Clinical Symptoms and Quality of Life: Insomnia and Muscle/Joint Aches

Abstract

Introduction: The variety of symptoms associated to menopause and the various forms through which these symptoms affect a woman make it difficult to evaluate the impact of the estrogen deprivation on the health status. The development of the Menopause Rate Scale (MRS) has been considered a breakthrough to objectify the impact of the menopause on the quality of life (QOL). Using this scale, a multinational study showed that the most prevalent menopausal symptoms were physical mental exhaustion (64.8%), joint/muscular discomfort (63%), depressive mood (60.5%), and sleep problems (59.0%); vasomotor symptoms were less frequent (54.5%). In this chapter, we will analyze only two symptoms, insomnia and muscle and joint aches. Insomnia: sleep disorders are highly prevalent in middle-aged women and they also deteriorate their QOL. They are closely associated with other climacteric symptoms, particularly hot flushes, suggesting a similar pathogenesis. Estrogen-related changes in serotonergic neuronal transmission, including changes in the number of serotonin transporter (SERT) binding sites, have been cited as a possible cause for changes in sleep, mood, and memory that occur during the menopausal transition. Menopause hormonal therapy (MHT) could contribute to the improvement of insomnia in women affected with menopausal symptoms. Muscle and joint aches are another highly prevalent symptom in middle-aged women. As well as insomnia, this symptom has a higher prevalence in women complaining of other climacteric symptoms, particularly hot flushes. This relationship could suggest that hypoestrogenism is involved in pathogenesis of muscle and joint aches characteristic of the climacteric period. Estrogens, through glutamatergic receptors localized in dorsal horn neurons of the spinal cord, modulate pain pathways. In this regard, it is not surprising that HMT can associate to a lower risk of presenting musculoskeletal pain. Conclusion: Hypoestrogenism characteristic of the menopausal period is not only associated with vasomotor symptoms but also with other symptoms like insomnia and joint aches, which not always is perceived as linked to the menopause. MHT could have beneficial effects on all these symptoms.