Hot flashes, night sweats and mood changes are well-known symptoms of menopause. But many women are surprised to learn that muscle and joint pain are also extremely common during the menopausal transition.

In fact, research suggests that nearly 7 out of 10 women experience musculoskeletal pain during perimenopause. Yet these symptoms often go unrecognized or are attributed to aging, overuse or previous injuries.

Understanding why these symptoms occur is the first step toward managing them effectively.

Why does menopause cause muscle and joint pain?

Many women report experiencing musculoskeletal pain (MSP) during the perimenopausal transition. A systematic review and meta-analysis conducted by Chang-bo and colleagues [1] found that approximately 71% of women in perimenopause experience symptoms such as: 

  • muscle pain;
  • joint pain;
  • back pain;
  • generalized body aches.

More recently, the collection of musculoskeletal signs and symptoms associated with declining estrogen levels has been described as the musculoskeletal syndrome of menopause (MSM).

When does it usually start?

To better understand when these symptoms occur, it is important to define the stages of reproductive aging. 

Premenopause refers to the stage during which women continue to have regular menstrual cycles, typically every 21-35 days. 

Perimenopause is characterized by menstrual cycle irregularity lasting more than one year or by an interval of 2-11 months of amenorrhea before the final menstrual period.

Postmenopause is defined as the absence of menstruation for 12 consecutive months.

The prevalence of MSP (musculoskeletal pain) appears to peak during the early menopausal transition. Studies have demonstrated a significant increase in musculoskeletal symptoms during perimenopause compared with premenopause. Interestingly, Chang-bo and colleagues [1] found no significant difference in symptom prevalence between perimenopausal and postmenopausal women, suggesting that these symptoms often emerge during the transition and may persist thereafter.

The risk of developing MSP increases as women enter perimenopause, and symptom severity tends to increase progressively from the premenopausal to the postmenopausal stages. 

Why do some women experience more pain than others?

While symptoms such as hot flashes, mood changes, and depression are widely recognized as hallmark features of menopause, MSP is also one of the most common yet often underrecognized symptoms. 

Several health-related factors have been associated with an increased risk of MSP, including smoking, depression, and body mass index (BMI). Notably, a higher BMI (≥30 kg/m²) has been identified as an independent risk factor for MSP, with women reporting higher rates of back pain, joint stiffness, and bone pain.

What does the research say about treatment?

Managing MSP can be particularly challenging when combined with the many other physical and psychological symptoms associated with menopause. 

Among non-pharmacological interventions, exercise has consistently demonstrated the strongest evidence for preventing and managing menopause-related MSP. 

As highlighted in the review by Wright and colleagues [2], resistance training is considered the most non-controversial exercise modality. In particular, strength-focused resistance training using heavier loads and fewer repetitions is recommended over lighter loads with higher repetitions to improve muscle power. In fact, declining estrogen levels contribute to the loss of type II (fast-twitch) muscle fibers, leading to reduced muscle power. 

Maintaining muscle power is essential for performing activities of daily living and preserving functional independence. Furthermore, resistance training has been shown to improve bone health, reduce the risk of falls and fractures.

When should you seek professional help?

Many women between the ages of 45 and 55 are unaware that hormonal changes can have a significant impact on their musculoskeletal health. 

As a result, they often present to private physiotherapy clinics with musculoskeletal complaints without recognizing menopause as a contributing factor. 

The Musculoskeletal Syndrome of Menopause encompasses a wide range of conditions, including: 

  • loss of lean muscle mass;
  • reduced bone mineral density;
  • increased fracture risk;
  • tendon and ligament injuries;
  • frozen shoulder (adhesive capsulitis);
  • progression of osteoarthritis;
  • and the genitourinary syndrome of menopause. 

Given the broad impact of menopause on musculoskeletal health, maintaining physical activity and prioritizing overall physical and mental well-being are essential. 

Healthcare professionals, including physiotherapists, osteopaths, chiropractors, and occupational therapists can all play an important role not only in reducing pain, but also in promoting long-term prevention, maintaining function, and improving quality of life throughout the menopausal transition.

Understanding menopause symptoms

Muscle and joint pain are among the most common, yet often overlooked, symptoms of menopause. Recognizing the connection between hormonal changes and musculoskeletal health can help women better understand their symptoms and seek appropriate care sooner.

If you’re experiencing persistent muscle or joint pain during perimenopause or menopause, you don’t have to navigate it alone. At Ekinox, our interdisciplinary team works together to help you manage pain, restore function and stay active throughout every stage of the menopausal transition.

References: 

  • Lu, C. B., Liu, P. F., Zhou, Y. S., Meng, F. C., Qiao, T. Y., Yang, X. J., Li, X. Y., Xue, Q., Xu, H., Liu, Y., Han, Y., & Zhang, Y. (2020). Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis. Neural plasticity, 2020, 8842110. Https://doi.org/10.1155/2020/8842110 
  • Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466-472. Http://doi.org/10.1080/13697137.2024.2380363