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Restoring trust in menopause management: menopause hormone therapy is not a panacea, and physical activity remains a critical intervention

PainSci » bibliography » Tulloh 2025
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One page on PainSci cites Tulloh 2025: Menopause and pain, hormones and exercise: a beginning

PainSci commentary on Tulloh 2025: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This editorial for an exercise-focused issue of the British Journal of Sports Medicine makes a strong case for strength as the best overall preventive medicine for aging women, including for “musculoskeletal syndrome of menopause.” The myth is that menopause hormone therapy (MHT, formerly HRT) is “a panacea capable of reversing ageing, restoring athleticism and eliminating all symptoms.” Its value has beenexaggerated in recent years, after being demonized erroneously for cancer risks:

Despite a renaissance in menopause awareness, the over-medicalisation of women’s midlife health threatens to eclipse foundational interventions like physical activity.

MHT has its place, Tulloh argues, but needs to be kept there: it can help with some symptoms, and probably reduces fracture risk, but it’s no magic bullet, and the risks and benefits vary greatly from person to person. Tulloh emphasizes: hormones are not a universal cure, and MHT should be limited “primarily to symptomatic management and fracture prevention.”

Meanwhile, physical activity in general, and exercise specifically, actually offers many of the benefits that women wish they could get from MHT. “Menopause represents a critical ‘window of opportunity’ for risk modification” and there's no better way to do it than resistance training. “Trust the muscle not the myth.”

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Despite a renaissance in menopause awareness, the over-­medicalisation of women’s midlife health threatens to eclipse foundational interventions like physical activity. Menopause is a pivotal milestone in the female lifespan, marked by important physiological, psychological and musculoskeletal changes. While ‘menopause’, by definition, is a point in time, the peri- menopause and postmenopause stages vary widely in symptom experience, severity and duration. While vasomotor symptoms are well recognised, sleep disturbance, mood changes, headaches, aches and pains, brain fog and bladder irritability are also commonly reported. Though a natural life stage, the clinical and quality-­of-­life impacts of meno- pause, particularly on the musculoskeletal system, remain underappreciated. This editorial highlights the effects of meno- pause on the musculoskeletal system and the critical role physical activity can play in fostering musculoskeletal health and well-­ being during and after menopause.

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