How to Stay Strong in Menopause & Beyond With Dr. Wright

Dr. Vonda Wright is a double boarded orthopedic sports surgeon. At 40, she was in the best shape of her life. At 48, she thought perimenopause might be killing her. But she learned how to master midlife, and now she’s dedicated to helping other women do the same. We were thrilled to sit down with her for a webinar recently.

Read highlights from her interview with Alloy community manager, Rachel Hughes, on bones, joints, muscles, and how to stay healthy and strong as we age.

Watch the entire interview on our YouTube and follow us everywhere @myalloy to learn about future webinars!

Rachel Hughes: Let's get right into it and talk about the impact of estrogen and its decline over time. Where does this evidence of that decline show up in our bodies?

Dr. Vonda Wright: So, Mondays and Thursdays are my clinic days. People show up and I’ll see on my list that there’s a midlife woman with a shoulder problem. Before I even go in, I know that there’s a high likelihood that she has frozen shoulder.

When it comes to menopause, we’re so focused on things like hot flashes, brain fog, and night sweats. But what people don’t realize is that 80% of women in midlife will experience the musculoskeletal syndrome of menopause, and 20% will be devastated by it. That could include arthralgia, which is when your body hurts but you can’t see anything wrong on an X-ray or an MRI, but that if you don’t treat it could cause you to lose 20% of your bone density and 20% of your muscle mass. Then there’s fat. We accumulate belly fat, and we all talk about it because it’s so common, and women think they’re falling apart. But they’re not falling apart, they’re just perimenopausal. 

That doesn’t mean we don’t need to treat them. Things like osteoporosis, frailty, loss of lean muscle mass, and hurting to the point that you can’t live your life, can be really devastating. And we can prevent osteoporosis, or treat it, with estrogen at very low doses. I’m so passionate about the fact that we can be healthy, vital, active, and joyful. We just have to understand what’s happening. We need to educate ourselves, fight for ourselves, and we need to have resources.

Rachel Hughes: You made some points before we went live, and we were paralleling it to the work of urologists and vaginal estrogen.

Dr. Vonda Wright: Yes. So, with the genitourinary syndrome of menopause, doctors want you to be using vaginal estrogen because it rejuvenates your vagina and vulva, but also because it helps to prevent urinary tract infections. Urosepsis, or bladder infections that go to your whole body can kill you. So, doctors encourage you to use vaginal estrogen not just because it makes you feel better, but because it prevents death.

People don’t die of hot flashes, brain fog, and night sweats, but they do die of hip fractures. More people die of hip fractures than any kind of cancer every year. We use DEXA scans to look at bone density when you’re 65. Well, ladies, that’s too late. Every perimenopausal woman who comes to my office gets a DEXA scan. You can’t know what your bones are doing unless you know what your bones are doing, right? Right. And then you can take steps. 

And it’s not easy. Insurance will only pay for a DEXA scan once you’re 65. But just because an executive somewhere has decided not to pay for it, doesn’t mean it’s not important. I have seen them available for $99. If you are able, you should try to get one.

Rachel Hughes: Great. Moving on, you’ve talked about sugar…

Dr. Vonda Wright: NOOO!!!

I mean, we’re adults, we have agency. But we know sugar causes inflammation, which can cause pain and metabolic issues. So, we should be trying to stay away from sugar and simple carbs as much as we can. I’m not anti-carb! But, if you look at the label of any packaged food, you’re going to see grams of added sugar. Why does yogurt need added sugar? Why do corn chips? Why does anything? Complex carbs are a whole other story. I love complex carbs, like in steel cut oatmeal. And I love fiber, like in sweet potatoes. Skin on! 

Rachel Hughes: Great, thank you. So, what I’m getting is, menopausal hormone treatment, eliminate sugar. Those are two major things you can do to address what’s hurting today and to prevent trauma in the future.

Dr. Vonda Wright: Yes, but that’s not all!

Rachel Hughes: Yes, and I do want to get to that. But first I want to get to a few questions. The first is about frozen shoulder. I saw a photograph that you posted that was an internal picture of frozen shoulder, and it looked red and raw and irritated, and you talked about inflammation in that post. You also talked about mobility, injections, and hormone treatment to combat the inflammation. Can you speak about that? I feel like it’s a good springboard into lifting and exercise.

Dr. Vonda Wright: So, basically, frozen shoulder is a natural response. If something is hurting, protect it. Something like hitting your shoulder against the door in the middle of the night, something you might think nothing of, will trigger this protective response. The shoulder synovium, the lining of your shoulder, is sensitive to inflammation, and that will make it contract. And then within a week you can’t move it.

So, when a patient comes in with frozen shoulder, we discuss the decision of whether or not to go on hormone therapy. I’ll usually dispel a bunch of WHI myths, and I’ll always refer them to the book Estrogen Matters, which I know you all know! And then, if they’re not in too much pain, I’ll send them to physical therapy because stiffness is painful. If they’re in so much pain that they can’t tolerate motion, we’ll try a steroid injection so they can get a jumpstart on therapy. Sometimes I’ll try platelet-enriched plasma. You draw blood from the antecubital vein, spin it in a spectral centrifuge where we can harvest 5 billion platelets, and then inject it into the area. It has a very profound anti-inflammatory capability.

When nothing works, which is what you see in my post, I take someone to the OR, put them to sleep, and very gently move their arm for them. I’ll hear a pop, and they’ll get some mobility. And then we do therapy five days in a row.

Rachel Hughes: Is there a connection between thyroid disease and frozen shoulder? A community member is asking about Hashimoto’s. 

Dr. Vonda Wright: So, Hashimoto's thyroiditis is an inflammatory problem. Frozen shoulder is not unique to only midlife perimenopause menopause. It happens when estrogen walks out the door, it happens when you have diabetes, and it happens when you have autoimmune inflammation. So, yes, you can get frozen shoulder with any inflammatory process.

Rachel Hughes: Okay, great, thank you. Someone asked about frozen hip. Is that a thing? If so, she thinks she has it!

Dr. Vonda Wright: Well, not as much as frozen shoulder, but if you’re having groin pain, that’s your hip, and if you’re having pain out on the side of your leg and down the side of your leg, that’s called bursitis, and it feels like pain in your hip. That comes from having a weak core and walking like a supermodel, which puts undue stress on our hips. So, frozen hip, not so much, but maybe stiffness because it’s hurting and you’re not moving it, if that makes sense. 

Rachel Hughes: It does make sense. That made me think about strength. What should we be doing in and out of the gym to keep ourselves limber, lubricated, strong, balanced? 

Dr. Vonda Wright: We are designed to move. Research has shown that fidgeting and walking around and standing up and down every hour and getting microbursts of mobility is actually what we’re designed to do. We’re not designed to sit all day. So I want you to get up, get a standing desk, sit down, take your calls doing wall squats. And in the gym, lift heavy. Lift as heavy as your bones will allow. 

Rachel Hughes: I love that. What are the best bone building exercises for hip osteopenia?

Dr. Vonda Wright: Three things. One, jumping on a mini trampoline or walking in water. You’re moving, you get some impact, but it’s less painful. Two, jumping up and down 20 times on a regular surface. If that’s too painful, just stick to number one. Number three, lift as heavy as your bones will allow, because there’s a direct connection between your muscles and your bones. 

Rachel Hughes: Okay, great. This is an interesting question. What strength, estrogen patch is high enough to reduce the musculoskeletal syndrome of menopause?

Dr. Vonda Wright: A very low dose estrogen will lessen the musculoskeletal syndrome of menopause. But estrogen is dosed according to symptoms and everyone is different. So if you’re on the lowest dose of estrogen and still having them, they can increase your dose. And, estrogen is just one part of the solution.

Rachel Hughes: Thank you. Is there anything else you want us to know? 

Dr. Vonda Wright: Here's what I want you to know. I know this can be really hard. I know it's hard. I've been through it. It's hard. But here's the deal: Until you decide that you are worth the daily investment in your health, then nothing else matters. And you are worth the daily investment in your health. And even if it's a tiny, tiny little step, you are worth it. And so I hope that you will take it and seek out the help from people like me and Rachel to build community and to know that you're not alone. Because I think that midlife can be the most amazing time of life.

Rachel Hughes: So true. Thank you very much!

Dr. Vonda Wright: Thank you.

To watch the entire webinar and get all of Dr. Wright’s great advice, head over to our YouTube. And, check out Dr. Wright’s website: https://www.drvondawright.com/. 

Follow us everywhere @myalloy to learn more about upcoming webinars. See you next time!