Menopause and Joint Pain: Why Everything Aches in Your 40s and 50s

Your hands are stiff when you wake up. Your knees have started complaining on the stairs, and a shoulder that has never given you any trouble suddenly will not let you reach the top shelf. There was no injury and nothing in your routine has changed. Your blood tests came back normal, yet you know something is different.

It is something we hear a lot from women in their 40s and 50s. Joint and muscle pain is one of the most common symptoms of perimenopause, but it gets far less attention than hot flushes or poor sleep. More often than not it gets put down to getting older.

Age plays a part, but hormones are a bigger piece of the puzzle than most people realise.

A new name for an old problem

In 2024, a group of orthopaedic researchers writing in Climacteric (the journal of the International Menopause Society) proposed a new term: the musculoskeletal syndrome of menopause (Wright et al., 2024).

They pointed out that joint pain, muscle loss, bone loss, tendon and ligament injuries and worsening osteoarthritis tend to show up together around menopause. These problems usually get treated one at a time by different specialists. The authors argue they should be seen as related, because falling oestrogen affects all of them.

They estimate that more than 70% of women have musculoskeletal symptoms at some point during the menopause transition, and that around a quarter will be disabled by them. Having a name for it helps. It means doctors are more likely to recognise it and women are less likely to be told to just live with it.

How common is it?

Very. A 2020 meta-analysis of 16 studies found that 71% of perimenopausal women reported musculoskeletal pain, and that they were significantly more likely to have pain than women who had not yet reached perimenopause (Lu et al., 2020).

A larger 2026 analysis of over 93,000 women from 22 countries came up with slightly lower numbers: around 40% of premenopausal women reported muscle or joint pain, compared with 57% in perimenopause and 59% after menopause (Kruse et al., 2026). The percentages vary from study to study, but they all point the same way.

The SWAN study, which has followed thousands of American women through midlife, found that about one in six had aches and pains every day. Postmenopausal women reported more pain than premenopausal women even after the researchers accounted for age, weight, mood and other health factors (Dugan et al., 2006).

Why oestrogen matters for your joints

Oestrogen does a lot more than regulate your cycle. Cartilage, bone, muscle, tendons, ligaments and the lining of your joints all have oestrogen receptors, so when levels drop they all feel it.

Oestrogen helps keep inflammation in check. As it falls, low-grade inflammation in and around the joints tends to rise. Tendons, ligaments and joint capsules also become stiffer and slower to heal, which is one reason frozen shoulder is so common in women between 40 and 60 (Navarro-Ledesma, 2025).

Muscle changes too. Body composition data from the SWAN study show that lean mass starts dropping at the beginning of the menopause transition and keeps dropping until around two years after your final period (Greendale et al., 2019). Less muscle means less support around your knees, hips and back. Bone loss speeds up over the same period, which is why resistance training for bone density becomes so important from your 40s onwards.

Sleep plays a role as well. Night sweats and broken sleep lower your pain threshold, so everything feels worse, and pain then makes it harder to sleep.

What we see in practice

In the clinic, the musculoskeletal side of menopause tends to show up as:

General aches and morning stiffness in the hands, feet, knees and hips that ease once you get moving
Frozen shoulder, often with no injury to explain it
Pain on the outside of the hip, which is usually gluteal tendinopathy rather than bursitis
Achilles, elbow and other tendon problems that take a long time to settle
Knee osteoarthritis that seems to get worse quite quickly
Noticeable loss of strength, especially when carrying shopping, climbing stairs or getting up off the floor

Not all of this is hormonal. Inflammatory arthritis, thyroid problems and low vitamin D can cause very similar symptoms, so they need to be ruled out. If your joints are hot and swollen, you are stiff for more than an hour every morning or you feel generally unwell, see your GP first.

Will HRT help?

It is one of the first things patients ask about. HRT may help a little, but you should not rely on it to fix joint pain.

The strongest data come from the Women’s Health Initiative, where over 10,000 women were randomly given oestrogen or a placebo. After a year, 76.3% of the oestrogen group reported joint pain compared with 79.2% on placebo (Chlebowski et al., 2013). The difference lasted, but it was small.

A 2026 meta-analysis of 57 studies found HRT made no overall difference to general musculoskeletal pain, with mixed results for specific conditions (Overton et al., 2026).

HRT has other benefits, including protecting bone density, and whether it is right for you is a decision to make with your GP or gynaecologist. Just do not expect it to take care of your joints on its own.

What helps

Strength training

If you only change one thing, make it this. A 2024 meta-analysis of 12 randomised trials in healthy postmenopausal women found resistance training led to big improvements in upper and lower body strength, and the authors suggested training around three times a week (González-Gálvez et al., 2024). A 2026 review of 17 trials in postmenopausal women with sarcopenia (age-related muscle loss) found exercise improved muscle mass, grip strength, walking speed and how easily they could get up and move (Deng et al., 2026).

Stronger muscles absorb more of the load that would otherwise go through your joints. If you have never lifted weights before, now is a good time to start. You do not need a gym to begin, but the weights do need to get heavier over time for it to work.

Regular movement for arthritic joints

Exercise is the first-line treatment for knee and hip osteoarthritis in every major guideline. The UK’s NICE guideline says everyone with osteoarthritis should be offered therapeutic exercise (NICE, 2022), and the international OARSI guidelines put exercise and education at the core of treatment for knee and hip osteoarthritis (Bannuru et al., 2019). A 2024 Cochrane review of 139 trials confirmed that exercise reduces pain and improves function in knee osteoarthritis (Lawford et al., 2024).

Cartilage relies on movement to stay healthy, so resting a stiff joint usually makes it stiffer.

Hands-on treatment, alongside exercise

NICE recommends manual therapy (manipulation, mobilisation and soft tissue work) for hip and knee osteoarthritis, but only in combination with exercise. That is how we use it too.

A stiff, sore joint is hard to train. Chiropractic adjustments, joint mobilisation, dry needling and fascial release help settle pain and free up movement so you can actually do the exercises. For stubborn tendon problems and frozen shoulder, we often add shockwave therapy, which has good evidence behind it and tends to speed recovery up. As you get stronger, you need less of our help.

Protein, vitamin D and sleep

Most women in midlife do not eat enough protein to maintain muscle, and a lot of our patients turn out to be low in vitamin D. Some find magnesium helps with sleep and cramps. None of these replace exercise, but getting them right makes it easier to recover from training.

When to come and see us

It is worth getting checked if:

Joint or muscle pain has built up over months and is not going away
One of your shoulders is getting steadily stiffer
Pain on the outside of your hip is waking you at night or making stairs hard
Pain or stiffness is getting in the way of exercise
You want to start strength training but are worried about hurting something

Most of what happens to your joints and muscles around menopause responds well to the right treatment and a consistent strength programme.

If this sounds like you, get in touch or book an appointment at our Sandton practice. We will work out what is behind your pain, treat it and help you build the strength to stay active.

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