad tantalizing me with keywords that I fully identified with, I caved and clicked. Though I did not purchase whatever quick fix it was offering, that ad gave me enough information to know that GT is real. Women are suffering needlessly due to either a lack of concern by health insurers or insufficient education of too many of our medicals.
To end on a lighter note, there have been a variety of Come and Go musculoskeletal symptoms, too. I am an active person – maybe not exactly exercising, per se, but certainly moving my body in meaningful ways on the regular. Spending the day working in my garden, handling llamas or trekking five miles under the watchful gaze of the Wallowa Mountains are treats – these often result in full body pain for the next few days yet I carry on, simply living my best life and having a good day. To give these things up are to give up, in truth. An untenable option for me so onward I go.
It may not come as a surprise, then, to learn that musculoskeletal symptoms are experienced by more than 70% of women and one-quarter of those will be disabled by them through the menopausal transition. Due to loss of muscle mass, bone density and osteoarthritis, many women experience this pain and discomfort for years. Most of us, to include many medicals, do not understand that it is caused in many cases by the fluctuation of estrogen as it slowly diminishes in our bodies.
Dr. Vonda Wright, Jonathan D. Shwartzman, Rafael Itnoche and Jocelyn Wittstein have released a paper through the National Library of Medicine that coins the term Musculoskeletal Syndrome of Menopause (MSM). Actual risk assessment, meaningful management and treatment to mitigate damage will hopefully now begin to be initiated for far more women. The effects of MSM on our bodies will dramatically impact many women’s quality of life, which has significant downstream effects on our personal and financial lives and certainly includes the people in our lives who we offer care and support. In other words, this ain’t nothing.
*Medicals – a term I will use to describe the medical community as a whole.