An Expert Guide to Perimenopause & Menopause Joint Pain

It can feel strange to be in your early 50s, 40s, or even late 30s and find yourself complaining about tight hips, an achy back, or stiff shoulders. You're clearly too young — and too active — for joint issues.

So why is this happening? It could be your hormones.

Joint pain is one of the most common yet seldom-discussed symptoms of perimenopause and early menopause. More than 70% of women transitioning to menopause will experience musculoskeletal symptoms and 25% will experience symptoms that severely disrupt their daily lives.

If you’re on the cusp of menopause, you may be even more likely to struggle with joint issues. As women approach their final menstrual period, joint and muscle pain become about twice as common compared to other times in the menopause transition.

Wondering what's going on in your body and how you can start feeling better? As a Menopause Society-certified nurse practitioner on the founding team at Elektra Health, I've got you covered.

What does perimenopause or menopause joint pain feel like?

Early signs of menopause-related joint pain include a gradual increase in stiffness, aching, and swelling in the joints. These sensations often flare up after you’ve been inactive for a while, for example after driving, working at a desk, or sleeping.

Where you’re likely to notice menopause-related joint pain:

• Spine
• Shoulders
• Hips
• Hands
• Knees
• Feet

The sensations you feel in your joints may not register as pain — especially if you've been through childbirth or other painful health issues. Other terms women often use in place of “pain to describe joint discomfort:

• Stiffness
• Achiness
• Creakiness
• Heat and Swelling

Can menopause cause joint pain?

The link between menopause and joint pain is not completely understood, but there are well-supported theories. First among them is that changing hormones lead to increased inflammation.

Estrogen's impact on joint pain:

Let’s start with Estrogen. One of estrogen's many jobs is to reduce inflammation by interacting with estrogen receptors in joints and connective tissues. A drop in estrogen levels during menopause can contribute to the breakdown of cartilage, which can lead to pain.

Estrogen also helps with joint lubrication. Lower estrogen reduces lubrication, which can change friction in the joint and increase likelihood of pain.

Also worth noting: Higher estrogen levels can help "turn down the volume" of pain. That means that joint pain we feel during menopause may have been there before — estrogen was simply masking it.

Progesterone's impact on joint pain:

As estrogen declines during the menopausal transition, so does progesterone. An estrogen-balancing hormone, progesterone also has potent anti-inflammatory properties. Emerging science is revealing progesterone’s role in joint and muscle disorders, from menopause pain, to fibromyalgia, to arthritis.

Other reasons menopause can lead to joint pain:

Menopause can also bring on changes to other musculoskeletal issues, causing or contributing to pain. These issues can include:

• Sarcopenia - loss of the muscle mass that cushions and protects the joints
• Rheumatoid arthritis - a chronic autoimmune disorder that mostly affects joints
• Osteoarthritis - a degenerative joint condition

How can you tell if hormones are causing your joint pain?

In general, menopausal joint pain evolves gradually as estrogen starts to decline. In contrast, pain caused by a traumatic event, injury, strain, or overuse comes on more quickly. That said, joint pain that occurs during the menopause transition can often be a combination of both.

Other conditions that can mimic menopausal joint pain include gout, infections, and a condition called polymyalgia rheumatica.

Overall, menopause-related joint pain is a fairly complex diagnosis of exclusion. A specialist will have to rule out other causes or conditions first.

What raises your risk for joint pain in menopause or perimenopause?

Repeated joint injuries or surgery that leads to scar tissue can ramp up inflammation and weaken the joint, making you more prone to pain.

Depression, being overweight, struggling with insomnia, and having rheumatoid arthritis are also risk factors for menopause-related joint pain.

Why is it key to advocate for yourself?

Unfortunately, not enough women seek care for stiff, achy joints — and they may run into barriers when they do. Healthcare providers can be quick to dismiss female pain. And, outside of menopause specialists, most doctors aren't trained to think about hormones when evaluating joint pain.

The upshot is that asking for a referral to a menopause specialist is crucial. Most specialists think about body parts in silos, limiting their ability to recognize the effects of menopause.

Menopause specialists, like those at Elektra Health do the opposite. Hormones are important for connecting tissues in the body. Women have estrogen receptors on every tissue, organ, and cell. As trained clinicians, we think more holistically about medical problems and connect the dots for our patients.

Top treatments for menopause-related joint pain:

An Anti-Inflammatory Diet

Given that inflammation is at the root of the problem, a diet rich in antioxidants and other anti-inflammatory whole foods is highly recommended. The Mediterranean diet is typically your best bet.

Hydration

Maintaining good hydration is essential for overall muscle and joint health.

Exercise

Regular exercise will help with strength, endurance, and stability, all of which are all important as we approach the menopause transition. Strength training is excellent for joints and bones, as are exercises that involve twisting and moving in all planes of motion.

Menopausal Hormone Therapy (aka Hormone Replacement Therapy)

The anti-inflammatory effect of Menopausal Hormone Therapy (MHT) can help with pain to some extent. Women experiencing joint pain that affects their quality of life and mobility should consider trying MHT after other causes of pain have been ruled out. It may help improve their symptoms, even though it's unlikely to be a complete solution.

Physical therapy for perimenopause and menopause joint pain:

A physical therapist who specializes in menopause can help in a number of ways, including all of the following:

• Explaining the influences of hormones on your joint health and entire musculoskeletal system
• Helping you find the ideal exercises and workouts for you given your current symptoms, goals, and fitness level
• Using mobilization techniques to help improve your joint function and decrease pain

A women’s health PT can also help you address symptoms of pelvic floor dysfunction, which are common throughout this transition. A recent study found that 63% of women in perimenopause and menopause experienced bladder leaks in the past year. The same survey found that 21% experienced pain with sex.

What are the best exercises for perimenopause or menopause joint pain?

Strength training is ideal. It helps maintain your muscle, endurance, stability, and balance – all of which can help support joint mobility.

Patients with joint pain often do well with low-impact forms of exercise that still allow them to build strength. Great options include water aerobics, swimming, pilates, yoga and Tai-chi. Regular stretching is also great for joints.

If you prefer high-impact workouts, you don't have to give them up. Consider talking to a PT about how best to prevent pain and injury.

Are there any promising alternative therapies or supplements?

Some studies show that acupuncture can help with joint pain, particularly pain caused by osteoarthritis. OTC options like capsaicin cream, arnica, and CBD are safe to try, although the evidence is mixed for their effectiveness.

Supplements that may help prevent and treat menopause joint pain:

• Glucosamine & Chondroitin: Both constituents of cartilage, when paired together, they can help with joint pain management and joint function
• Vitamin D: Important for bone and muscle function and may have anti-inflammatory effects
• Omega-3 Fatty Acid: Recognized for their anti-inflammatory properties, Omega-3 fatty acids can help mitigate joint pain and cartilage loss

Don’t settle for less than feeling good in your body!

We really are the first generation of women to demand care for issues related to menopause and perimenopause. Every time we do, we set an example for our friends, relatives, and colleagues, as well as our daughters.

From menopause specialists to women's health PTs, experts are finally available to treat symptoms like joint pain. Take advantage of them now — and surprise yourself by feeling good in your body through every stage of the menopausal transition.