Why Do Joints Ache During Menopause? Understanding the Hormonal Connection
When women reach their 40s and 50s, many experience something unexpected: sudden joint pain that seems to come out of nowhere. A woman who has been running, dancing, or lifting weights for decades without problems suddenly finds herself struggling with a stiff shoulder, aching hips, or persistent heel pain. For years, doctors have told women this is simply part of aging, but the truth is far more specific and treatable. The real culprit is menopause and the dramatic drop in estrogen that comes with it.
More than 70 percent of women experience musculoskeletal pain during perimenopause and menopause, and conditions like osteoarthritis become three times more common after menopause [4]. This widespread experience is not random wear and tear. It is a direct result of hormonal changes that affect how your body maintains and repairs connective tissue. Understanding this connection is the first step toward managing these symptoms effectively.
What Happens to Your Body During Menopause
Menopause is not a sudden event but rather a transition period called perimenopause that can last several years. During this time, your ovaries gradually produce less estrogen and progesterone. These hormones do far more than regulate your menstrual cycle. Estrogen plays a crucial protective role in maintaining the health of your joints, bones, muscles, and connective tissues throughout your body.
When estrogen levels decline, your body undergoes several significant changes. Research published in the Journal of Applied Physiology has shown that estrogen helps stimulate collagen synthesis, which is the primary protein that gives your tendons, ligaments, and cartilage their strength and flexibility [1]. As estrogen drops during perimenopause, your body’s ability to produce and maintain collagen decreases dramatically. This is not a gradual process that you might expect from normal aging. Instead, it is an accelerated breakdown of the very structures that hold your joints together and allow them to move smoothly.
The Three Main Ways Estrogen Loss Damages Your Joints
The first major change is that collagen production slows significantly [1]. Your body struggles to repair the tiny micro-tears that occur naturally during daily activity. When you walk, exercise, or even just move through your day, your tendons and ligaments experience small amounts of stress. In a healthy estrogen environment, your body quickly repairs these micro-tears. But when estrogen is low, these repairs happen much more slowly, and the damage accumulates over time.
The second change is that your tissues literally dry out [1]. Estrogen helps tissues retain water, which keeps them supple and flexible. Without adequate estrogen, your tendons become stiffer and more brittle. They lose their ability to absorb shock and adapt to movement. This is why women often describe their joints as feeling stiff, especially in the morning, and why movements that used to feel easy suddenly feel difficult and painful.
The third change is that inflammation increases dramatically [1]. A lack of estrogen leads to an increase in inflammatory cytokines, which are signaling molecules that cause joints to swell and ache. This inflammation is not localized to one area. It can affect multiple joints throughout your body simultaneously, which is why many women experience widespread joint pain rather than pain in just one location.
Additionally, estrogen has anti-inflammatory effects throughout your body [3]. When estrogen levels decline during menopause, your body becomes more prone to inflammation. This can contribute to joint stiffness and pain, particularly in joints like the hips [3]. The loss of this protective anti-inflammatory effect means your immune system becomes more reactive, and your joints bear the brunt of this increased inflammatory response.
Common Joint Problems That Appear During Menopause
Certain joint problems appear with striking frequency during perimenopause and menopause. These are not random injuries but rather predictable consequences of the hormonal changes happening in your body.
Frozen shoulder, medically known as adhesive capsulitis, is one of the most common complaints [1]. This condition causes a painful stiffening of the shoulder capsule and disproportionately affects women aged 40 to 60 [1]. Women describe it as a progressive loss of shoulder mobility that makes even simple tasks like reaching for something on a shelf or putting on a shirt extremely painful. What makes frozen shoulder particularly frustrating is that it often develops without any obvious injury or trauma.
Gluteal tendinopathy is another classic menopause-related problem [1]. This condition is often misdiagnosed as hip bursitis, but it is actually a breakdown of the tendons on the side of the hip [1]. Women experience pain on the outer hip that can radiate down the leg, and it often worsens with certain movements like climbing stairs or lying on that side.
Achilles tendonitis is also extremely common during menopause [1]. Women develop persistent heel pain that does not respond to standard rest and ice treatments. The Achilles tendon, which connects your calf muscle to your heel bone, becomes inflamed and painful. This can make walking, running, or even standing for long periods difficult.
Beyond these specific conditions, women commonly experience low back pain, muscle pain and stiffness, and general joint aching throughout their bodies [4]. The pattern is often symmetrical, meaning both sides of the body hurt similarly, and morning stiffness is particularly pronounced [5].
How Bone Density Changes Affect Your Joints
Beyond the direct effects on tendons and ligaments, menopause also affects your bones. Declining bone density is a major concern during menopause [3]. The average woman loses approximately 10 percent of her bone mineral density during menopause [5]. This loss of bone density increases your risk of fractures, but it also affects your joints in another way. Weakened bones can place extra strain on nearby joints and tissues, sometimes showing up as hip pain or other joint discomfort [3].
Osteoporosis, which is the severe form of bone loss, can lead to back pain, joint pain, inflammation, and fractures [4]. For women in menopause, lower estrogen levels may accelerate cartilage loss and inflammation [3]. This can worsen or even trigger osteoarthritis symptoms. Osteoarthritis happens when the cartilage that cushions the ends of your bones breaks down, causing bones to rub against each other [3]. This then leads to pain, swelling, and decreased mobility [3].
The Muscle and Weight Changes That Compound Joint Pain
During perimenopause and menopause, you also lose muscle mass [4]. This loss of muscle mass can affect balance, endurance, and increase the risk of falls and injuries [4]. Muscles are crucial for supporting and stabilizing your joints. When you lose muscle mass, your joints have to work harder to maintain stability
