How can I improve persistent joint and tendon problems, including Achilles tendonitis, hand swelling, and knee stiffness, despite hormone therapy with estrogen gel and Mirena (levonorgestrel) IUD?

Management of Perimenopause-Related Joint and Tendon Problems

Eccentric strengthening exercises are the most effective treatment for your tendon and joint problems, which should be combined with your current hormone therapy and anti-inflammatory supplements for optimal improvement.

Understanding Your Condition

Your symptoms of Achilles tendonitis, hand joint swelling, and knee stiffness during perimenopause are likely related to hormonal changes affecting tendon and joint structure. Research shows that estrogen has significant effects on musculoskeletal tissues:

• Estrogen affects tendon structure and function, with lower estrogen levels potentially leading to decreased collagen content and altered tendon properties 1
• Postmenopausal women on hormone replacement therapy (HRT) have been shown to have smaller Achilles tendon diameter and less tendon abnormality compared to those not on HRT 2
• Your recent start of estrogen gel therapy is likely beneficial, as evidenced by your Achilles pain improvement from 8/10 to 2/10

Treatment Recommendations

1. Eccentric Strengthening Exercises (First-line)

• Implement a structured eccentric exercise program specifically targeting your affected tendons 3, 4
• Eccentric exercises have the strongest evidence for effectiveness in tendinopathy treatment 5
• For Achilles tendonitis: Perform heel drops (standing on edge of step, slowly lowering heel below step level)
• For hand/thumb issues: Perform controlled finger/thumb extension exercises against resistance
• For knee stiffness: Include controlled eccentric knee extensions

2. Continue Hormone Therapy

• Continue your estrogen gel and Mirena IUD as these may help improve tendon structure 2
• The improvement in your Achilles pain suggests hormone therapy is beneficial
• Allow more time for the hormone therapy to take effect on your hand and knee symptoms

3. Relative Rest and Activity Modification

• Reduce activities that worsen symptoms but maintain activity that doesn't increase pain 3
• Complete immobilization should be avoided to prevent muscle atrophy 3
• Continue walking and modified gym activities that don't exacerbate symptoms

4. Cryotherapy (Ice)

• Apply ice through a wet towel for 10-minute periods to affected areas 3
• Most effective for acute pain relief and reducing inflammation

5. Anti-inflammatory Approaches

• Continue your turmeric supplements as they may provide benefit
• Consider topical NSAIDs for localized pain relief with fewer systemic side effects 3
• Note that oral NSAIDs provide short-term relief but don't improve long-term outcomes 6

6. Consider Physical Therapy

• Seek professional guidance for a structured rehabilitation program
• Include stretching exercises which are generally helpful for tendinopathies 3
• Focus on progressive loading of tendons to stimulate collagen production and proper alignment

What to Avoid

1. Corticosteroid injections - Use with caution as they may inhibit healing and reduce tendon strength 3
2. Complete rest - This can lead to muscle atrophy and deconditioning 3
3. Rapid return to high-impact activities - Gradually increase activity as symptoms improve

Monitoring and Follow-up

• If no improvement in hand symptoms within 1-2 months, proceed with the planned X-rays
• Consider ultrasound or MRI if symptoms persist despite treatment, as these imaging modalities can detect tendon thickening, degenerative changes, and other structural abnormalities 3
• Track your symptoms with activity logs to identify patterns and triggers

Expected Outcomes

• Improvement should be gradual but progressive
• Eccentric exercises typically show results within 6-12 weeks
• Full recovery from tendinopathy may take 3-6 months with proper management
• Early intervention (as you've already started) generally leads to better outcomes

Remember that your recent start of hormone therapy is promising given the improvement in your Achilles pain. The hand and knee symptoms may take longer to respond, but the combination of hormone therapy, eccentric exercises, and anti-inflammatory approaches offers the best chance for improvement.