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[GinaM]

This account is long and tangled - apologies for that. I was wondering if those of you who are experienced with menopause (and others experiences) might be able to identify what is run-of-the-mill and what might not be.

I was in an RTA just as I was transitioning to menopause. I was concussed and it seemed to take a while for me to recover from it - and when I did, I'd gained a lot of weight and lost a huge amount of my fitness, endurance/stamina, and strength (all of which were considerable - 4 weeks before the accident, I shifted 4 tonnes of hard landscaping material through the house in a weekend, unaided, as there's no rear access to our back garden; I've engaged in various sports since childhood).

I'm down to 20-30% of the weights that I used to use for strength training warm-ups and my personal bests are unrecognisably low. My stamina is poor (for me).

Everyone kept saying that muscle memory would ensure that my muscle mass/strength/fitness would return. Well, it didn't. And I was having tremendous difficulty losing the added weight. Enough things happened that I opted for a body composition analysis (later confirmed by DXA scan) and was horrified to discover that I was 42% body fat.

To cut a long story short, I gained a lot of weight but also in 3-4 years, somehow I lost 25lbs of lean body mass (including muscle) and gained far more body fat than even the scale had indicated. I picked up several joint injuries; I'd lost enough muscle mass that at the age of 53, I was categorised at sarcopenic by the Baumgartner formula.

I've had repeat DXAs to monitor what's happening and although I've got the body fat under control (it's currently 20%), I'm rapidly losing bone mineral density, and I'm putting in a tremendous amount of time and effort to maintain my muscle mass (such as it is) but I'm losing muscle quality and making no progress (I'm still going backwards in strength terms). My cholesterol has also increased beyond recognition.

I'd like to follow the BEST programme (Bone, Estrogen and Strength Training) to improve both my strength and bones. However, at the last DXA, I was advised that I should have my lumbar and sacro-iliac spine checked as it looked as if they're considerably less dense than other areas and I was warned that I'm at risk for fragility fractures.

I'm working with a physiotherapist at present to improve the quality of my joints (I was advised to have surgery on them but I really don't think I can tolerate the immobilisation or rehab. without losing more muscle mass and that would set up a host of other problems). The physiotherapist was non-confrontational and didn't get frustrated with me but at my last session, he asked if I'm aware that I sometimes have amnesia for something that I've just done and that for someone who is otherwise functioning well, I seem to have a lot of difficulty learning a new exercise. He suggested that I should speak to a neurologist.

I can't tell if I need a chat with a neurologist, an endocrinologist, or if it's all part of the many facets of menopause. Does the above pretty much sound like menopause?

So, I'm wondering if it's time for a chat with a GP to discuss whether HRT might help with the loss of bone mineral density and other issues or if, when they finally look at the detail of my blood work, the automatic recommendation will be for statins altho' I feel they're the last thing I need given my muscle loss/memory issues.

[Dancinggirl]

Hi and welcome to MM GinaM
You are clearly someone who has and still is putting a great deal of time, effort and resources into keeping healthy. Many of the issues you are concerned about are very much part of the menopausal and ageing process. You obviously went through a nasty time with the RTA and it has left you with ongoing problems.
I have to say that your focus on weight and fitness and trying to regain what your once had may be preventing you from moving forward in a positive way. I originally trained and worked as a professional dancer - I am now 59 and my joints are giving me real problems - I did expect this as for any athlete or dancer the strain we have put on our joints and bones does have consequences. I have tried to keep active but as the years have passed I have had to accept that I have limitations and I now need to be 'kind to myself'. I am on HRT but mainly because of vaginal atrophy and lack of sleep due to dreadful night sweats.
Gaining a little weight and loosing muscle in our 50s is normal and actually being too thin can make menopausal symptoms worse. If ones diet is low in calcium and vitamin D then bone loss will be accelerated. I have a  friend who has recently had aggressive breast cancer - she has always been fit and slim and coped with the cancer treatment really well.  The worst thing for her has been the discovery that she has advanced stage osteoporosis at the age of 55 - she hates dairy and has kept out of the sun because she was scared of skin cancer!!!
Maintaining some sensible exercise to help bone density e.g. brisk walking, is important but a diet rich in calcium, Vitamin D (or enough sunshine) and magnesium is vital.  Keeping core muscle strength to support the back is good but setting realistic levels of fitness and body weight is very important - through our 50s and 60s expecting to have the fitness and body we had in our 30s and 40s is rarely possible or even preferable.
HRT would possibly help prevent further bone loss but I believe it is not usually the front line treatment for osteoporosis, however if you are finding flushes etc troublesome then HRT may be worth trying.
Do read up all the info on this site and browse through some of the threads.
HRT is not always the answer and the benefits need to outweight the side effects and risks.
DG x

[CLKD]

Welcome.  Have a chat with someone at the Charity Headway.  I would also ask my GP to refer me to a Neuropsychologist trained in head injury who can discuss your accident, put you through various memory and reaction tests to judge what further treatment you require.  I worked with a PA to a Head Injury Consultant several years ago typing insurance reports  ………

Concussion is not to be taken lightly!  No one is 'only' or 'just' concussed.  Concussion is a serious injury to the brain which has various implications for recovery and there is a risk of late onset epilepsy. 

Have a browse round here, we don't bite  .  We have a 'funny' room too .

The best place for a bone density scan is the pelvis! 

[GinaM]

Thank you, both!

I had been looking through the International Menopause Society's Guidelines (2013) which are linked on the websites of several of the specialists listed in that section of this site.

Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health
T. J. de Villiers, A. Pines*, N. Panay􏰁, M. Gambacciani􏰂, D. F. Archer**, R. J. Baber􏰁􏰁, S. R. Davis􏰂􏰂, A. A. Gompel***, V. W. Henderson􏰁􏰁􏰁, R. Langer􏰂􏰂􏰂, R. A. Lobo****, G. Plu-Bureau􏰁􏰁􏰁􏰁 and D. W. Sturdee􏰂􏰂􏰂􏰂, on behalf of the International Menopause Society

The Guidelines include a section on Postmenopausal Osteoporosis that had prompted me to consider discussing HRT as I meet the criteria:

Postmenopausal osteoporosis
MHT is effective in preventing the acceleration of bone turnover and the bone loss associated with the menopause. MHT decreases the incidence of all osteoporosis-related fractures, including vertebral and hip fractures, even in women not at high risk of fracture. In postmenopausal women at risk of fracture and younger than 60 years, or within 10 years of menopause, MHT can be considered as one of the first-line therapies for the prevention and treatment of osteoporosis-related fractures.
The initiation of MHT for the sole purpose of the prevention of fractures after the age of 60 years is currently not recommended since the risk of long-term complications, e.g. breast cancer, outweighs the potential benefits. [my emphasis]

Whether or not a GP would accept this guideline in the same way that one of the listed specialists would is, of course, a very different matter.

I read a piece by Nelson Watts M.D.: What is osteopenia, and what should be done about it?
This is quite eye-opening on the inappropriate use of particular metrics to assess bone density (and which body parts count as per CLKD) and which classification systems are appropriate for sex/age/race.

[GinaM]

Have a chat with someone at the Charity Headway.………

Concussion is not to be taken lightly!  No one is 'only' or 'just' concussed.  Concussion is a serious injury to the brain which has various implications for recovery and there is a risk of late onset epilepsy. 

It hadn't occurred to me to chat to Headway because I'd recovered 

However, it might well be helpful as I've had a number of concussions (a couple of which were moderately-long) and it's possible that I'm being a little complacent about it having no longer-term consequences.

Thanks again.