While much of the mainstream discussion around menopause symptoms focuses on hot flashes, mood changes, difficulty concentrating and sexual health changes, the musculoskeletal changes are often overlooked.
However, the effects of menopause on joints, muscles, bones and tendons that occur during this time are far reaching and have serious consequences. The disability and frailty that can occur often leads to decreased quality of life and increased mortality in post-menopausal women.
In this article we will look at the effects of menopause on the musculoskeletal system, including menopause joint and muscle pain. We will also discuss common injuries that occur in menopausal women and how to prevent and treat these injuries.
Table of Contents
Effects of Menopause on Joints, Muscles, Bones & Tendons
Menopause is a natural process that occurs in women in their midlife. It is characterized by a drop in the hormones estrogen and progesterone, marking the end of the reproductive stage for female sexual organs.
This shift in hormones impacts other systems and organs, including:
Muscle: Sarcopenia is defined as age-related loss of lean muscle mass. Estrogen has an enormous effect on the preservation of muscle mass and muscle quality. Evidence shows that the reduction in hormones accelerates a reduction in strength beginning in women between 45-52 years old.[i]
Bone: Declines in estrogen contribute to significant bone loss and decreased bone mineral density. This decline leads to higher risk of osteopenia and osteoporosis leading to increased fragility and risk of fracture.[ii]
Joints: It is now recognized that cartilage degeneration and inflammation can occur due to estrogen deficiency during menopause. In a comprehensive review of estrogen and osteoarthritis a possible association was suggested between menopausal estrogen reduction and the frequency of knee, hip and finger osteoarthritis and severity of hip osteoarthritis.[iii]
Tendons: Estrogen levels have a direct effect on collagen effecting the tensile strength and biomechanical properties of the tissue.[iv] Decreased collagen strength leads to an increased risk of injuries because tissues like tendons and ligaments lose flexibility and structural integrity, and bones become more brittle.
Menopause Joint and Muscle Pain and Other Common Midlife Injuries
The natural hormonal shift in a woman’s midlife can lead to menopause joint and muscle pain, stiffness and injury and disability.
1. Tendinopathies – Tendons are highly sensitive to hormonal shifts. Lower estrogen can lead to micro-tearing and reduced load tolerance, making tendinopathies one of the most common conditions in midlife women.
Typical sites include:
- Rotator cuff (shoulder)
- Lateral elbow (tennis elbow)
- Achilles tendon
- Gluteal tendons (outer hip pain)
Women often notice pain with daily tasks such as lifting, climbing stairs, or carrying groceries.
2. Plantar Fasciitis
Changes in collagen stiffness, reduced shock absorption, and tightness in the calf make plantar fasciitis more likely during menopause. Morning heel pain or discomfort during prolonged standing are classic symptoms.
3. Osteoarthritis Flares or Onset
Menopause is a key turning point for joint health. Estrogen helps regulate cartilage and inflammation, so its decline can accelerate:
- Knee osteoarthritis
- Hip osteoarthritis
- Finger and thumb (CMC) osteoarthritis
- Spinal facet joint degeneration
Women often report increased stiffness, reduced mobility, or worsening joint pain during early post-menopause.
4. Stress Fractures
With declining bone mineral density, even moderate increases in physical activity may lead to stress injuries. Common sites include the metatarsals and tibia in the lower leg.[v] Women returning to high impact exercise or long-distance walking or running should increase training gradually to allow bones time to adapt.
5. Carpal Tunnel Syndrome
Fluid shifts and connective-tissue changes can increase pressure on the median nerve in the wrist. Numbness, tingling, or nighttime hand symptoms often emerge around menopause.
6. Frozen Shoulder
Adhesive capsulitis is more common in midlife women and is believed to have a hormonal component. The gradual onset of shoulder stiffness and pain can interfere with sleep, dressing, and daily function.
Physiotherapy for Menopause Joint & Muscle Pain
Physiotherapy can effectively help manage menopause joint and muscle pain and other MSK symptoms by focusing on exercises that strengthen muscles, improve flexibility, and enhance joint mobility, as well as providing education, manual therapy and other modalities that aid in pain management.
Pain management – manual therapy such as mobilizations and soft tissue release, acupuncture, ultrasound, shock wave therapy and other modalities can aid in pain management
Strength training – targeted and functional strength training can help protect joints and decrease risk of injury
Flexibility/ROM – flexible muscles are more elastic and can better absorb the forces of physical activity
Education – education on proper techniques and posture for activities such as sitting, lifting, and weight training are essential to ensure proper form and reduce strain on joints and muscles
Conclusion
It is important to discern the endless content found on the internet and social media to evidence-based health information that’s right for you. As the musculoskeletal demands of menopause evolve, physiotherapy provides evidence-based strategies to reduce pain, improve function, and prevent injury.
Through targeted exercise, education, and individualized treatment plans, physiotherapists can help women maintain mobility and quality of life during this important life transition. Early intervention and consistent support can make a significant difference in long-term outcomes.
