DOES MENOPAUSE AFFECT YOUR MUSCLES?
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Episode 221:
Show Notes
In this podcast episode of the Real Health and Weight Loss Menopause Series, host Dr Lucy Burns is joined by special guest Dr Sunita Chelva, a General Practitioner with expertise in musculoskeletal health and menopause. They explore the critical role of muscle maintenance, the impact of exercise on mental health, and the importance of body acceptance during menopause.
Dr Sunita Chelva is a Women’s Health GP with extensive experience and a strong passion for menopause medicine. She is dedicated to educating and empowering women through their menopausal transition and is a co-founder of 'Hera Menopause and Women’s Health' in Perth, offering expert, compassionate care.
Exercise and Mental Health: Dr Lucy discusses the mental health benefits of exercise, particularly how contracting muscles releases myokines, which positively influence mood and mental well-being.
Weight and Muscle Loss: Menopause often leads to muscle loss, which can contribute to weight gain and insulin resistance. Dr Sunita explains that even with good nutrition, muscle-building exercises are crucial to reversing this cycle. Building muscle improves insulin resistance, mental health, and motivation, leading to an upward spiral of positive health outcomes.
Body Composition and Weight Management: Dr Lucy criticises the outdated "calories in, calories out" approach, arguing that while reducing caloric intake might initially reduce weight, it doesn't address muscle loss or improve health. Sustainable weight loss requires focusing on body composition, particularly preserving and building muscle.
Genetics and Body Acceptance: Dr Sunita shares a personal revelation about body acceptance, recognising that genetics and ethnicity play a significant role in body shape and size. She emphasises the importance of embracing one’s genetic blueprint while working on muscle health.
Small Steps for Strength: Both doctors advocate for incorporating simple strength-building exercises into daily routines. Tips include standing on one leg while brushing teeth, sidestepping while waiting for the kettle and rising from a chair without using hands to build balance, glute strength, and proprioception. These small habits, when practised regularly, can compound over time to significantly improve strength and mobility.
Body Appreciation: Dr Lucy makes a comparison to how we appreciate the unique attributes of different dog breeds, urging women to embrace their individual bodies rather than conform to unrealistic societal standards.
The discussion highlights the interconnectedness of physical strength, mental well-being, and body acceptance during menopause and advocates for simple, sustainable lifestyle changes to improve overall health.
Stay tuned for next week’s episode, where Dr Sunita Chelva will return to delve into bone health and its importance during menopause.
Connect with Dr Sunita:
IG : @heramenopause, @drsunitachelva
FB: @Hera Menopause and Women’s Health
LinkedIn: @DrSunitaChelva @Hera Menopause and Women’s Health
Episode 221:
Transcript
Dr Mary Barson Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (0:58) Good morning, my beautiful friend. How are you today? I am without Dr Mary as sometimes I am, as you know, we have guests from time to time and I have a cracker. I have a guest this morning, I think that you will learn so much about things that we don't talk enough about. And of course, as you know, we have been chatting quite a lot about menopause and perimenopause, but I'm here to tell you, as is my guest, that it is way more than just a hot flush or two. I am pleased to introduce to you Dr Sunita Chalva. She is a legend. She's got her own specific perimenopause and menopause clinic over in WA called HERA, which I love, it is like the opposite of a hero, but HERA is an absolute wealth of information. So Sunita, welcome to the podcast.
Dr Sunita Chelva (01:48) Thank you so much for having me, Lucy. It's a real honour. I've been enjoying listening to your podcast and I've learned a lot myself actually, so thank you.
Dr Lucy Burns (01:58) Oh, excellent, thank you. Well, as we were talking off air, we know, and we've been doing this menopause series to sort of bring home the fact that menopause is more than hot flushes. And whilst hot flushes are annoying and inconvenient and can certainly impact a woman's life, there is a whole heap of other things that we're not talking about necessarily. And so it's time for us to shine a bit of light on it. And I'm super interested to hear your thoughts particularly around the musculoskeletal system.
Dr Sunita Chelva (02:32) Yes, I know. Now, it's something I think that you know, we know that bones, Lucy, and muscles are a framework of our body, but without them, we would be a quivering pile of jelly. I mean, they're not just for support and structure and movement, but they've got many other functions that we don't really think about. So mineral storage, blood production in the case of bones, metabolism in the case of muscles. And we don't really pay attention to our muscles and bones when we're younger, do we? Because, you know, it's not until we actually injure something that they generate pain and we go, Oh, that's inconvenient. Mobility is really a gift that we take for granted until we actually lose it, I believe. So we know at menopause, as we talked about, there's this seismic shift in physiology. With this reduction in oestrogen, progesterone and testosterone. And this has quite an impact on our bones and muscles. And women suddenly notice, I mean, it's almost overnight that they can wake up with terrible aches and pains and stiffness. And my patients often come in saying, gosh, I feel like an 80-year-old woman. You know, I'm 45 and I feel horrendous. It's actually, yeah. You talked about hot flushes and night sweats and things. That's what we all know. But musculoskeletal issues are actually one of the most common complaints and least talked about. I see it with women who are, you know, not just sedentary as often happens at this stage of life, but even the ones who are actually great exercisers, the ones who've always had good habits. And they find this very distressing, particularly with the limitations of their movements. They're suddenly not being able to do what they used to be able to do. And that's, you know, that really is impactful on someone's life.
Dr Lucy Burns (04:27) Absolutely. So what I'm hearing from you is that there are almost two components to the whole musculoskeletal issue, the things that happen immediately, and then the things that go on to happen as we age and progress, if we don't do anything about it for the future. Have I got that right?
Dr Sunita Chelva (04:48) Absolutely. I mean, it's a different trajectory for everybody. That's the interesting thing and I guess it all depends on your individual experience of menopause. It's very different for different women. And you know, menopause is one day, seemingly. It's an arbitrary scientific thing that we've conjured up to say on this day, you know, 12 months after your last period, you've thrown out your last egg. All your hormones are rock bottom, but through, you know, four months to 10 years before three perimenopause, things are starting to fluctuate on an average, they are reducing. So, you know, a lot of the things that are here, patients have been to many doctors, many specialists and other allied health before they've come to see us. And no, one's actually validated them for the fact that perhaps you are actually perimenopause or you're losing your hormones. because we know that all these hormones impact every single cell in our body, and your symptoms are probably due to that. And so there's this new terminology you may have heard about the musculoskeletal syndrome of menopause. It's recently been coined and I think it's a great umbrella term for what happens to our muscles and bones at this time. Things like back pain, plantar fasciitis, hip and shoulder bursitis and frozen shoulder often seem to cluster around this time of menopause as well. And, you know, we see increasing diagnoses of inflammatory arthritis and fibromyalgia. A recent study has shown that up to 70% of menopausal women have musculoskeletal symptoms and 25% of them have disabling ones. And so frustratingly for clinicians and patients alike, some of these pain syndromes don't correlate with any of the findings that we see on radiological imaging. I actually have a lot of compassion for patients who come in complaining of severe joint pain. you know, aches and pains because actually part of my own menopause journey landed me at the rheumatologist with a diagnosis of seronegative inflammatory arthritis. I know you personally understand this very much as well. I mean, I remember feeling so sore, Lucy, bone weary, weak. I remember carrying this pot of boiling water from the stove. Across to the sink and I didn't make it and I spilled it all over the floor. And it was during a dinner party and it was very embarrassing. I was put on methotrexate for years. My hair was starting to fall out. I wasn't feeling better. I went through early menopause and I'd already started HRT at this point. But after quite a bit of research, I realised a few things. Probably I wasn't on an optimal dose of oestrogen. Increasing it actually helped a bit. The other thing that struck me was that my gut health wasn't very good. Muscle loss definitely was contributing. So addressing these things meant actually that I didn't have inflammatory arthritis at all, but musculoskeletal syndrome of the menopause looking back. And I often see this same inflammatory picture coming in through the door with my perimenopausal and menopausal women. We know that oestrogen particularly has a very anti-inflammatory effect on the body. And it's a really hard thing for doctors to differentiate because currently with aging, there's also the risk of autoimmune diseases like rheumatoid arthritis or inflammatory arthritis increase. So they can absolutely still be present in tandem and they also need to be managed accordingly. So we can't just say, here's some HRT, it's all going to get better. We actually need to tease out these symptoms and see what's actually going on here. So that's part of what we do in a consultation, but it's a really common presentation for sure.
Dr Lucy Burns (08:55) I think it's so interesting, isn't it? Because as you said that oestrogen, we know oestrogen is anti-inflammatory. We also know that oestrogen is important for bone and muscle health and tendons and ligaments. And we're seeing now. particularly with the increase of women in competitive sports, that things like their menstrual cycle affect injury rates and things like that. So we know that there is intense, you know, association between our female hormones and muscles, tendons, ligaments, but yet. It's like there's this kind of cloudy wall that you've gone through menopause, but that won't be the cause of your joint pain. It's like, what? Hang on. We've just established X, Y, and Z and now we're going, no, no, it won't be that. It'll just be something, you know, it'll be just, you've just gotten, you know, an artist of some sort.
Dr Sunita Chelva (09:49) You've done too much. You're just getting too old. Exactly. It's very, very frustrating for women, I think, to be told, and it is impactful. I mean, women saying that they're sore, turning over in bed at night. I mean, normally we're taught in medical school, that's a red flag that something bad's going on here. But often there can just be this wonderful conglomeration of Losing hormones, not just that, it's the far-reaching effects of the whole metabolic effect on our bones and muscles.
Dr Lucy Burns (10:26) Yeah. Absolutely. And one of the things you said earlier too is that, you know, there's hormone receptors in every single cell. But the other thing that we see a lot of is that you know, all the hormones talk to all the hormones. And so at our neck of the woods, where we are really interested in insulin resistance, we say the decline in oestrogen increases insulin. Women start gaining fat around the middle. If they weren't insulin resistant in the past, they often become insulin resistant. Their visceral fat is inflammatory. It sends out all these inflammatory mediators, adipokines, and then also just adds to that inflammatory load. And it's like, wow, we're just one giant bag of inflammation.
Dr Sunita Chelva (11:16) Absolutely. And I mean, you know, we can talk to sarcopenia, if you like. I mean, sarcopenia is, I mean, it's really only been, so what it means literally is muscle loss. And we really don't know enough about it because it's only been recognised as a disease entity since 2016, which is kind of scary. And, you know, we know that muscles like our bones are dynamic entities and they're not just for locomotion. They're not just for stabilising our joints, but they have, as you said, that metabolic thermoregulatory role as well, the amount of muscle mass we have actually defines our basal metabolic rate. So, you know, that's the rate we burn calories at rest.
Dr Lucy Burns (12:05) Yes, I like to call that where you lie around burning calories for free.
Dr Sunita Chelva (12:08) Feeling strong. It makes sense, you know, therefore, like you said, that psychopenia is associated with fatty liver, diabetes, cardiovascular disease, and possibly even dementia. The menopause transition itself actually causes loss specifically of skeletal muscle, independent of aging, which is interesting because again, they're occurring in tandem. oestrogen loss rapidly at menopause leads to reduced muscle protein synthesis. Increased muscle protein breakdown. We are more sedentary around this time. I mean, pain as we talked about, low mood, fatigue. I mean, often that's why women shy away from being as active as they once were. And they prefer a couch and a bit of Netflix, because why would you do that in the middle of winter you know, over-exercise? And, you know, women are often told, just take it easy. You don't need to be moving so much. As he said, when we do exercise, Lucy, our muscles are less responsive to change. And that's often due to aging. So yes, even my very active patients will say they pull up quite sore from the gym. Our nutrition, as you said, I mean, we don't eat enough protein. We're craving more carbs and sugar. That's insulin resistance, the change in the gut microbiome, and more inflammation. So yes, this is a wonderful, vicious cycle that's set up. And that's why when women come into us, they're broken and they find it hard to lift themselves out of that place, I think, because it's become. It's a vicious cycle and it's not just one thing. There's obviously this catalytic menopausal event or perimenopausal loss of hormones, but it's many, it's multifactorial. Like everything, as you said, it's all communicating together.
Dr Lucy Burns (13:58) Yeah. And I think there's two things in that one is that. That means that you often need a couple of things to improve the situation. There's no magic bullet. And as you know, and I know you advocate, you know, we're big fans of MHT or HRT as it used to be called. And I still call it HRT. Yeah, I know. Cause you're saying MHT and people don't know what you're talking about, but either or, the thing that I think is. And it can sometimes be the, like the circuit breaker so that you can use that and then suddenly you've got a little less pain so you can then do your strength training or you've got a little less, you know, you're sleeping better so you can remember to then do the shopping so that you can eat real food.
Dr Sunita Chelva (14:51) That's a very important point. I think that it's not always, I mean for some women and it's actually less than I would always see because there is no magic fix for anything. We know that for weight or for. For menopause itself. I mean, yes, HRT does actually help restore our levels to normal. The flow-on effects are what is really important, what you do with that as well is really important. And that's why sometimes the catalyst needs to be HRT because women cannot even entertain doing any of this without their hormones. And so, you know, the other things that I like to talk about to women. Particularly when we're talking about losing muscle, you know, as you talk about, and you're better preaching at me about this but nutrition and protein intake, you know, they're the building blocks of muscles. I mean, whether you're omnivorous or vegetarian, you're vegan. I think we know the Mediterranean diet has been shown to support muscle health and psychopenia and really high protein is important. Really high-quality protein is important. So, as you say always, food is medicine. Good lean meats, fish nuts, and eggs. I think a guide for women is one gram of protein per kilogram. This is post menopause, one gram of protein per kilogram of body weight daily. And that's probably more than you or I, or you know, most of us eat. So it's actually been
Dr Lucy Burns (16:31) oh, I'm pretty good at hitting that macro now. But yes, it's something that you have to learn to do and people. Yeah, people struggle because it's very filling which is great. Again, I always go, great. How amazing to be able to eat. Like we're telling you to eat more of something. And for decades, women have always been told to eat less.
Dr Sunita Chelva (16:55) Put stuff in, don't take it away. I mean, that's what I say to my patients as well, you know?
Dr Lucy Burns (00:00) Yeah. Crowd out the junk is great, it's one of Dr Mary's favourite sayings, particularly around kids. Cause you to know, kids again, kids are attracted to shiny objects and we all know that junk food is marketed to children and yeah, but if you can crowd out the junk, then they're at least, they're less likely to overconsume it. So it's interesting. So with the women that you see, then the type of advice you give them for muscles. Cause I think just taking a step back again is that you know, the women that you and I are seeing are women forties, fifties, sixties, give or take. And we've all dieted for such a long time and been on that diet roller coaster of losing weight, gaining weight, losing weight, gaining weight, you know, being good, whatever that means. So now as part of that our inner, I guess, vision has been that we need to be small and thin. And the sentence that I used to say in my head was I didn't want to bulk up at the gym. You know, you didn't want to get too big.
Dr Sunita Chelva (18:22) And that's what we were told, weren't we? I mean, like, it's like the Olivia Newton, John, let's get physical, the little way. It's a real about-turn, isn't it?
Dr Lucy Burns (18:35) Yeah. And now we need to know that actually being strong is good, that being strong is feminine, whatever that means. Correct. That means different things to different people. Women. People. Yeah. And that we don't need to be small or little or tiny or diminutive, or whatever other adjective has been to describe us as humans. In order to be an acceptable woman.
Dr Sunita Chelva (19:05) Correct. Studies have shown that increasing resistance training is really important, not just for our muscles, but just, I mean, for our bones, because that's extremely important for later life. I see, you know, there's a, there's a lot on social media and there's a lot of people doing a lot of posing at the gym, lifting heavy weights and showing their beautiful sculpted bodies, which is, you know, inspirational for some, but for that woman, a lot of the time that we see, it can be quite overwhelming. And I think, you know, I like to say, just start off with small little habits, just do something, move a little bit, lift your shopping bags, a few more repetitions, you know. Take the stairs, ride your bike to work. If you don't do it every day, that's okay, but start somewhere and build up. I mean, If you're not sure, if you've had injuries before, get help from a physiotherapist or an exercise physiologist. Not everyone loves the gym, but really the key is finding something that you love. And midlife is a really important time to start doing these things and start building small habits. I was not a natural exerciser, but learning that actually pain is often treated with exercise movement and weights is quite a revolutionary thing. Because if you pair that thought, if you think pain relief, Also endorphins really is a powerful motivator, I think, for women.
Dr Lucy Burns (21:04) Yeah, absolutely. I use the mental health component of exercise to get me going because the future me, well current me sometimes doesn't care about the future me. So current me, I need to bring it back to what does current me need? And because when I swim, which, is helpful for lots of things, not helpful for bones, but we can talk about that in a minute, but it's the, the contracting of muscles that increases those myokines, which then talks to your brain and basically improves your mental health. So it sounds weird, but you contract your muscles and you are happier.
Dr Sunita Chelva (21:49) Absolutely. And. I know that your podcast is a lot about weight and, you know, our patients do, and women do, concentrate on their weight, not just for vanity's sake, but for health's sake. And, as we said, losing muscle, losing skeletal muscle, we don't realise that that actually contributes to our weight gain. And so also coming at it from, you know, patients will say I'm eating really well. I'm doing everything that you're saying. I'm putting all the protein in, but I'm not losing weight. Well, you know, if you can actually change, we can build some muscle. Our bodies are so dynamic. You can actually build some muscle that will help with your insulin resistance. That will help, as you said, with your mental health, which will help with your motivation, which will help you get back to the gym. And so undoing that vicious cycle into a positive cycle.
Dr Lucy Burns (22:42) Yeah. Yeah. We call it spiraling upwards. Spiraling upwards. Yes. And this is, do you know, one of the things I think you just touched upon there too, is that whole body composition. And this is what drives me bananas. know, it is the hill that I will die on, which is when people tell women to cut their calories or they'll go based on their height and weight, this is how many calories a day you should eat to lose weight.
Dr Sunita Chelva (23:14) Very archaic. Very, very archaic. Input, output. So archaic. No.
Dr Lucy Burns (23:19) So simplified, and they will.. And because it sort of promises this simplicity, people are attracted to it. And because initially, if you do reduce your oral intake, your calories, your food, whatever you want to call it, the number on the scales may well go down. But that doesn't mean that you've lost fat. It doesn't mean that you've improved your health. And it is unlikely for that number to stay down.
Dr Sunita Chelva (23:55) That's right. I'll tell you an interesting sort of epiphany. I had actually a few years ago, if I may, you know, as you said, we're all taught that we need to be very slim and small and diminutive and my body's never been that. So part of, you know, I think, Accepting who we are is part of our ethnicity and our genetics. And it wasn't until, so my ancestry is Sri Lankan and I went to Sri Lanka for the very first time in my life, about six years ago. And I saw this sort of cultural dance where they were doing amazing acrobatic flips and jumps and amazing displays of strength. And I noticed, I was like, wow. These people, they're not diminutive. These women are not tiny. They are strong. I realised that is where my genetics and my body shape come from. So often within our own genetics, we have to accept, you know, and we know there's lots of interesting, you know, genetic drivers for that, but accepting our body for where it's at and composing it as such. So, you know, we will lose and gain weight, put muscle on in different areas, genetically, ethnically determined. So accepting that I think as we get older is really important and part of how we harness the best out of our bodies.
Dr Lucy Burns (25:22) Oh, absolutely. Like 100%. I wrote a blog a few years ago now, which I probably should rename because it's called Self-love and Whippets, which is not a very searchable term. So people don't really go looking for it. But what it was, was drawing a comparison basically to the care we give to our dogs. And you know, as a dog lover, I have four dogs. They're all different shapes. I love them all equally. I look after them well and I don't want them to change. I don't want one dog to be the same as the other dog. One's a Kelpie, one's a Border Collie, and two are little white fluffies. And somehow in human aesthetics, we've decided that everybody should look like a Whippet. And we can't, we aren't, and we don't need to be.
Dr Sunita Chelva (26:21) That's right. And sometimes that Whippet will think it is as strong as a Ridgeback. And it probably is, even though it has tiny ankles. And that's the thing, I think, wherever your body's at. You can still achieve the same outcome as well. I remember that blog that you wrote and I loved it because I love dogs as well and that is an amazing message to get across to humans in terms of our body acceptance.
Dr Lucy Burns (27:48) Yes. I think we need to hear it a lot because again, women our age have internalised for decades that be, be a bit smaller, be a bit quieter, be a bit less. So yeah, definitely continuing to hear that. So the summary for the muscles that I'm hearing from you then is that yes, there are musculoskeletal or there's certainly muscular issues that start that are often unveiled around that perimenopause time.
Dr Sunita Chelva (27:18) Even earlier possibly actually, I think these things even occur. So actually we peak our bones and our muscles peak in our 30s. Even before, you know, when we even are cognisant of what's going on. And we start to lose it from then. Yeah. So it's actually for younger women listening, something that we need to address earlier.
Dr Lucy Burns (27:42) Yeah. It's like compound interest. You know, people often go, I wish I'd started my super a bit earlier, or I wish I'd started set, you know, yeah, do start as early as possible. Build good habits that become easy. We run another little a post just not that long ago called Five Ways to Increase Your Strength When You Haven't Got Any Time. And so the first little tip was to stand on one leg. when you're brushing your teeth. Yes, so start, so everyone, you know, most people brush their teeth twice a day for roughly two minutes. So if you can get into the habit and extend it out to one minute for each leg, that's a really good tip for balance, strength, glutes, and appropriate reception. Yes, all these things without taking any extra time or costing you any money. And then you can challenge yourself by closing your eyes. Yes. Oh, yes. Yeah. Yeah. Absolutely. Yes. Yes. Don't do that until you're really confident. And then then we did one where you, you know, if you're boiling the kettle, which again, lots of us still boil a kettle, making cups of tea or whatever to do some sideways, some sideways steps. Because we spend a lot of time walking forwards. That's right. And we don't spend much time sidestepping. We then said when you get out of bed in the morning, instead of just sort of lolling out of bed, you spin around, put both feet on the floor, and stand up from your bed without using your arms. And if you find that easy, you know, just do it 10 times. It will take you like 10 seconds or do it every time you get up out of a chair or off the toilet. Yes. You can fit it in without actually being somewhere. Yeah. Every time you get out of the car, but unless you're conscious or mindful, you don't, you just, humans are so interesting. We, again, Not only have I got, four dogs, we also have three cats and I've noticed that both, all the pets, when they get up, they get up and they'll stretch. Yes, they do. They stretch, downward dog, cat arch. They do all of that. And we just. Get up and walk.
Dr Sunita Chelva (30:15) Yes. And wonder why we're so stiff.
Dr Lucy Burns (30:20) Absolutely. Yes. So many things that you can do that just, you know, the power of small steps, little tiny things that you can add in that over time compound interest, make a huge difference to your wellbeing.
Dr Lucy Burns (30:36) Gorgeous friends. We are coming back next week to talk about bones. It's been such a great chat and we've just gone on and on about the muscles, which is wonderful. And what we're going to do is rejoin, revisit this conversation next week. And so I would love for you to join us where we will be talking about all things bones. Sunita, I'll see you next week.
Dr Sunita Chelva (31:04) See you next week.
Dr Lucy Burns (38:57) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
