Joint pain in menopause: why it happens & what helps

Key takeaways

• Joint pain affects more than 70% of women during the menopausal transition, driven primarily by falling oestrogen levels that reduce the body's natural anti-inflammatory protection.
• A landmark 2024 paper in Climacteric gave this cluster of symptoms an official name: the musculoskeletal syndrome of menopause.
• Effective relief options exist, ranging from exercise and nutrition to HRT and testosterone therapy, and the right combination depends on your individual symptoms and medical history.

If your knees started aching in your mid-40s, or your fingers feel stiff every morning, or your shoulders have developed a mysterious tenderness that wasn't there a few years ago, you may have wondered whether menopause is to blame. The answer is: quite possibly, yes.

Joint pain is one of the most common and least-talked-about symptoms of the menopausal transition. A meta-analysis published in Neural Plasticity found that 71% of perimenopausal women experience musculoskeletal pain, and that perimenopausal women are significantly more likely to experience it than their premenopausal peers. Yet it rarely features prominently in the conversation about menopause, and many women are told their symptoms are simply a sign of ageing.

They are not. In this guide, we explain why menopause causes joint pain, which joints are most commonly affected, how long symptoms typically last, and what the evidence says about the treatments that can help.

Why does menopause cause joint pain?

Oestrogen does far more in the body than regulate the menstrual cycle. It also plays a significant anti-inflammatory role across multiple tissues, including cartilage, tendons, ligaments, and bone. Research published in Frontiers in Physiology confirmed that oestrogen receptors are present throughout musculoskeletal tissue, meaning that when oestrogen levels fall during perimenopause and menopause, the effects are felt well beyond the reproductive system.

When oestrogen declines, the body's ability to regulate inflammation decreases. Cartilage, the tissue that cushions joints, becomes less protected. Synovial fluid (the lubricant that keeps joints moving smoothly) reduces. Tendons and ligaments lose some of their elasticity and repair capacity. The result is a cluster of symptoms that can feel like early-onset arthritis but is driven primarily by hormonal change rather than structural joint damage.

A useful illustration of this mechanism comes from oncology. Women taking aromatase inhibitors (drugs used in breast cancer treatment that sharply suppress oestrogen) develop joint pain in approximately 50% of cases. This is not coincidence; it is the same hormonal mechanism at work, at higher speed. The link between falling oestrogen and joint pain is not incidental; it is causal

As well as oestrogen decline, there can be other contributing factors to joint pain. Reduction in testosterone levels can make it difficult to maintain muscle strength; and menopausal weight gain can add extra strain to the joints

It has a name: the musculoskeletal syndrome of menopause

Until recently, joint pain in menopause was often treated as a vague complaint rather than a recognised clinical condition. That changed in 2024, when Wright, Schwartzman, Itinoche, and Wittstein published a landmark paper in Climacteric naming the "musculoskeletal syndrome of menopause" as a distinct clinical entity driven by oestrogen loss.

The paper reported that more than 70% of women will experience musculoskeletal symptoms during the menopausal transition, and that 25% are significantly disabled by them. These are not trivial numbers.

Naming the syndrome matters for two reasons. First, it validates the experience of women who have been told their symptoms are "just ageing" or who have had scans showing no structural damage and been sent away without explanation. Research suggests that around 40% of women with musculoskeletal symptoms during menopause have no structural findings on imaging; their pain is real and hormonally driven, not a sign of structural joint disease. Second, it gives women the language to advocate for themselves.

If you have been dismissed with a normal scan result and no further investigation, it is worth knowing that "no structural damage" does not mean "nothing is wrong". It may mean that what is wrong is hormonal, not structural, and that the appropriate treatment pathway is different.

Which joints are most affected?

Menopausal joint pain is not random. It tends to follow recognisable patterns.

Hands and fingers are among the most commonly reported sites. Morning stiffness, swelling around the knuckles, and aching at the base of the thumb are typical presentations. This can look and feel like early rheumatoid arthritis, which is why accurate clinical assessment matters.

Knees and hips are particularly affected because they are weight-bearing joints. As muscle mass declines during the menopausal transition (more on this in the next section), the load on these joints increases.

The spine is another frequent site, with lower back and neck pain both reported more commonly during perimenopause and menopause.

Frozen shoulder (adhesive capsulitis) is an underrecognised presentation. Women in their mid-40s who develop sudden-onset shoulder stiffness and pain are rarely told that this may be hormonally related; in practice, there is a well-documented association between menopause and frozen shoulder that remains underrepresented in clinical settings.

Tendons and ligaments are also affected. The same Frontiers in Physiology research showed that oestrogen decline reduces tendon repair capacity and increases injury risk, which is why women in perimenopause may notice more tendon-related pain, such as plantar fasciitis or tennis elbow, without any clear mechanical cause.

It is not just oestrogen: the role of testosterone and muscle loss

Oestrogen is the primary driver of menopausal joint pain, but it is not the only hormonal factor. Testosterone, often associated with men but equally important for women, also declines during the menopausal transition. Testosterone plays a role in maintaining muscle mass, supporting connective tissue strength, and modulating pain perception. When it falls alongside oestrogen, the combined effect on joints and muscles can be significant.

Muscle loss (sarcopenia) is a related concern. During perimenopause and menopause, women tend to lose muscle mass at an accelerating rate. Muscle supports and stabilises joints; when muscle bulk reduces, joints become more vulnerable to load and repetitive strain. The knee is particularly exposed: the quadriceps, which protect the knee joint, are among the muscles most affected by age and hormonal decline.

This is why a comprehensive approach to menopause joint pain goes beyond joint-specific treatment. Addressing muscle health through both exercise and, where appropriate, testosterone therapy, is increasingly recognised as part of a complete management plan.

NICE guideline NG23 formally includes musculoskeletal symptoms, including joint and muscle pain, as recognised menopause-associated symptoms requiring clinical management.

How long does menopause joint pain last?

This is one of the most common questions women ask, and the honest answer is that it varies.

For many women, joint pain is most pronounced during perimenopause, when hormone levels are fluctuating most dramatically. Once the body adjusts to consistently lower oestrogen levels post-menopause, some women find that symptoms stabilise or reduce.

However, research from the Neural Plasticity meta-analysis suggests that musculoskeletal pain does not automatically resolve after menopause. For a significant proportion of women, it persists into the post-menopausal years, particularly if it is left unaddressed.

The key variables that affect duration include:

• How early symptoms are recognised and treated
• Whether the underlying hormonal picture is addressed
• Lifestyle factors, particularly exercise and diet
• Individual health history, including pre-existing joint conditions

“This is worth knowing not to alarm you, but to reinforce that joint pain in menopause is not something to simply wait out. Early intervention, whether through lifestyle change, medical treatment, or both, generally produces better outcomes than watchful waiting.”

Katy Jackson, Clinical Director - Women's Health

What actually helps: a guide to relief

Exercise

The evidence for exercise in managing menopausal joint pain is robust. Resistance training helps maintain and rebuild the muscle mass that protects joints. Low-impact aerobic exercise (swimming, cycling, walking) keeps joints mobile without excess loading. Flexibility and balance work reduces injury risk (yoga, pilates.)

The important qualifier: exercise needs to be appropriate to your current level of joint pain and function. If your symptoms are acute, starting with low-impact movement and building gradually is more sustainable than pushing through a high-intensity programme.

Nutrition

An anti-inflammatory diet supports joint health during the menopausal transition. This means prioritising oily fish (a source of omega-3 fatty acids), vegetables, whole grains, and foods rich in vitamin D and calcium. Weight management also matters: for every extra kilogram carried, the load on the knee joint increases by roughly four kilograms. This is not a moral judgement; it is a straightforward biomechanical reality that is worth being aware of.

Supplements

Clinically personalised supplementation can support musculoskeletal health during menopause. Creatine (5g daily) may support muscle strength, energy, and brain function. Magnesium glycinate may help with muscle relaxation and sleep. Vitamin D3 and K2 supports bone health.

These are not curative treatments for joint pain, but they can form a useful part of a wider plan. Voy's supplementation approach is symptom-led and clinician-recommended, not a self-select wellness shelf.

HRT

The evidence for HRT improving musculoskeletal symptoms is growing, though it is not yet definitive for all joint conditions.

A 2025 systematic review and meta-analysis published in Therapeutic Advances in Musculoskeletal Disease by Overton and colleagues is the most comprehensive synthesis to date. The review searched 30,739 studies and included 57 studies covering nearly four million participants. It synthesised evidence on HRT and generalised musculoskeletal pain, osteoarthritis, rheumatoid arthritis, gout, and carpal tunnel syndrome. The authors noted the absence of formal clinical guidance on HRT specifically for musculoskeletal pain, and the overall body of evidence points in a consistent direction: HRT addresses the hormonal mechanism underlying joint symptoms.

A 2022 feasibility study published in The Lancet Rheumatology specifically examined HRT in post-menopausal women with painful hand osteoarthritis. When women stopped treatment, pain flared in nearly half, compared to one in six on placebo. This is preliminary evidence (the study was designed to test feasibility for a larger trial, not to establish definitive efficacy), but the signal is meaningful.

For most women, HRT addresses the root hormonal cause of joint symptoms rather than masking pain. Research suggests it reduces systemic inflammation, supports cartilage and connective tissue, and improves the hormonal environment that protects joints.

HRT is a prescription treatment, and suitability is assessed individually. If you have concerns about HRT safety, including questions about breast cancer risk, a specialist consultation is the appropriate place to explore this. Your individual health history, family history, and symptom profile all inform the risk-benefit assessment.

Testosterone therapy

Testosterone for women remains underused and underrecognised, partly because it sits outside the standard menopause conversation, and partly because many GPs have limited experience prescribing it for women.

Where testosterone levels are low, testosterone therapy may support muscle mass, connective tissue strength, energy, and pain perception. For women whose joint and muscle symptoms include significant fatigue and loss of strength alongside pain, a testosterone assessment as part of a broader menopause review is worth discussing with a specialist.

Voy's menopause treatment plans can include testosterone therapy (available as Testogel, Androfeme, or Voy's Testosterone cream) alongside HRT and other treatment components. A testosterone blood test within the last three months is required before a prescription can be issued.

When should you see a specialist, and what to expect?

Some joint pain during menopause will respond to lifestyle changes alone. But there are clear indicators that a specialist assessment is warranted:

• Pain that is significant enough to affect daily life, sleep, or mobility
• Morning stiffness lasting more than 30 minutes
• Joint swelling, warmth, or redness (these may indicate inflammatory arthritis and need separate clinical assessment)
• Pain that is worsening rather than stable
• Symptoms that have not responded to lifestyle modification after several weeks
• Any suspicion that your symptoms may be hormonally driven but you have not had a menopause-focused assessment

It is also worth seeking specialist input if you have been told "everything looks normal" on a scan but are still in significant pain. As noted earlier, the absence of structural findings does not mean the absence of a treatable condition.

The standard GP appointment often does not provide the time or the specialist focus needed to fully assess musculoskeletal symptoms in the context of menopause. A 45-minute consultation with a BMS-trained menopause specialist is a different kind of appointment: one where your symptoms are explored in full, your hormonal picture is assessed, and a treatment plan is built around you rather than around a standard protocol.

88% of Voy members felt more hormonally balanced at three months (compared to 62% receiving standard care), and 93% reported an improvement in overall quality of life, data presented at The Menopause Society 2025 and forthcoming in Climacteric. Joint pain is one part of a symptom picture that, when properly addressed, can change significantly.

An initial consultation with Voy costs £99, compared to £295 at many private clinics.

Conclusion

Joint pain in menopause is not something you need to accept as the price of getting older. It has a recognised hormonal mechanism, a growing evidence base for treatment, and effective options that can make a real difference to daily life.

If your symptoms are affecting your sleep, your mobility, or your quality of life, you deserve a proper assessment from someone who understands the full picture.