Menopause, Joint Pain and Musculoskeletal Health: What Does the Evidence Tell Us?

By Maxence Legout, MSc · Advanced Practice MSK Physiotherapist & Sonographer · Published January 2026

You might reasonably wonder what a middle-aged man could know about menopause and women's health. I understand the question, I will obviously never experience menopause in my own body. But for the past two decades, first as a fitness coach and later as a physiotherapist and musculoskeletal clinician, I have assessed and treated many conditions that become particularly common around midlife. For years I treated osteoarthritis, tendon problems, frozen shoulders, loss of strength and recurrent pain largely as standalone conditions, without necessarily considering the wider connection with the menopausal transition. That perspective is beginning to change, and recent research increasingly supports an association between menopause and musculoskeletal symptoms, even if there's still much we don't understand.

What is menopause?

The World Health Organization defines natural menopause as occurring after 12 consecutive months without menstruation, when there's no other physiological or pathological cause. It most commonly occurs between about 45 and 55 years of age, with considerable individual variation. Menopause itself is one point in a longer transition: perimenopause describes the years around the final period, when ovarian hormone production can fluctuate substantially. For musculoskeletal health this matters, because symptoms can begin before periods have completely stopped.

What's the link between menopause and musculoskeletal pain?

One of the major hormonal changes during the transition is a progressive decline in ovarian oestrogen, particularly oestradiol. Oestrogen is not simply a reproductive hormone, its receptors are found throughout the musculoskeletal system, including skeletal muscle, bone, articular cartilage, synovium, tendons and ligaments, and it's involved in bone remodelling, muscle physiology, collagen metabolism and inflammatory signalling.

So it's biologically plausible that major hormonal change could affect how the musculoskeletal system functions and adapts. But falling oestrogen alone doesn't explain every midlife ache. Ageing, genetics, previous injuries, sleep, physical activity, body composition, metabolic health, stress and changes in training load all interact. The best current evidence supports menopause as a potential contributor to musculoskeletal vulnerability rather than a universal diagnosis.

How common is musculoskeletal pain during menopause?

Quite common. A 2020 systematic review and meta-analysis found musculoskeletal pain highly prevalent during the transition, and more common in perimenopausal than premenopausal women (Lu et al., 2020). A large 2026 review of more than 93,000 women again found an increased risk of muscle or joint pain compared with premenopausal women (Kruse et al., 2026). Importantly, the authors highlighted a key limitation: most studies didn't clearly identify what was actually causing the pain. Menopause appears associated with more pain, but we can't assume every painful shoulder, hip, knee or tendon is directly caused by hormonal change. That distinction is clinically vital.

The "musculoskeletal syndrome of menopause"

In 2024, orthopaedic surgeon Dr Vonda Wright and colleagues proposed the term "musculoskeletal syndrome of menopause" (Wright et al., 2024), a collection of changes around the transition including musculoskeletal pain, loss of muscle mass, loss of bone density, increased tendon and soft-tissue problems, reduced recovery and tissue capacity, and progression of some degenerative conditions. The authors estimate more than 70% of women experience musculoskeletal symptoms during the transition, with around 25% experiencing significant disability.

It's an increasingly influential concept, but it's currently a proposed clinical framework rather than a formally established diagnosis. For me its greatest value is that it encourages clinicians to stop looking at every musculoskeletal condition completely in isolation.

"I feel like I'm falling apart"

This is something I hear surprisingly often. In both my musculoskeletal clinics and my radiology work, I've encountered variations of the same story: "I was referred because of my hip, but now my shoulder hurts too." Or "everything seems to have started hurting at once." Or simply "I feel like I'm falling apart." Sometimes imaging shows a clear problem; sometimes it doesn't. The key is neither to automatically label these symptoms "menopause pain", nor to ignore that the transition may be contributing to a broader change in resilience, recovery and pain.

Five musculoskeletal problems I commonly see around menopause

1. Knee osteoarthritis

Knee osteoarthritis becomes increasingly common in women through midlife. Women have a higher prevalence of symptomatic knee OA than men after midlife, and hormonal change has been investigated as one possible contributor alongside age, genetics, previous injury, muscle strength, body composition and biomechanics (Dennison, 2022). That doesn't mean menopause directly causes knee OA, rather, it may be one component in a multifactorial condition. Maintaining quadriceps and lower-limb strength, staying active and managing body composition are particularly important. (For treatment options, see knee osteoarthritis treatment.)

2. Base-of-thumb osteoarthritis

OA of the first carpometacarpal joint at the base of the thumb is particularly common in middle-aged and older women, and large studies show substantial sex differences in hand OA (Prieto-Alhambra et al., 2014). People notice pain opening jars, gripping, turning keys, pinching, using scissors or lifting pans. Treatment depends on severity, activity modification, hand therapy, splinting, analgesia and, in selected cases, injection or surgical assessment.

3. Frozen shoulder

Frozen shoulder (adhesive capsulitis) causes progressive pain and marked stiffness, commonly between about 40 and 60 years and frequently around the menopausal years. Whether hormonal change directly causes it remains uncertain, and associations such as diabetes and thyroid disease matter. The important point: a painful, increasingly stiff shoulder shouldn't simply be dismissed as "menopause pain", it's a specific condition with specific management, including rehabilitation and, when appropriate, ultrasound-guided corticosteroid injection or hydrodistension.

4. Lateral hip pain and gluteal tendinopathy

Pain over the outside of the hip is extremely common in middle-aged women, often gluteal tendinopathy, sometimes grouped under greater trochanteric pain syndrome. Sex hormones may influence tendon biology and collagen metabolism, though current evidence doesn't prove menopause directly causes tendinopathy. In practice several factors converge: reduced muscle capacity, sudden changes in activity, altered body composition, poor sleep and recovery, tendon compression and hormonal change. Progressive gluteal strengthening and load management remain central. (This is distinct from hip osteoarthritis, which affects the joint itself.)

5. Spinal and lower-back pain

Back pain is multifactorial and becomes common with age in both women and men; pain generators include discs, muscles, sacroiliac structures, nerve roots and facet joints. Oestrogen deficiency has been investigated in relation to spinal degeneration, bone health and facet-joint OA, but imaging findings alone can't establish the source of pain (Chagas et al., 2026). Again, menopause may form part of the wider context without being the sole explanation.

How do I know whether my pain is related to menopause?

There's no single test that says "this pain is caused by menopause", probably one of the most important messages of this article. If you twist your ankle, suddenly double your running mileage or overload your shoulder at the gym, menopause may not be the main reason you're hurting. Equally, persistent swelling, prolonged morning stiffness or progressive weakness may warrant investigation for another condition.

A musculoskeletal assessment is useful when symptoms persist, keep recurring, affect several regions, significantly limit activity, come with loss of strength, or simply don't behave like a straightforward injury. The aim is to establish whether there's a specific joint, tendon, muscle or neurological problem, then consider how menopause and other factors might be contributing.

Why muscle matters so much during and after menopause

For me this is one of the most important practical aspects of care. From midlife onwards, preserving muscle mass, strength and power becomes increasingly important. Strong muscles help stabilise joints, absorb load, maintain balance, preserve bone loading, climb stairs, get up from the floor, keep you exercising, reduce fall risk, support metabolic health and keep you independent later in life. Menopause happens just as age-related muscle loss is starting to matter, and the answer isn't to accept becoming progressively weaker.

Resistance training is one of our best tools

Adults should aim for regular aerobic activity alongside muscle-strengthening exercise for the major muscle groups. During and after the transition I'd place particular emphasis on progressive resistance training, progressively challenging your muscles rather than repeating very light movements indefinitely. Examples: squats, sit-to-stand, leg press, step-ups, lunges, hip-hinge/deadlift variations, rowing and pushing movements, calf raises and loaded carries. You don't need to become a bodybuilder, and you don't necessarily need a gym, the programme simply needs enough stimulus for your muscles to adapt. For most adults, strengthening the major muscle groups on at least two days a week is a sensible minimum.

The best exercise is the one you'll actually do

Prescribing exercise is theoretically simple; implementing it in someone's real life is much harder. People have demanding jobs, children, poor sleep, little exercise experience, pain, fatigue, or no interest in a gym. Telling someone to "exercise more" is rarely enough, our job is to find something realistic. For one person that's structured resistance training; for another it might start as dancing, swimming, Pilates, cycling, walking hills, classes or short home strength sessions. Everyday activity counts too: stairs instead of the lift, carrying shopping, walking short journeys, getting up from the desk regularly. There's an option for almost everyone.

Bone health and menopause

The link between menopause and bone loss is much more firmly established than many other proposed effects. Declining oestrogen accelerates bone turnover and can reduce bone mineral density, increasing the lifetime risk of osteoporosis and fragility fractures, which makes bone health an important part of preventive care. Useful strategies include resistance training, weight-bearing and (where safe) impact exercise, adequate calcium and vitamin D, not smoking, limiting excess alcohol, and good nutrition. Some women should also have formal fracture-risk assessment and potentially a DXA bone-density scan, particularly with additional risk factors.

Can HRT help joint and muscle pain?

Hormone replacement therapy (HRT) is an established treatment for menopausal symptoms and helps protect against menopause-related bone loss. Its role specifically in musculoskeletal pain is less straightforward. There's biological plausibility, and some studies suggest improvement in joint symptoms with hormone therapy, but current evidence isn't consistent enough to recommend HRT purely as a treatment for an individual musculoskeletal condition such as osteoarthritis, gluteal tendinopathy or rotator-cuff pain. NICE notes uncertainty in the evidence relating HRT to joint pain and swelling, and advises menopause treatment be individualised to the woman's overall symptoms, history and risks and benefits (NICE NG23, 2024).

It helps to separate two questions: "Would HRT be appropriate for this woman's menopause?" and "What is causing this particular painful joint or tendon?" Both can be relevant at once. HRT can be considered following assessment by a clinician qualified in menopause care, the British Menopause Society maintains a directory of recognised specialists: thebms.org.uk/find-a-menopause-specialist. HRT and musculoskeletal treatment are best seen as complementary rather than interchangeable.

Is there a preventive strategy?

Yes, although most research looks at management rather than true prevention. I'd focus on five areas:

1. Maintain muscle strength. Progressive resistance training is one of the most useful non-pharmacological tools, the major muscle groups at least twice a week, progressively increasing the challenge.
2. Keep loading your bones. Walking is valuable, but bone responds particularly well to resistance and appropriate weight-bearing or impact loading, tailored to your history.
3. Maintain a healthy body composition. Excess weight increases demand on weight-bearing joints; but aggressive dieting with muscle loss isn't the answer either. Aim to preserve or build lean muscle while improving general health.
4. Pay attention to nutrition. Adequate protein matters for maintaining muscle, alongside calcium and micronutrients; correct vitamin D deficiency where appropriate. Supplements can't replace good nutrition and exercise.
5. Protect sleep and recovery. Sleep disturbance is common in the transition and affects pain sensitivity, recovery, mood and motivation. Managing menopausal symptoms can indirectly make rehabilitation much easier.

Does having one problem mean I'll develop others?

Not necessarily. Knee pain doesn't destine you to shoulder pain, and gluteal tendinopathy doesn't inevitably lead to hand arthritis. But women with persistent or widespread pain during the transition may experience symptoms in several areas, reflecting a period of broader musculoskeletal vulnerability, in which hormonal change interacts with reduced muscle capacity, ageing, activity changes, body composition, sleep, metabolic health, previous injuries and psychological and social factors. That's another reason treating each painful part completely in isolation can miss the wider picture.

Do I need an injection?

Not necessarily, injections aren't a treatment for menopause itself. But they can have an important role when there's a specific diagnosis for which injection is appropriate. Pain management matters because persistent pain disturbs sleep, reduces walking, prevents strength training, drives avoidance of activity and contributes to deconditioning. Appropriately selected patients with osteoarthritis, frozen shoulder, bursitis, certain tendon disorders or other inflammatory conditions may benefit from an ultrasound-guided intervention as part of their wider management. Sometimes reducing pain is exactly what allows someone to start moving and strengthening again. The injection is a tool within a broader strategy, not the entire treatment.

Can this be managed in the NHS?

Yes. Menopause care forms part of the Women's Health Strategy for England, and assessment and treatment can usually begin in primary care, with referral to specialist menopause expertise for more complex cases. Musculoskeletal problems can also be assessed through primary care, physiotherapy and community or hospital MSK pathways. However, menopause care and MSK care don't always sit within the same pathway, which is why patients sometimes discuss their menopause with one clinician and their tendon, joint or muscle problem with another. A more integrated approach would help.

When should I seek medical advice?

Menopause-associated aches are common, but pain shouldn't automatically be blamed on hormones. Seek assessment if you experience:

My approach to musculoskeletal health around menopause

The biggest change in my own thinking has been moving away from viewing every diagnosis completely in isolation. If someone presents with lateral hip pain, I still need to determine whether she has gluteal tendinopathy. If she has a stiff, painful shoulder, I still need to determine whether it's frozen shoulder. If she has knee pain, we still need to know whether it's osteoarthritis, meniscal pathology or something else. But particularly around perimenopause and menopause, I now also think about the person behind the painful structure:

• Has her strength changed?
• Has her physical activity changed?
• Is she sleeping?
• Are several areas becoming painful?
• Has body composition changed?
• Is bone health relevant?
• Is she experiencing other menopausal symptoms?
• Would menopause assessment also be appropriate?

That doesn't mean blaming every injury on hormones. It means recognising that musculoskeletal health, hormonal health, exercise, sleep, nutrition and ageing are interconnected. And women can spend several decades of life after menopause, so maintaining muscle, bone, mobility and confidence in physical activity through this transition isn't just about today's painful shoulder or knee. It's an investment in long-term health, function and independence.

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