Why Hormonal Changes Cause Joint Pain in Menopause | Stella
Your body
4 mins

Why hormonal changes are making your body ache

byDr Michelle Griffin

Are you making a weird “Ooofff!” noise every time you get up from the sofa? Do your legs feel stiff if you’ve sat down too long? Does it sometimes feel like someone’s taken a hammer to your shoulders, hips, knees and feet? It’s likely your aches and joint pain in menopause that can come and go are down to hormonal changes affecting your musculoskeletal system. In other words, your bones, joints, muscles, ligaments and tendons start to become stiff and sore during menopause – we’ve got some exercises to help aching joints during menopause.

During perimenopause and beyond, your body begins to produce much lower levels of certain female hormones, including oestrogen and progesterone. Since these play a vital role in the health and maintenance of the musculoskeletal system, the decrease in hormones can cause a number of different problems. 

Increased sensitivity to joint pain in menopause

Changes to the way you feel pain are common after menopause. Although this isn’t a medical condition as such, it can have a huge impact on your life. It can mean that pre-existing medical conditions become more painful and that you feel more acutely joint pain in menopause.

Why is this? Yes, you guessed correctly, it’s down to decreased oestrogen levels. When oestrogen levels are high, your brain’s centre for pain acts more efficiently and encourages the release of chemicals called endorphins and enkephalins. These act as natural painkillers and reduce the amount of pain we feel.

When oestrogen levels are low, these chemicals are released more inefficiently and at lower levels. This means we experience higher levels of menopause joint pain than we would have felt prior to menopause.

If you are struggling with any kind of pain, talk to your GP to make sure that you are getting the correct treatment. Read more in our symptoms library about aches and pain.


Your tendons are the thick, tough bundles of tissue that connect muscles to bones, made mostly of a protein called collagen. The decrease in oestrogen levels at menopause causes a decline in collagen production. As well as skin and hair changes, reduced collagen can cause tendon degeneration and make them more prone to injury and wear. This is known as tendinopathy.

Tendinopathy is most commonly found in the Achilles tendon (at your heel), the rotator cuff (in your shoulder) and the patellar tendon (near your knee). Pace your exercise program and incorporate stretching into your routine to prevent and reduce tendinopathy.

See your doctor for advice if you think you may have tendinopathy or a tendon injury, as further treatment is sometimes needed.


Osteoarthritis is extremely common and often known as the ‘wear and tear’ form of arthritis. It can affect any joint, from the tiny joints in your hands to larger joints, including the hip and knee.

Symptoms include joint pain in menopause or stiffness, although you may feel pain in other areas as well. You may have painful swelling of the joints or a grinding or crunching sensation when moving joints. 

  • Around one in five adults over the age of 45 suffer from osteoarthritis of the knee and one in nine have it in their hips
  • Postmenopausal women are more prone to it compared with men of a similar age
  • 18% of women over 60 have osteoarthritis compared to 10% of men of the same age according to one study

Why does osteoarthritis become more common around the time of menopause?

A joint is when two bones come together alongside other structures which cushion and protect the bony surfaces, including cartilage. Osteoarthritis causes cartilage to become thin and it struggles to regenerate, partly due to inflammation. These changes can cause pain, swelling and reduce your movement and, eventually, lead to changes in the bone itself.

We know that the female hormone oestrogen protects the body, including tissues like cartilage from inflammation. When oestrogen levels drop at menopause, inflammation and, in turn, osteoarthritis becomes more common. This why you have increased joint pain in menopause.

Don’t panic! It’s not all doom and gloom and there is something you can do. Exercise has been proven to reduce joint pain, improve physical function and increase quality of life among those with osteoarthritis. In moderation, it even has a natural anti-inflammatory effect which can help improve your symptoms as exercise reduces levels of a chemical, prostaglandin E2, which promotes inflammation and pain perception in the body.

A note of caution, as balance is important here. Exercise which is too intense or demanding can trigger inflammation and cause injuries, particularly as we age. Avoid exercising excessively, and ensure that you warm-up and cool down properly.

If you still struggle with pain or mobility, your GP may be able to suggest treatments to help.

Thinning bones (osteoporosis and osteopaenia)

Thinning bones is very common in women postmenopause and is known as osteoporosis or, in milder cases, osteopenia. Both of these conditions can increase your risk of fractures.

Did you know that bones replace 10% of their mass every year? Your bones are constantly regenerating just like any other living tissue and are able to heal and repair following injury throughout our lives. They are also able to strengthen in areas which are subject to more stress, for example due to heavy physical work or repeated movements.

Much of this constant repair and strengthening of the bones is undertaken by cells which are stimulated by oestrogen. When oestrogen levels decrease during menopause, the cells receive less encouragement to repair bones, and the whole process slows down.

You can improve your bone density with certain types of exercise, including weight-bearing exercises (running, walking and even Highland dancing, if you are an adventurous type) and muscle-strengthening exercises (weightlifting, body-weight exercises such as push-ups, and some types of yoga). Read more about osteoporosis.

Reduced muscle mass (sarcopaenia)

It’s not just bone density that decreases during and after menopause. You may find that it is also harder to maintain muscle mass, which is particularly galling if you have been putting in the hours at the gym but finding it harder to keep up. Sarcopenia is the medical term for this process.

The loss of muscle mass accelerates at the time of menopause due to hormonal changes. Oestrogen is thought to encourage your muscles’ response to factors which typically encourage growth and repair, including strength training. When oestrogen levels drop due to menopause, this beneficial effect is lost.

You can, however, help slow the rate of muscle mass loss by ensuring that your diet is rich in proteins (found in meat, fish, dairy products and legumes among others), and by doing regular strength training. There is also evidence that hormone replacement therapy (HRT) can increase muscle mass.

Menopause joint pain natural remedies

Pilates helps strengthen and stretch your muscles and joints, making it an excellent choice for bone and muscle health in menopause. Remember to:

  • Pace yourself
  • Engage your core
  • Don’t be afraid of a little discomfort

1 – Shoulder lift

This is a good warm-up. Bring shoulders to the ground and then lift from the ground. Hold for 20 seconds and relax. Repeat two more times. During the shoulder lift, take time to engage your mind, or set a goal for your pilates session.

2 – Core activation

Loosen your shoulders and back. Engage your core and hold for two minutes.

3 – Hamstring stretch

This exercise loosens the hamstrings, hip flexors and calves. Reach for your toes (or as far as you can get!) and hold at the point of discomfort. It helps to do two sets of 30 seconds as you build up to a full one-minute hold.

4 – Glute bridge

Aim to hold this glute bridge position for two minutes – breaking it into two one-minute intervals or four 30-second intervals can be a useful start. If you can’t quite reach the full-bridge position, you can place your legs out further in front of you and lift from there. Engaging your core and glutes together is key in this exercise!

Menopause joint pain

  1. Talk to your doctor if you have joint pain in menopause
  2. Pace your exercise program and incorporate stretching into your routine to prevent and reduce tendinopathy
  3. Moderation exercise has a natural anti-inflammatory effect if you have osteoarthritis
  4. Improve bone density with weight-bearing and muscle-strengthening exercises
  5. Slow muscle mass loss by eating more protein

Find out more about the stages of menopause, and more, by reading our blog. Or head to our symptoms library to find information about your most bothersome symptoms.