Exploring Hypermobility, Ehlers-Danlos Syndrome (EDS), and the Menopause Transition

Something you may not know about clinic owner Vanessa Weiland, NP, is that she's dealt with chronic pain since she was 13 years old. After consulting over a dozen medical professionals and later becoming a nurse practitioner herself, it wasn’t until she came across a physical therapy account on Instagram that she had her lightbulb moment: her chronic pain was due to hypermobility spectrum disorder (HSD). Since then, she has had her diagnosis confirmed, which has empowered her to not only manage her own health but also guide others with connective tissue disorders through the challenges of life transitions like menopause.

Hormonal Influence on Connective Tissue and Hypermobility

Hormones, especially estrogen, play a crucial role in maintaining connective tissue health by enhancing collagen production, which is essential for joint stability. During perimenopause and menopause, as estrogen levels decline, symptoms like joint pain, instability, and tissue fragility often worsen. For individuals with hypermobility spectrum disorder (HSD) or Ehlers-Danlos Syndrome (EDS), these hormonal changes can amplify existing challenges (1, 2). Vanessa’s journey reflects the importance of recognizing how hormonal transitions interact with hypermobility—a topic that often goes unaddressed in routine care.

Menopause-Related Musculoskeletal Symptoms

The musculoskeletal syndrome of menopause introduces challenges that are particularly pronounced in individuals with connective tissue disorders like HSD and EDS. Key symptoms include:

• Joint Pain and Instability: Ligaments and tendons already prone to laxity in hypermobility are further destabilized during estrogen decline (3, 4).

• Sarcopenia and Bone Density Loss: Muscle weakness and reduced bone density exacerbate the risk of fractures and chronic joint pain (5, 6).

• Increased Risk of Pelvic Prolapse: Connective tissue laxity contributes to higher rates of pelvic organ prolapse in individuals assigned female at birth (AFAB) with hypermobility (3).

  
  

Gynecologic, Obstetric, and Pelvic Pain Challenges

Individuals AFAB with EDS or HSD often report significant gynecologic symptoms, such as heavy menstrual bleeding (76%), painful periods (72%), and painful intercourse (63%) (4). A high prevalence of conditions such as vulvodynia (50%) and dyspareunia adds to the complexity of care required in this population (2). Moreover, pregnancy complications, including spontaneous abortion (28%) and preterm delivery, highlight the need for specialized gynecologic and obstetric care (4).

Endometriosis and Menopause

Endometriosis, a condition frequently co-occurring in those with hypermobility, can further complicate the menopause transition. While some individuals experience symptom relief post-menopause due to lower estrogen levels, others may continue to struggle with chronic pain, scarring, and complications. For those navigating both conditions, hormonal therapy and specialized care can make a significant difference. To read more about endometriosis and menopause, visit this blog post.

Vanessa’s Approach to Managing Menopause and Hypermobility

Vanessa combines her personal experience and professional expertise to guide patients through these complex transitions. Here are some strategies she often recommends:

1. Exercise and Physical Therapy Strength training and therapies tailored to hypermobility can reduce pain, stabilize joints, and improve overall function (1, 2).

2. Hormone Replacement Therapy (HRT) For some individuals, HRT can be a game-changer by stabilizing estrogen levels, improving collagen production, and alleviating symptoms like chronic pain and tissue fragility (3, 4). Although estrogen is beneficial for musculoskeletal symptoms of menopause, progesterone can worsen tissue laxity, which may exacerbate symptoms for some (6, 7).

3. Nutritional Support A diet rich in calcium, magnesium, vitamin D, and protein is essential to counteract bone and muscle loss while supporting connective tissue health (5, 6).

4. Pelvic Floor Health Addressing pelvic prolapse risks through pelvic floor therapy or early interventions can significantly improve quality of life for individuals during menopause (2, 3).

A Message of Empowerment

Vanessa’s personal journey is a reminder that it’s never too late to seek answers and advocate for your health. Whether you’re navigating chronic pain, hypermobility, or the menopause transition, personalized care and a proactive approach can make all the difference.

As research on hypermobility, EDS, and hormonal changes grows, Vanessa’s mission is to help patients understand their bodies better and equip them with the tools to thrive—because everyone deserves a chance to feel strong, supported, and seen.

Sources

1. Hypermobility Syndromes Association, "Hormones and Hypermobility." Accessed 1/26/25 at https://www.hypermobility.org/hormones-and-hypermobility.

2. Glayzer, J.E., et al., "High Rate of Dyspareunia and Probable Vulvodynia in Ehlers-Danlos Syndromes," American Journal of Medical Genetics, 2021.

3. Gilliam, E., et al., "Urogenital and Pelvic Complications in the Ehlers-Danlos Syndromes," Clinical Genetics, 2020.

4. Hugon-Rodin, J., et al., "Gynecologic Symptoms and the Influence on Reproductive Life in Women with hEDS," Orphanet Journal of Rare Diseases, 2016.

5. Hurst, B.S., et al., "Obstetric and Gynecologic Challenges in Women with Ehlers-Danlos Syndrome," Obstetrics & Gynecology, 2014.

6. Pérez-López, F.R., et al., "The Musculoskeletal Syndrome of Menopause," Maturitas, 2009; 62(2): 117-123.

7. House M., et al., "Mechanical and Biochemical Effects of Progesterone on Engineered Cervical Tissue," Tissue Eng Part A, 2018.