By Dr. Marguerite Weston |
Menopause & Joint Pain
Natural Hormone Changes Impact Joint Health & Chronic Discomfort
Many women don’t realize that shifting hormones can show up as achy, stiff joints — not just hot flashes, brain fog or sleep changes. Joint discomfort can feel “everyday,” making it easy to shrug off, which makes it easy to overlook during a routine doctor’s appointment.
Let’s connect the dots between menopause and joint pain so you can get to the root cause of your discomfort faster.
Why Do My Joints Hurt During Menopause?
As estrogen levels fall during the natural menopausal transition, tissues inside the joint (cartilage, synovium, ligaments) lose some of the anti-inflammatory and lubricating support that estrogen used to provide. That shift can heighten pain signaling and stiffness, especially in the hallmark regions like hands, knees, hips, neck and low back.
More than half of people going through menopause report arthralgia (aka joint pain), although it’s under-reported.
“I’ve had patients where I have to bring up joint discomfort to them first because they’re so used to living with it for so long. While it is quite common, than doesn’t mean it should be normal, especially when we have options to mitigate that pain.”
-Dr. Marguerite Weston
What Is Musculoskeletal Syndrome of Menopause?
It’s a helpful umbrella term proposed in 2024 to describe the common, estrogen-linked cluster of arthralgia, loss of muscle mass, bone loss and faster osteoarthritis progression that many people notice from perimenopause into the postmenopausal years. Naming it helps demystify what patients already feel and points toward proactive steps to improve overall well-being.
How Does Menopause Influence Osteoarthritis (OA) Risks?
After menopause, lower estradiol alters cartilage metabolism, synovial inflammation and subchondral bone remodeling. This is part of why OA becomes more prevalent and why symptoms can accelerate in midlife.
Women should watch for activity-related joint pain, progressive stiffness, bony enlargement and function loss. If swelling/warmth or prolonged morning stiffness appear, get evaluated to rule out inflammatory arthritis and discuss treatment options (from exercise and weight management to medications and, in select cases, hormone therapy).
You May Have Experienced Lighter Versions of Discomfort Before
It’s common to notice joint aches cyclically with periods and again in perimenopause when hormones are fluctuating. Many women just don’t recognize it as “joint pain” and chalk it up to being tired or “just sore.” These milder flares can intensify as estrogen steadies at a lower level after the final menstrual period.
The Hormones That Impact How We Feel During Menopause
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Helps modulate inflammation, maintain cartilage metabolism and support the production of joint-lubricating synovial fluid. With less estrogen, joints can feel stiffer and more sensitive.
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The most biologically active estrogen. During perimenopause, it swings before settling lower after menopause; those shifts are closely linked with the “musculoskeletal syndrome of menopause,” including arthralgia, loss of muscle mass and faster OA progression.
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Adequate levels help preserve muscle mass and may support overall musculoskeletal health, but testosterone therapy in women is evidence-based specifically for hypoactive sexual desire disorder only. In trials, added testosterone hasn’t shown clear reductions in average joint pain.
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Stress and poor sleep can dysregulate cortisol, which in turn can heighten pain sensitivity and amplify inflammation. Breaking the pain-stress cycle with good sleep hygiene, paced breathing and movement can help profoundly.
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Softens ligaments during pregnancy and can contribute to pelvic girdle pain. It’s not a major driver of menopausal joint pain (levels are low outside pregnancy), but a history of pregnancy-related laxity may shape how joints feel later.
Does Hormone Therapy For Joint Pain Work?
Hormone replacement therapy (HRT) can be effective at treating menopause related symptoms, especially early after menopause has started. In the Women’s Health Initiative estrogen-alone trial (women without a uterus), participants reported a modest but sustained reduction in joint pain versus placebo.
HRT isn’t prescribed specifically for joint pain. However, it is often a welcome benefit for patients that seek a tailored health plan that improves sleep, mood and musculoskeletal comfort.
“Hormone therapy raises all ships when prescribed correctly. It can help address a multitude of symptoms at once. Even if it doesn’t completely erase all discomfort stemming from one symptom, the collective improvement really helps improve quality of life.”
-Dr. Marguerite Weston
Lifestyle Changes You Can Make To Ease Joint Pain
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Keep moving daily: Short, frequent walks or cycling reduce stiffness and improve function; movement is one of the most effective arthritis self-management tools.
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Hydrate & fuel consistently: Aim for regular fluids and balanced meals with more protein, colorful plants and fiber to support tissue repair and a healthy inflammatory response.
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Prioritize sleep: A consistent sleep regimen — rooted in minimal blue light exposure and a calming routine — helps normalize cortisol and pain processing.
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Vitamin D & calcium: Ask your clinician about vitamin D testing and meeting calcium needs to protect bone during and after menopause.
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Heat in the morning & movement breaks: Warm showers and heating pads ease stiffness; set hourly timers to stand and stretch wrists, hips and hamstrings.
- Work with PT or OT if pain lingers: Targeted mobility, gait and ergonomic coaching pays off, especially for knees, hips and hands.
- Strength train 2–3 days/week: Build/maintain muscle around joints to improve support and reduce pain over time. Start light; focus on form.
“Lifting weights is probably the last thing you want to do, coming off a hot flash. But moving — especially resistance work — is one of the most influential lifestyle changes you can make for your menopausal symptoms.”-Dr. Marguerite Weston
Dr. Weston’s Top 3
Strength Training For Menopause: Resistance Exercises To Protect Joints Long-Term
Box Squat (to chair) or Goblet Squat
Feet shoulder-width, brace your core, hinge slightly then sit back to tap the box/chair, with knees tracking over toes.
2–3 sets of 6–10 controlled reps; pause on the box to avoid bouncing
Hip-Hinge Romanian Deadlift (dumbbells)
Soft knees, push hips back to feel tension in hamstrings, keep spine neutral, weights close to thighs; stand tall by driving through heels and glutes.
2–3 sets of 6–10 reps; range stops before back rounds
Band or Cable Row (seated or half-kneeling)
Neutral spine, pull elbows toward ribs without shrugging; slow return. Think “chest tall, ribs down” to spare the neck/shoulder joints.
2–3 sets of 8–12 reps
What Are The Benefits Of Creatine For Menopausal Women?
Creatine monohydrate (about 2.5–5 grams/day) is among the most studied and safest supplements on the market. When paired with resistance training, it helps preserve muscle strength and function while indirectly stabilizing and unloading sore joints. Creatine can reduce inflammation and improve functional movements that can matter for fall risk.
This supplement is quite easy to mix into your daily diet and can be a low-risk adjunct to exercise for joint comfort and healthy aging. As always, confirm your dose and kidney history with your clinician before taking creatine.
“And don’t worry, ladies. You’re not going to bulk up by using creatine. You’re just going to feel less stiff & more like yourself again.”– Dr. Marguerite Weston
When Should I Consider Labs or Imaging Tests For Joint Pain?
We advise that patients see a professional if pain persists beyond a few weeks, limits function and/or comes with swelling, warmth/redness, morning stiffness lasting 30–60 minutes, fever, rash or unexplained fatigue/weight change. These are red flags that merit evaluation.
Your discomfort deserves an answer and a solution. If you are not getting enough out of your visits with your traditional healthcare provider, functional medicine offers the opportunity to discover what is happening inside your body. This often includes the use of diagnostic lab testing, such as CBC, ESR/CRP (to gauge inflammation), thyroid panels, autoimmune markers, vitamin D panels and other mineral deficiency testing.
Some clinicians also use the DUTCH test, a dried-urine hormone metabolite test to map estrogen/progesterone patterns. Analytic studies show strong agreement with serum/24-hour urine for certain hormones.
About The Author
Marguerite Weston, MD, IFMCP, is a double board-certified physician specializing in functional medicine in Columbus, Ohio. She partners with patients to identify root causes of discomfort in the menopausal transition and beyond. She employs education-driven care and, when appropriate, hormone therapy as part of a personalized plan to improve overall quality of life.
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