Hormonal Shifts and Structural Strain: A Literature Review of Menopause and Perimenopause in Relation to Overuse Injuries and Stress Fractures.
Level 5 - mechanism / opinion, no new human data
Narrative literature review synthesizing secondary evidence without systematic review or meta-analysis methodology.
PubMed 42332940 · doi:10.5535/arm.250134
What was done
This structured narrative review synthesized findings across endocrinology, biomechanics, and musculoskeletal epidemiology regarding the impact of perimenopause and menopause on overuse injuries (such as Achilles and rotator cuff tendinopathies, plantar fasciitis) and stress fractures. The authors evaluated current research limitations and proposed a hormone-tissue-load mismatch model to reframe midlife injury prevention.
What was found
The review reports that early menopause leads to annual bone demineralization rates of 2% to 5%, impaired tendon repair, and sarcopenia, while fluctuating estradiol in perimenopause increases transient ligament laxity. Early hormone replacement therapy initiation is noted to reduce fracture risk by 20% to 40%. Other cited risk amplifiers include prior fractures, aromatase inhibitor therapy, low bone mineral density, and sudden training volume spikes.
Why it matters
It expands the clinical model of midlife female musculoskeletal health beyond isolated estrogen loss to include broader neuromuscular and mechanical tissue loading vulnerabilities. This supports integrating non-hormonal interventions like progressive resistance training and targeted screening alongside individualized medical therapy.
Limits
As a narrative review, it lacks systematic search criteria, quality appraisal scores, or quantitative meta-analytic pooling. The primary literature synthesized is constrained by observational designs, racially and socioeconomically homogeneous cohorts, and technocentric diagnostic tools with limited accessibility in marginalized groups.
Cited by
- context Estrogen depletion is associated with increased tearing of ligaments and tendons.