Question 21
Dr N:
Please let me know if the extreme muscle and joint stiffness I am feeling can possibly be related to menopause. My doctors seem to think that I should be stretching my muscles in order to make this horrible feeling go away. I feel 100 years old and can barely walk at times. I was never like this and I have been trying to keep active aerobically. If this discomfort could be attributed to menopause will it ever diminish as my body adjusts hormonally? I am 50 years old. I had a bilateral mastectomy on 7/2/99 with 4 cycles of chemotherapy (adriamycin and cytoxin) starting in August and ending in October. I stopped menstruating abruptly after my first cycle of chemotherapy. I am taking a multivitamin daily, extra calcium daily, and a supplement for joints which has soy in it. One doctor said I have fibromyalgia and recommended stretching exercises. They did not help. I have also been weight training and walking on a treadmill for aerobic exercise. I have just started taking Fosamax for bone loss. The stiffness started in January 2000. Any help you can provide me will be appreciated.
Thank you.
Reply:
Hi,
I am sorry that you are having these problems.
I think that are a number of possibilities for your muscle and joint stiffness, but a few are more likely. It is possible that you may have developed some sort of recent muscle inflammation or form of arthritis independent of your previous problems and if so it is possible that this could be documented by blood tests. There is also something called Polymyalgia Rheumatica, and a less often a more serious related disorder, Temporal Arteritis. These both can usually be diagnosed by a simple blood test called a sedimentation rate, which is almost always significantly elevated in both It is common for the sedimentation rate to become mildly elevated as we age, so if you have a slight elevation, this would likely be expected. The Westerner method of performing the sedimentation rate should be used as it is more accurate if the problem is present.
However, although these things are possible, I think that this is less likely than some other possibilities. It is possible that you have developed some muscle inflammation, or myositis secondary to the chemotherapy. This is an area that I don't know much about, but the oncologist will have more insight about this possibility.
I believe that the most likely possibility is that the chemotherapy has affected your ovaries and possibly adrenals and either reduced or completely stopped the production of estrogen, testosterone and conceivably other hormonal substances.
As you are likely already aware this presents a dilemma for you. If you were to replace your hormones and the stiffness went away, you would have your answer as to why this is happening. This is a little bit of a simplification as at times a more individualized HRT regimen is needed to accomplish this if initial HRT attempts are unsuccessful. However, given your previous malignancy, this may be an uncomfortable option for you, and/or your physicians. I do not think that estrogen causes cancer, but there is some question as to whether it accelerates the growth of an already present cancer.
Another option would be to take one of the so-called designer estrogens, or SERMS, which do offer some hormonal affects and is not felt to stimulate breast tissue. Don't let anyone dictate what you do about this. These are your decisions, not anyone else's, your individual desires and the quality of your life are the most important determinant of what you decide to do
Let me know what and how you do.
Dr N