Joint Pain in Perimenopause and Menopause: What May Be Behind It and What Helps
You wake up with a stiff knee and can't remember doing anything to it. A shoulder that never bothered you now aches when you reach for the top shelf. You take a strength class on Tuesday and you are still sore on Friday. An old injury you thought you'd left behind is suddenly back. Joint pain is real after menopause.
And the most frustrating part? You are doing more for your health than ever. You walk, you stretch, you finally started lifting weights. Yet your body doesn't seem to be getting the message.
If you've ever thought, “Is this just what getting older feels like?”, you are not alone. Many women quietly decide the aches are something to push through, or a sign that they should do less. Some stop exercising altogether because every workout seems to cost them three days of soreness.
These are common complaints I hear from my Pilates clients. Many are committed to exercise but notice that their joints feel different. In my practice, some report feeling better when they move regularly at an appropriate intensity. My approach is to build strength gradually and help them practice controlled, comfortable movement, not push through pain.
What you are feeling is real. Muscle and joint symptoms are common during the menopause transition, and researchers are paying more attention to them. But new pain still deserves an assessment rather than an automatic menopause label, so listen to your body and seek help from a physician when needed.
The musculoskeletal syndrome of menopause
In 2024, researchers writing in Climacteric proposed the term ‘musculoskeletal syndrome of menopause’ to describe a collection of musculoskeletal changes associated with estrogen loss. It covers the joint pain, muscle aches, and stiffness that so often show up in perimenopause and menopause [1].
Muscle and joint pain are common during the transition. A 2020 review combining results from multiple studies estimated that 71% of perimenopausal women reported muscle or joint pain, although estimates varied considerably [3]. The takeaway is not that every woman will develop these symptoms. Muscle and joint discomfort during this transition is common enough though to deserve attention.
Naming it matters. When you know there is a reason behind the aches, you can stop blaming yourself and start working with your body instead of against it.
Why join pain happens in menopause
There is unlikely to be one explanation for every woman’s pain. Hormonal changes may contribute, but age, existing joint or tendon conditions, changes in activity, and sleep can also matter.
1. Your tissues are changing. Estrogen acts on tissues throughout the musculoskeletal system, including bone and skeletal muscle. Changes in estrogen may contribute to musculoskeletal changes during menopause. However, the evidence is clearer for some outcomes, such as bone loss, than for explaining an individual woman’s joint pain or workout recovery [1].
2. Your nervous system may be more sensitive. This was one of the most eye-opening points from a women's health summit I attended last month. Researchers believe that hormonal changes during perimenopause may influence how the nervous system processes pain, so discomfort in the knee or shoulder may feel more intense. This is one possible contributor [3]. Poor sleep, which is common in perimenopause and beyond, can add to the problem by making you more sensitive to pain [4].
These changes may leave your body feeling less resilient and more sensitive at the same time. That is not a personal failing. Your symptoms deserve attention, not blame. Understanding the possible contributors can help you and/or your healthcare team choose a more useful plan.
Why your workouts leave you sore for days now
Here is something most of us were never taught: your muscles do not get stronger during your workout alone. You also build strength during recovery. Strength training provides a stimulus for adaptation, and recovery is part of that process. Feeling sore is not the goal. Delayed onset muscle soreness is especially common after unfamiliar or strenuous exercise and often peaks one to three days later [8].
Many women enter a frustrating cycle where they push through soreness because they were told consistency is everything. They then get more run down, or tweak something, causing them to stop for a few weeks to heal. After that they start again from scratch.
What good recovery looks like:
Give each muscle group about 48 hours before training it hard again [5]. You can still move every day; just alternate, such as upper body one day and lower body the next.
Make rest days active. A walk, a gentle Pilates session, or easy mobility work often eases soreness better than sitting still [9].
Eat protein at every meal, about 25 to 30 grams, instead of saving most of it for dinner [6]. Your muscles need those building blocks spread through the day.
Protect your sleep. Much of your body's repair happens while you sleep. Poor sleep can also make you more sensitive to pain [4].
Build up gradually. Going from nothing to a bootcamp class is a big jump and could lead to injury. Increase the load a little at a time.
Know the difference between soreness and pain. A dull, achy feeling in the muscle a day or two after a workout can be normal soreness [8]. Sharp pain, radiating pain, joint pain, swelling, or soreness that gets worse instead of better means your body is asking you to stop and get it checked.
What helps joint pain day to day
The good news is that the same habits that support recovery also ease the aches.
Move a little every day. Daily movement and exercise, even a walk, is one of the most consistent ways to reduce joint and muscle pain and improve function [7]. Movement is how joints get nourished.
Strengthen the muscles around your joints. Strong muscles support your knees, hips, back, and bones [2, 5]. IIf you want to know why not every workout builds bone, read my blog on Why Your Workouts May Not Be Building Stronger Bones.
Pay attention to alignment. How you stand, sit, and move changes where the stress lands. I wrote more about this in my blog on How Better Body Alignment Can Lead to Joint Pain Reduction.
Treat sleep as part of your training plan, not an afterthought.
Eat to support repair: plenty of protein, fiber, fruits and vegetables, and less added sugar.
Ask your doctor the right questions. If aches are affecting your life, ask whether hormone changes could be playing a role and what your options are. Your physician can help you weigh treatment options if you are interested.
When to see a doctor: swelling, pain that wakes you up or stops you from moving normally, or symptoms that keep getting worse. Your physician can consider other causes, such as arthritis, thyroid problems or an injury, and decide whether testing or imaging is needed [2]. Seek urgent medical attention for a hot, swollen joint, especially with fever or feeling unwell, or sudden severe joint pain [10].
How I can help with joint pain in menopause
No single provider covers all of this, and that is exactly the problem. Your doctor diagnoses and treats. A physical therapist rehabs an injury. A trainer gives you a workout. But someone needs to connect all of it to how you actually live, train, and recover from week to week.
That is where I come in. As a STOTT certified Pilates reformer instructor with specialized training in injuries and osteoporosis, I help clients build strength safely and progressively, without the cycle of overdoing it and starting over. As a National Board-Certified Health and Wellness Coach, I help with the pieces that make recovery work: sleep, protein, daily movement, nutrition, and a plan you can actually stick to. And after 25 years in clinical research, I read the studies so you don’t have to, and I help you bring informed questions to your doctor. Book a 55-minutes Optimal Health strategy session today and let's get started!
References
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466-472. doi:10.1080/13697137.2024.2380363
Harvard Health Publishing. Musculoskeletal syndrome of menopause: when menopause makes you ache all over. Harvard Medical School. https://www.health.harvard.edu/womens-health/musculoskeletal-syndrome-of-menopause-when-menopause-makes-you-ache-all-over
Lu CB, Liu PF, Zhou YS, et al. Musculoskeletal pain during the menopausal transition: a systematic review and meta analysis. Neural Plasticity. 2020;2020:8842110. doi:10.1155/2020/8842110
Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. Journal of Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine & Science in Sports & Exercise. 2011;43(7):1334-1359. doi:10.1249/MSS.0b013e318213fefb
Paddon Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Current Opinion in Clinical Nutrition and Metabolic Care. 2009;12(1):86-90. doi:10.1097/MCO.0b013e32831cef8b
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017;4:CD011279. doi:10.1002/14651858.CD011279.pub3
Wilke J, Behringer M. Is “Delayed Onset Muscle Soreness” a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort. International Journal of Molecular Sciences. 2021;22(17):9482. doi:10.3390/ijms22179482.
Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology. 2018;9:403. doi:10.3389/fphys.2018.00403.
National Health Service. Joint pain. Patient guidance on symptoms and when to seek medical help.
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