Musculoskeletal disorders (MSDs) are a leading cause of disability and reduced quality of life for women across the life course. In Australia, MSD affect over a third of women, and includes a wide range of conditions, from osteoarthritis and osteoporosis to inflammatory arthritis and chronic pain syndromes such as fibromyalgia.
GPs play a pivotal role in the early recognition and management of these conditions. MSDs often present with non-specific symptoms such as joint pain, fatigue, or functional decline, which can be mistakenly attributed to normal ageing. Early identification through routine enquiry and targeted examination allows timely intervention and better long-term outcomes.
Examination
A comprehensive history is essential when assessing women with suspected MSDs. A history should include onset, pattern, and duration of symptoms, family history, and any associated red-flag features, such as weight loss or neurological deficits. Functional impact on daily activities, sleep, and mood should also be explored.
Physical examination should include joint examination, range of motion assessment, and screening for signs of systemic involvement.
While many diagnoses are clinical, blood tests and imaging may assist in clarifying the underlying cause or excluding inflammatory or structural pathology.
Management
Management of MSDs in women requires a holistic, biopsychosocial approach and can often be effectively initiated in primary care.
Lifestyle modifications remain the foundation of treatment for many conditions. These include weight management, physical activity, and diet, particularly for conditions such as osteoarthritis and osteoporosis.
Evidence supports the role of physiotherapy and individualised exercise programs in improving pain, mobility, and quality of life.
Pharmacological options such as simple analgesia and non-steroidal anti-inflammatory drugs may be appropriate first-line therapies. For specific conditions, additional treatments such as bisphosphonates for osteoporosis or disease-modifying agents for inflammatory arthritis should be considered in collaboration with specialist care.
Musculoskeletal disorders in pregnancy
Pregnancy introduces a unique set of challenges. Pelvic girdle pain, which affects up to 70 per cent of pregnant women, is frequently under-recognised and undertreated. Women may be unsure whether musculoskeletal discomfort is a normal part of pregnancy or may hesitate to seek care due to concerns about medication safety. GPs should reassure patients, offer non-pharmacological interventions such as physiotherapy and support garments, and consider referral to specialist care.
Musculoskeletal disorders in menopause
Menopause is another critical window when MSDs become more prevalent. Oestrogen deficiency contributes to reduced bone density, muscle mass, and joint integrity, increasing the risk of osteoporosis and osteoarthritis. Hormone replacement therapy (HRT) may offer dual benefits in alleviating vasomotor symptoms and providing bone protection, though risks and benefits must be carefully discussed with patients.
Musculoskeletal disorders represent a significant and often underestimated aspect of women's health. With a proactive, patient-centred approach, GPs are well-positioned to detect and manage these conditions, improving function, independence, and quality of life for their female patients.
Dr Samantha Miller, MBChB
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References
Australian Government. Australian Institute of Health and Welfare (2024). Chronic musculoskeletal conditions. https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-musculoskeletal-conditions/overview
The Royal Australian College of General Practitioners (2018). Guideline for the management of knee and hip osteoarthritis. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoarthritis
National Institute for Health and Care Excellence (NICE)(2022). Pelvic girdle pain in pregnancy. https://www.nice.org.uk/guidance/ng201/evidence/u-management-of-pelvic-girdle-pain-in-pregnancy-pdf-331305934394
Royal College of Australian General Practitioners (RACGP)(2022). Menopausal Hormonal Therapy. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoporosis/pharmacologic-approaches-to-prevention/menopausal-hormonal-therapy
National Institute for Health and Care Excellence (NICE)(2022). Chronic pain (primary and secondary) in over 16s: Assessment of all chronic pain and management of chronic primary pain. https://www.nice.org.uk/guidance/ng193
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