Joint and muscle pain

5 min read Clinically reviewed · September 28, 2026 Updated: October 27, 2026 PerimenopauseMenopausePostmenopause

Summary

Stiff hands and knees in the morning, stairs that are not what they were, shoulder pain that started for no reason. More than half of women going through the menopausal transition report joint or muscle pain; most put it down to aging or "rheumatism" and never connect it with menopause. Yet estrogen plays a direct part in cartilage, tendon, ligament and muscle tissue, and its decline affects all of them. In recent years this picture has begun to be described as "the musculoskeletal syndrome of menopause". It can be treated — but non-menopausal causes have to be ruled out first.

What is happening?

Estrogen receptors are found in muscle, cartilage, tendon and ligament. When estrogen falls:

Joints: Cartilage metabolism and joint fluid are affected, and the pain threshold drops. The pain is often symmetrical (both hands, both knees), morning stiffness is short-lived, and things loosen up over the day.

Tendons and ligaments: Collagen quality declines; shoulder (frozen shoulder), elbow and heel tendon problems all increase in this period.

Muscle: Muscle mass and strength decline with age (sarcopenia), and menopause accelerates that loss. Losing muscle increases both pain and the risk of falls and fractures.

Bone: Loss of bone density speeds up in this period (see the separate article on bone health).

Indirect effects: Disturbed sleep heightens the perception of pain; weight gain loads the weight-bearing joints; low mood magnifies pain.

What do we know?

The symptom is common and related to menopause: In an Australian cohort, reports of joint pain were significantly higher in perimenopause and postmenopause than before menopause ². Among 1,500 women attending the first menopause center in Ankara, Türkiye, the commonest complaint was muscle, joint and bone pain (82%) ⁶. International reviews report that 50–70% of women experience musculoskeletal complaints in this period, and that the picture can be explained by the direct effect of estrogen loss ¹.

HRT may ease joint pain: In the estrogen-only arm of WHI, the frequency of joint pain in women taking estrogen was slightly but significantly lower than with placebo ³. Guidelines do not recommend HRT for joint pain on its own, but note that this complaint may also improve when HRT is given for vasomotor symptoms ⁴.

Resistance exercise is the best-evidenced intervention: Progressive resistance exercise working the large muscle groups, 2–3 days a week, increases muscle mass, strength and joint stability and reduces pain ⁵. Take-up of this kind of exercise among women in midlife is low; menopause is the most well-founded moment to start.

The pain can be confused with inflammatory arthritis: Rheumatoid arthritis and similar conditions also often begin in women in midlife. Menopausal pain usually comes with short morning stiffness and no joint swelling; prolonged stiffness, swelling and systemic symptoms call for a separate assessment.

Vitamin D and thyroid: Deficiency in either causes widespread muscle and joint pain, and both are identified with a simple blood test.

What does this give you?

Don't accept pain as "getting older": If it began alongside your other menopause symptoms in particular, describe the symptoms together to your doctor.

Movement is necessary despite the pain: A short-lived increase in pain is not a reason to stop exercising; sharp pain or pain with swelling, however, should be assessed. Walking is not enough — the muscle needs to meet resistance (weights, a resistance band, your own body weight).

Protein and sleep: Building muscle needs enough protein, and repair needs enough sleep. Managing pain is hard until sleep is put right.

Record it: Which joints, at what time of day, and alongside which other symptoms — that is valuable information for your doctor. In Lumia you can mark joint pain and muscle pain separately.

Painkillers: Discuss short-term use with your doctor; regular long-term use carries risks for the stomach, kidneys and heart.

When to see a doctor?

A single joint that is hot, swollen and red — infection or crystal arthritis should be assessed, and this does not wait.

Morning stiffness lasting more than an hour, with symmetrical swelling of the small joints of the hands and feet — assessment for inflammatory arthritis is needed.

Pain together with fever, weight loss, a rash, or pain at night.

Pain after a fall.

These signs should be assessed without delay.

Sources

Wright VJ, et al. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466-472.
Szoeke CE, et al. The relationship of reports of aches and joint pains to the menopausal transition. Climacteric. 2008;11(1):55-62.
Chlebowski RT, et al. Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial. Menopause. 2013;20(6):600-608.
The Menopause Society. The 2022 Hormone Therapy Position Statement. Menopause. 2022;29(7):767-794.
American College of Sports Medicine. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687-708.
Neslihan Carda S, et al. The menopausal age, related factors and climacteric symptoms in Turkish women. Maturitas. 1998;30(1):37-40.

What you can ask your doctor

Is my pain related to menopause, or does it need a rheumatological assessment?
Have my vitamin D and thyroid levels been checked?
Where could I be referred for a resistance exercise program suited to me?

This content is for information only; it does not replace medical advice, diagnosis or treatment. Discuss your health with your doctor before starting an exercise program.

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