The patient: “Serena,” a 49-year-old marketing manager.
Why she came to see me: Serena came to my health center because of joint pain. Her knees and hips often ached when she woke up, but it was her hands and fingers that were troubling her the most. What started as occasional discomfort in her hand joints progressed to the point that she found daily tasks such as typing, cooking, and carrying bags of groceries painful. She wanted to get to the bottom of her discomfort—and to find out if there was anything she could do to treat it naturally.
How I evaluated her: I began my evaluation of Serena with an in-depth discussion about her medical and personal history.
Serena had arrived in Hawaii shortly after college and loved every aspect about it: the tropical climate, the people and the bounty of outdoor activities. Up until a year before she came to see me, she spent almost all of her non-work time outside—stand-up paddling, surfing, hiking and kayaking.
Her athletic leanings organically fostered a healthy lifestyle. A self-proclaimed flexitarian, she ate what she pleased but aimed to eat organic as often as possible. She’d been in a long-term happy relationship since her early 30s, did not have children and had an overall positive outlook on life.
Given how much she relied on her body for the sports she relished, she was keenly sensitive to every change she experienced—including the pain in her joints, which had started out gradually and increased over time. She hadn’t been injured, or changed her diet, or done anything more physically taxing than usual. That said, her period, which used to arrive “every month on the dot,” had become almost non-existent in the last year—her last period was at least seven months earlier.
In addition to the joint pain she described when she first came in, she was experiencing night sweats, insomnia and weight gain. Most disconcerting of all, she hadn’t been able to enjoy the sports she so loved since her joint pain started and was feeling “flat” about life itself. She had also been, she admitted, “feeding her feelings,” which caused her to put on 15 pounds and brought her down further.
To determine the cause of Serena’s joint pain, I conducted a full physical exam, blood tests to rule out autoimmune conditions that could be associated with joint pain and a set of X-rays. Further, I ordered a hormone test to assess her levels of estrogen, progesterone, testosterone, DHEA and thyroid hormones.
What my evaluation revealed: Serena’s physical exam revealed what was obvious: She was in good health, with admirable blood pressure and blood sugar levels. Her X-rays, however, revealed cartilage loss, which is indicative of osteoarthritis, also known as degenerative joint disease, that causes pain, swelling and stiffness in the joints. Significantly more common among women than men, it typically impacts the knees, hips, hands and fingers—the very places that were concerning Serena the most.
Additionally, Serena’s hormone test demonstrated that her estrogen levels were low. I was quick to assure Serena that this was entirely normal at the age of 49. Women’s natural supply of estrogen begins to decline as they move into menopause. This “era,” if you will, is accompanied by plenty—hot flashes, night sweats, weight gain, headaches and mood swings, most of which she was also experiencing. And yet what few know or discuss is the direct link between declining estrogen levels and joint pain.
Why does this happen? In part, this occurs because in order for estrogen to exhibit its effects—those rushes of confidence and happiness we women commonly feel a week after our period, when estrogen levels are high—the hormone must bind to an estrogen receptor. Two types of estrogen receptors exist, what’s known as “ERa” and “ERb.” The first exists in a half dozen places, including the uterus, the ovaries and the mammary glands. The second receptor, which is just as ubiquitous, exists, among other places, in the brain, the liver, the blood vessel walls and the synovial fluid—a viscous solution that surrounds joints and helps protect cartilage against damage generated by friction during movement. During PMS, perimenopause or menopause, this synovial membrane thickens due to the natural decline in estrogen production. For a woman still menstruating, this may cause her to feel heavy during PMS (that bloat we know). For a woman whose days of menstruating are nearing their end, it can result in joint discomfort. What’s more, estrogen impacts the structure and function of other musculoskeletal tissues and affects collagen content. Waning estrogen levels also spur inflammation, leading to the pain and discomfort from which Serena was suffering.
How I addressed her problem: While there is no cure for osteoarthritis, it carries with it two pieces of good news: First, estrogen-related osteoarthritis does not worsen over time. In fact, as a woman’s hormone levels find equilibrium after menopause, pain may fade. Second, its symptoms, from aches to swelling, can be moderated through a combination of lifestyle changes, hormones and supplementation.
To address the first, I urged Serena to return to her healthier weight, as joints bear the brunt of the pounds we carry. Also, excess weight creates more systemic inflammation in the body. To this end, I urged her to not only adopt a tweaked diet that included more satiating clean protein and antioxidant-rich vegetables, but to also adopt exercises that would help her deal with the hormone fluctuations she was going through and the deflation she was experiencing.
Within this, though, I encouraged her to find exercises that didn’t put repetitive stress on her wrists and hands. Sadly, this meant avoiding the paddling and kayaking she enjoyed. Repetitive actions, such as typing, can “overwork” one’s joints and increase joint pain. Swimming provides a low-impact, full-body workout without stressing out one particular area. Yoga, meanwhile, has been shown to diminish pain and improve physical function and joint stiffness.
We then discussed estrogen replacement therapy. While Serena was nervous that the treatment would increase her risk of breast cancer, I explained that her family history, as well as her overall health, put her in a low-risk category. I also provided her with data showing that estrogen replacement therapy may help mitigate joint pain. I started her off with bio-identical hormones from a compounding pharmacy consisting of two types of estrogen: estradiol and estriol, mixed together in a ratio of estradiol 20%/estriol 80%, at a dose of 1.25mg. This was mixed in a cream base that she applied to her vulva each night when she also took a bio-identical progesterone pill (100mg).
When it came to supplements, I recommended that Serena take 1,000mg of curcumin per day. Curcumin, a major active component of turmeric, was shown, in one study, to be as effective as OTC pain relievers. I also encouraged her to take 500mg of magnesium glycinate per day, as low magnesium has been associated with increased osteoarthritis-related pain. Optimal amounts of magnesium, meanwhile, may improve sleep quality, while poor sleep can exacerbate joint pain and ultimately lead to depression. In addition, I recommended she take 1,500mg of glucosamine sulfate and 400mg twice a day of wild yam root extract. Technically known as diosgenin, wild yam root extract has been found to decrease menopausal symptoms and to inhibit inflammatory mediators, thereby reducing pain.
Lastly, I recommended that she omit nightshades from her diet. Belonging to the same family as belladonna (yes, the ancient form of poison), nightshades include tomatoes, tomatillos, potatoes (sweet potatoes are fine—they’re not nightshades), eggplant, peppers and goji berries as well as pepper-based spices like paprika and cayenne. While perfectly palatable to many, some people—myself included—are highly sensitive to the alkaloids (or toxic compounds) in these plants and may experience joint pain after consuming them.
The patient’s progress: Eight weeks after Serena started her recovery, she returned to my office with a grin. Ten pounds lighter—“back at my fighting weight,” she joked—and with a newfound love for long-distance swimming, she felt stronger than she’d been at 40. While her osteoarthritic pain emerged when it rained or when she “overdid it” while playing outside, for the most part she was symptom-free and thrilled to have full range of movement in her hands. Most of all, though, she felt happy again, which made any pain she did encounter all the easier to handle.~
Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.