Menopause and Musculoskeletal Health: Why is my injury taking so long to recover?! (and what Can Help..)
By Women’s Health Physiotherapist, Kathryn Melvin
For many women, menopause is associated with hot flushes, night sweats and mood changes.
What is often less recognised is the significant impact hormonal changes can have on the musculoskeletal (MSK) system. Joint pain, muscle aches, tendon problems, reduced strength and an increased risk of osteoporosis are common during the perimenopausal and menopausal years.
Many women present to healthcare professionals reporting new aches and pains, unexplained stiffness, frozen shoulder, plantar fasciitis, Achilles pain or worsening osteoarthritis symptoms.
These symptoms are not simply a consequence of ageing. In many cases, declining oestrogen levels play a significant role.
How Menopause Affects the Musculoskeletal System
Oestrogen has important effects throughout the body, including the muscles, bones, tendons, ligaments and joints. As oestrogen levels fluctuate and decline during perimenopause and menopause, several changes can occur:
Increased joint pain and stiffness
Reduced muscle mass and strength (sarcopenia)
Slower recovery following exercise
Increased tendon vulnerability and injury risk
Accelerated bone loss and greater fracture risk
Increased inflammation and pain sensitivity
These changes can affect daily activities, exercise participation, sleep and overall quality of life.
In recent years, experts have increasingly recognised what has been termed the "Musculoskeletal Syndrome of Menopause", describing the cluster of MSK symptoms experienced by many women during the menopause transition.
Common Musculoskeletal Symptoms During Menopause
Women may experience:
Joint Pain and Stiffness- Often affecting the hands, knees, hips, shoulders and spine, symptoms can be worse first thing in the morning or after periods of inactivity.
Muscle Aches and Weakness- Loss of muscle mass and reduced protein synthesis can result in decreased strength, endurance and physical performance.
Tendon Problems- Conditions such as frozen shoulder, rotator cuff tendinopathy, tennis elbow, Achilles tendinopathy and plantar fasciitis are frequently reported during perimenopause and menopause.
Bone Health Concerns- Reduced oestrogen accelerates bone resorption, leading to lower bone density and an increased risk of osteoporosis and fragility fractures.
Treatment Options
The good news is that there are effective strategies available to support women experiencing menopause-related MSK symptoms.
1. Exercise and Strength Training
Exercise remains one of the most powerful interventions.
Research consistently supports:
Progressive resistance training to preserve muscle mass
Weight-bearing exercise to support bone health
Balance and mobility exercises to reduce falls risk
Cardiovascular activity for overall health and wellbeing
Regular movement can also improve mood, sleep and energy levels.
2. Physiotherapy and MSK Rehabilitation
A tailored physiotherapy programme can help address:
Joint stiffness
Tendon pain
Reduced mobility
Strength deficits
Exercise confidence
Treatment may include education, rehabilitation exercises, pain management strategies and guidance on safe progression back to activity.
3. Menopausal Hormone Therapy (MHT/HRT)
Hormone replacement therapy may help reduce some menopause-related musculoskeletal symptoms and has a well-established role in preserving bone density and reducing fracture risk in appropriate patients.
Research suggests that restoring oestrogen levels can positively influence bone, muscle and joint health.
However, MHT is not suitable for everyone, and decisions should be made following discussion with a suitably qualified healthcare professional.
4. Nutrition and Lifestyle
Supporting musculoskeletal health also requires attention to:
Adequate protein intake
Calcium-rich foods
Vitamin D optimisation
Healthy body weight management
Smoking cessation
Limiting excessive alcohol consumption
These factors contribute to maintaining muscle function and bone health throughout midlife and beyond.
5. Osteoporosis Assessment and Management
Women with early menopause, significant risk factors or a history of fracture may benefit from formal assessment of bone health. Depending on individual risk, treatment options may include MHT or osteoporosis-specific medications.
The Take-Home Message
Joint pain, muscle aches and tendon problems are not always "just getting older". The hormonal changes of perimenopause and menopause can have a substantial impact on musculoskeletal health. Recognition of these symptoms is improving, but many women still go years without understanding the link. A combination of education, exercise, physiotherapy, lifestyle modification and, when appropriate, menopausal hormone therapy can make a significant difference.
If you are experiencing persistent pain, stiffness or declining physical function during menopause, it is worth discussing these symptoms with a healthcare professional who understands both menopause and musculoskeletal health.
References:
American Academy of Orthopaedic Surgeons (AAOS) (2026) Musculoskeletal Syndrome of Menopause. Available at: https://www.orthoinfo.org/diseases--conditions/musculoskeletal-syndrome-of-menopause-msm/ (Accessed: 6 August 2026).
Harvard Health Publishing (2026) Musculoskeletal syndrome of menopause: When menopause makes you ache all over. Available at: https://www.health.harvard.edu/womens-health/musculoskeletal-syndrome-of-menopause-when- menopause-makes-you-ache-all-over (Accessed: 6 August 2026).
New South Wales Agency for Clinical Innovation (2025) Menopause Care Clinician Toolkit: Musculoskeletal Health. Available at: https://aci.health.nsw.gov.au/projects/menopause/assessment-management/musculoskeletal (Accessed: 6 August 2026).
Sherwood Forest Hospitals NHS Foundation Trust (2025) Menopause and Musculoskeletal (MSK) Health. Available at: https://www.sfh-tr.nhs.uk/media/0labmvqv/pil202507-01-mmsk-menopause-and-musculoskeletal- msk-health.pdf (Accessed: 6 August 2026).