JOIN USMrs Sharma, a homemaker, led an idyllic life — her husband was in a well-placed job, both her children were doing well in studies, and the happy family lived on the second floor of a house in a lovely locality in Delhi.
It was when she turned 50 that her health started to go downhill gradually. She developed aches and pains in various areas, but did not pay much attention to them as her priority was taking care of her family. There wasn’t enough time after all household chores.
By the time she turned 54, both her children had left home and she had stopped using the stairs. While her husband was busy with his job, she was left all alone at home. As she kept gaining weight, her ability to walk kept decreasing. One day, she slipped in the bathroom and fell; developing a fracture in her back. This occurred when she was 57 years old. The pain subsided after some time, but her mobility went down further. When she was 60, she had a hip fracture and now needs help getting to the toilet. This is a familiar story that we see in patients on an everyday basis.
Studies show that as far as orthopaedic pain is concerned, women seem to be more severely affected than men. Women typically feel pain with higher intensity, more often, and in more parts of the body than men. For rather long, this was dismissed with thoughts of low threshold for pain and being more delicate, but evidence is piling up for scientific and physiological reasons behind this.
Biological factors
Female hormones play a significant role in the high vulnerability that women have towards pain. Many women experience an increase in joint pain just before or
during their period. Right before menstruation, the level of the oestrogen falls, and then it rises again once the period is over. Oestrogen is believed to be protective against pain. Female reproductive hormones are known to contribute to the high incidence of autoimmune diseases in women such as rheumatoid arthritis and lupus, which are most common during the childbearing years. Rheumatoid arthritis strikes approximately 3 times more women than men. Lupus, scleroderma, and multiple sclerosis (MS) also seem to hit women harder than men.
Fibromyalgia, another condition that can cause joint pain, affects women 8 times more frequently than men. Female structural differences also contribute to some kinds of joint pain — for example, osteoarthritis of the knee. Their broader pelvices designed for child birth can affect the direction of pull on the knee cap causing malalignment in the knee. Women are also at higher risk of osteoporosis especially after menopause and have more hip fractures related to thinning of their bones.
The human body produces natural painkillers in the form of endorphins and it is found that these endorphins work more effectively in men than in women. Recent studies show that women produce less of a chemical substance called dopamine in response to painful stimulation. Endorphins require a good amount of dopamine, in order to successfully
relieve pain.
Traditionally, girls in our country have not been encouraged to participate in sports and other cardiovascular activities to the same extent that boys have been, especially during the critical early years of life where bone mass is developed. Young women may put on a little extra weight during college, and then put on a little more during their child-bearing years.
By the time they are in their 50s, many women are battling a weight problem, and this excess weight puts additional stress on their joints. This, coupled with a sedentary lifestyle, makes women more likely to get weak bones and weaker muscles. This combination itself can cause an increased predisposition towards joint pains and wear out. Post menopause many women experience a significant increase in joint pain due to the decrease in oestrogen.
Women need to educate themselves about these factors and increase their awareness about how joint pain affects them so that they can ensure they get the best possible care and relief. Women should have bone density testing done a few years after menopause and they should be encouraged to get involved in weight-bearing exercises for better bone strength, as well as to help maintain a healthy weight. Proper diet and exercise play an important role in one’s overall health.
(The author is HOD & director — Department of orthopaedics, Fortis Flt Lt Rajan Dhall Hospital, New Delhi)