Can Menopause Cause Muscle and Joint Pain?

Written By Rachel Niemann

Did you know that musculoskeletal symptoms of menopause are an actual thing? Symptoms can include joint pain, muscle aches, pelvic floor dysfunction and muscle stiffness. In this blog, you can learn effective strategies and lifestyle tips tailored for women in the menopause transition, helping you maintain your quality of life and well-being during this time.

In this blog I’ll cover:

  1. Introduction

  2. Understanding muscle and joint pain in menopause

  3. Can menopause cause muscle and joint pain?

  4. The impact of musculoskeletal symptoms in menopause

  5. Management strategies

  6. Seeking professional help

  7. Conclusion

  8. Where to next?

Introduction

What is menopause?

Menopause. I promise it’s not a dirty word even though it feels like it. 

As you will likely know, menopause signifies the end of a woman’s reproductive years. 

It is not a sudden event, but more of a transition over time lasting 2-10 years culminating in the ovaries reaching a point where there are no more follicles capable of ovulating. i.e. no more eggs. 

More than 47 million women worldwide begin menopause each year. 

This transition results in significant fluctuations and changes in hormone levels which can contribute to the musculoskeletal symptoms of menopause. Left untreated, these symptoms can significantly affect your quality of life.  

Menopause and musculoskeletal symptoms

Until recently, musculoskeletal symptoms such as muscle and joint pain experienced by women in the menopause transition have not been well recognised as a symptom of menopause and instead have been attributed to aging, injury or current health status. 

And yet, 71% of perimenopausal women have a higher risk of musculoskeletal pain than premenopausal women. 

SEVENTY ONE PERCENT!

In 2024 Dr Vonda Wright, an orthopedic surgeon with a special interest in menopause coined the term ‘musculoskeletal syndrome of menopause’ and through her journal article of the same name, issued a call to clinicians to begin recognising and treating these conditions as signs and symptoms of menopause. 

Dr Wright listed the following conditions included in this syndrome:

  • Musculoskeletal pain

  • Joint pain including arthritis

  • Decrease in lean muscle mass

  • Decrease in bone density, 

  • Increase in tendon and ligament injury or pain

  • Frozen shoulder (adhesive capsulitis)

  • Fragility of cartilage matrices including those in joint capsules.

Understanding and addressing these symptoms is vital for the overall health of women during perimenopause and as they transition into post menopause and further aging, as an increase in pain and decrease in physical capacity and function can have a significant negative effect on a woman’s health and quality of life.  

Understanding muscle and joint pain in menopause

Put simply, the definition of musculoskeletal symptoms includes any symptoms affecting the muscles and bones of the body. 

As our bodies are very complex (and amazing) systems, we have several different tissue types that connect or are attached to these two components:

  • Tendons (connect muscle to bone)

  • Ligaments (connect bone to bone)

  • Joints 

  • Cartilage

  • Fascia 

Common types of musculoskeletal symptoms of menopause are:

  • Joint pain

  • Muscle stiffness

  • Osteoporosis

  • Tendonitis

  • Bursitis

  • Fibromyalgia

  • Back pain

  • Pelvic floor dysfunction such as leaking and prolapse

  • And many more

These symptoms can be attributed to a diagnosable mechanism or they can be considered idiopathic (no known cause). 

For example joint pain could be due to arthritis or for no detectable reason however, both should be considered to be symptoms of menopause for women in the relevant age range and symptom presentation.

Can menopause cause muscle and joint pain?

You guessed it, the musculoskeletal symptoms of menopause can be attributed to hormonal changes, largely estrogen deficiency. 

The musculoskeletal system is home to a considerable number of estrogen receptors and estrogen related receptors which allow estrogen to have an effect on these systems. 

With the decreased availability of estrogen being received by these receptors, five primary changes occur:

  • Increase in inflammation in musculoskeletal tissues (estrogen regulates inflammation)

  • Decrease in muscle mass and therefore strength

  • Decreased ability to maintain or gain muscle mass due to a decrease in satellite cell proliferation

  • Osteopenia and osteoporosis (decrease in bone density)

  • Arthritis

Now, I know it’s easy to blame menopause (and estrogen) for everything, but there’s no getting away from the fact that aging plays a part as well. 

In both men and women, muscle mass decreases at a rate of 3-8% per decade from the age of 30. 

Our collagen levels drop affecting not just our skin (hello wrinkles and the effects of gravity), but also our connective tissues including tendons, ligaments, cartilage and fascia. 

We may also start to experience other health conditions as a result of aging which may also have an effect on the musculoskeletal system either directly, or as a result of medications or inactivity. 

What a great segway into the effects of lifestyle factors on our musculoskeletal system. 

Inactivity, poor diet and weight management, smoking, drinking, and injury history can also have a strong influence on musculoskeletal symptoms both in general and through the menopause transition and beyond. 

Impact of Musculoskeletal Symptoms in Menopause

As I have experienced both myself and in the women I see and treat, these symptoms can have a significant effect on the quality of life. 

With potentially already a loss of sleep due to symptoms such as night sweats, ongoing musculoskeletal pain can further affect sleep quality and quantity. 

These symptoms can also have an effect on your ability to participate in activities you enjoy, or general exercise for health and wellbeing. 

This can have a snowball effect and lead to an increase in symptoms and health concerns and a decrease in physical and functional capacity. 

Some of the symptoms can be silent and you don’t even know it’s happening until it’s happened.

Loss of muscle mass and strength and a decrease in bone density are big players here.

Loss of strength and muscle mass can have a huge impact on women including pelvic floor function, balance, functional capacity and increased pain.

Chronic pain, loss of sleep and even a loss or decrease in independence can also negatively affect our mental health. 

For women in the menopause transition this can have a compounding effect as we are already more susceptible to mental health concerns at this time such as anxiety and depression. 

For a lot of women, menopause also coincides with other major life events, such as kids leaving home, aging parents and career progression. 

Adding menopause symptoms to this picture is A LOT. 

Even if your musculoskeletal symptoms are not severe but more along the lines of aches and pains, stiffness and dysfunction such as pelvic floor dysfunction, this can still negatively affect our mental health through decreased motivation, feelings of hopelessness and acknowledgement of the aging process. 

But there is hope! Because when we can move well, we feel good. 

Management Strategies

Exercise and Physical Activity

Regular exercise is super important during all stages of our lives but especially during perimenopause.

And while some exercise is better than no exercise (mostly), the right exercise for you and your circumstances can be a big contributor to staying consistent and making progress.

Trust me when I say I know that implementing exercise as a strategy is not easy. 

Common hurdles to exercise participation I see in perimenopausal women

  • Not knowing where to start

  • Feeling so unfit it feels like too bigger task to tackle

  • Not knowing what exercise will help or what may make symptoms worse

  • Not having time

  • Not having support 

  • Joining group classes and experiencing frequent injuries

  • Having an all or nothing approach

  • Fitness professionals who don’t know how to modify exercise or meet a person where they’re at

  • Not wanting, or being able to, join a gym or attend group classes. 

  • Financial concerns

  • Being told by another health professional, such as their doctor, not to do xyz 

  • Putting everyone else first

While research is limited in this area, it is slowly expanding and some recommendations, based on both studies on perimenopausal women and extrapolations of other exercise science research, have been made. 

More information can be found in my blogs Best Strength Training Exercises for Menopause and Best Exercise for Perimenopause Weight Gain

Nutrition and Supplements in menopause

As an exercise physiologist, nutrition, medication and supplements are a little outside my scope of practice, however Dr Wright addressed this in her article on the musculoskeletal syndrome of menopause. 

Key takeaways are:

  • Nutritional vitamin D improves bone mineral density in postmenopausal women

  • Vitamin D supplementation in postmenopausal women aged 50-65 was associated with reduced bone turnover markers suggesting reduced bone loss in these women

  • A study on postmenopausal women aged 44-76 found daily magnesium supplementation increased vitamin D levels

  • Vitamin K supplementation has been found to significantly increase bone mineral density in postmenopausal women

  • Increased protein intake alongside resistance training may be critical in reducing falls and fractures

  • Menopause Hormone Therapy (MHT) may be beneficial in managing the musculoskeletal symptoms of menopause in some women.

It is important to note here, to seek qualified advice when thinking about taking supplements as too much of what seems like a good thing can do serious harm.

With inflammation levels potentially increasing due to the decline in estrogen (an inflammation regulator), consuming antinflammatory foods and avoiding processed foods may also be of benefit in managing symptoms during perimenopause. 

Pain Management Techniques

Managing pain can be complex especially when the pain is chronic (has lasted longer than 3 months) as chronic pain can change the pathways in the brain resulting in ongoing pain even when the mechanism of that pain has resolved. 

Dr Lorimer Mosely did a great TED Talk on this and I highly recommend checking it out if you have chronic pain or have ever been told “your pain is all in your head” [Insert multiple eye roll emoji’s because I hear this a lot and while I’m sure the clinician means well, it usually doesn’t land well. Not surprisingly].

Pain management strategies that can help include:

  • Over the counter pain medication

  • Heat packs or cold packs

  • Hot baths or saunas

  • Meditation

  • Exercise 

  • Massage

  • Manual therapy such as dry needling, acupuncture, osteopathy and physical therapy

Seeking Professional Help

Musculoskeletal symptoms often need further investigation to inform the best treatment. The types of health professional who can help you include:

  • Doctors who will assess and refer as necessary as well as recommend and prescribe pain management strategies

  • Accredited Exercise Physiologists who can assess (but not diagnose) and prescribe exercise to improve your symptoms

  • Physiotherapists, osteopaths and chiropractors can assess, diagnose and manually treat your symptoms

  • Massage therapists can provide manual therapy using massage and tools such as dry needling, cupping and fascial tools. 

 When to seek help:

  • When symptoms are negatively affecting your life

  • When pain is constant and unrelenting 

  • If you experience bowel or bladder dysfunction with back pain 

  • If you experience numbness or weakness 

  • Your symptoms are not improving or are getting worse

  • Anytime something concerns you. 

Conclusion

Musculoskeletal symptoms in menopause can be a pain (pun intended), impact your daily life and mental health, and stop you doing the things you love. 

While often attributed to age or your health status, the change in hormones during perimenopause and beyond should not be dismissed as it can be a significant contributing factor to those aches, pains, niggles, stiffness and dysfunction. 

Finding exercise that meets you where you’re at in regard to both musculoskeletal symptoms and current fitness levels is the key. 

If you are interested in accessing my services specifically for women in perimenopause and menopause with musculoskeletal symptoms then head to my website: Ebb & Flow Exercise Physiology

Where to next:

Check out my other blogs for tips and info:

Want to work with me towards moving well and feeling good in perimenopause and beyond? Check out my menopause specific services here.

Disclaimer:The information provided in this blog is intended for educational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare professional before starting any exercise or health program. By using this content, you agree that FIND THE FLOW is not responsible for any injuries or health issues that may arise from your use of the exercises or advice provided.

Rachel Niemann
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