The Musculoskeletal Syndrome of Menopause: Why Your Joints Ache in Perimenopause

It Finally Has a Name

If your knees, hips or shoulders started aching somewhere in your 40s, you have probably already been offered the standard explanation: it's just aging. Take some ibuprofen.

In 2024, a group of researchers looked at the same pattern and reached a different conclusion. In a review published in Climacteric, the journal of the International Menopause Society, they named it the musculoskeletal syndrome of menopause: the cluster of joint pain, muscle aches, tendon problems and stiffness that arrives with the menopause transition.¹ By their account, more than 70% of women experience musculoskeletal symptoms through the transition from perimenopause to postmenopause, and about 25% are disabled by them.

It sounds almost unbelievable. One woman in four, significantly limited by something that until 2024 did not even have a name.

Naming matters. A symptom without a name gets explained away, by doctors and eventually by the woman herself. A symptom with a name can be looked for, studied and taken seriously.

How Common Is Joint and Muscle Pain in Perimenopause?

The naming paper was a review, so it is fair to ask what the underlying numbers look like. A 2026 meta-analysis in JBJS Open Access pooled data from 93,021 women and found muscle or joint pain in 40% of premenopausal women, 57% of perimenopausal women and 59% of postmenopausal women.²

One thing to keep in mind, which the authors state themselves: age and hormones travel together, so studies like this cannot fully separate the two. What they can say is that the steep change in pain sits at the perimenopause, not spread evenly across the decades.

Why It Happens: Estrogen and Your Joints

Estrogen is usually talked about as a reproductive hormone, but estrogen receptors sit in cartilage, tendon, ligament and muscle tissue.¹ Estrogen influences inflammation, collagen production and how connective tissue repairs itself. When levels fall, and in perimenopause they do not so much fall as lurch, that support becomes unreliable. For many women the result is joints that ache without injury, tendons that flare, mornings that start stiff, and workouts that take longer to recover from.

The usual sites are the shoulders, elbows, hips, hands and knees, and tendon problems like tennis elbow become more common in this decade even in women who have never held a racquet.¹

Researchers are candid that the mechanism is not fully mapped. But the pattern is consistent enough, and common enough, that "it's just aging" no longer holds up as the whole story.

Which is worth pausing on, because the advice most women get at this point was never built around any of it. The stretches, the ibuprofen, the "maybe ease off the exercise": all reasonable-sounding, all handed out as though a 48-year-old woman's joints were a 30-year-old's with more miles on them. Until 2024, the physiology underneath her pain did not even have a name.

Two Years of Hip Pain, and What I Wish Someone Had Said

I know this pattern from the inside.

For about two years, my hips hurt. It hurt to sleep (both sides!), so I was tired. It hurt getting out of bed, so mornings started with me shuffling like a 90-year-old. Some days it hurt to walk or exercise. I did what you are supposed to do: I saw doctors, PT. Bloodwork came back normal. Scans found nothing dramatic. Nobody could tell me why I hurt.

And here is the bit I suspect you will recognise. After enough appointments with no answers, I stopped wondering what was wrong with my hips and started wondering whether I was overreacting. Whether this was just what everyone felt like as they got older and everyone else simply coped better.

The pain has eased for months at a stretch, but it still comes and goes. I am not writing this from the far side of it. But what changed everything was learning that this was real, it has a name, and that there are things I can do to help.

What Actually Helps Menopause Joint Pain

No single thing fixes this. Anyone who tells you otherwise is selling the fix. What the evidence supports is a foundation built from several modest, reliable pieces.

Strength training, even now, even here

The single best-supported piece is resistance training. A 2026 meta-analysis of 126 studies covering 4,019 women found that postmenopausal women gained strength from resistance training at the same rate as premenopausal women.³ The window does not close. Stronger muscles stabilise and cushion the joints they cross, and muscle is exactly what the transition quietly takes; we have written more about that in why perimenopause weight gain starts with muscle loss.

For hip osteoarthritis specifically, an updated Cochrane review found exercise improves pain more modestly than once thought.⁴ Movement is not a cure. But avoidance has a documented cost of its own: move less and muscles weaken, joints stiffen, and pain tends to grow. If moving hurts, the working rule from rehabilitation research is that pain during sensible activity which settles within a day is generally acceptable, while sharp or escalating pain is a signal to scale back and get assessed. Hurting is not the same as harming, and a physiotherapist can help you find the line.

An honest word about hormone therapy

You might expect hormone therapy to fix a hormone-driven pain, and for some symptoms it is highly effective. For this one, the evidence is surprisingly muddy: a 2025 meta-analysis found no clear effect of hormone therapy use on musculoskeletal pain.⁵ That is not an argument against hormone therapy, which is a conversation for you and your clinician. It is an argument against expecting any one lever, including that one, to carry this alone.

Turmeric

Curcumin, the active compound in turmeric, has reasonable evidence behind it. A 2025 network meta-analysis of 17 trials found turmeric preparations significantly reduced osteoarthritis knee pain, and earlier pooled trials found curcumin comparable to over-the-counter anti-inflammatories with fewer stomach side effects.⁶ Worth discussing with your clinician, especially if you are reaching for ibuprofen often.

Omega-3s

A 2023 meta-analysis of nine trials covering 2,070 people with osteoarthritis found omega-3 supplementation brought small but real improvements in joint pain and function.⁷ A reasonable, low-risk piece of the foundation.

Collagen

Collagen is the protein your joints are largely made of, and supplementation has moderate supporting evidence for joint comfort, built gradually over months rather than weeks. We have covered what actually matters in a collagen for menopause joint pain, including why the form of collagen changes what your body can do with it.

Creatine

Creatine will not treat joint pain. Its role here is the muscle around the joint: a 2026 meta-analysis of seven trials in postmenopausal women found that creatine at 5 grams a day, combined with resistance training, added measurably more lean mass and strength than training alone.⁸ If you are considering it, read what the research says about creatine in menopause.

The quiet basics

Protein at most meals, sleep guarded the way you would guard a meeting, walking on the days lifting feels like too much. None of it is dramatic. All of it feeds the same repair systems estrogen used to manage.