Menopause, Joint & Muscle Health

Health Overview - How Menopause impacts our muscles and joints

Musculoskeletal (muscle & joint health) complaints are a frequently reported but underappreciated feature of the menopausal transition. Epidemiological data suggest that up to 60–70% of peri- and postmenopausal women experience new or worsening joint and muscle pain (Leveille et al., 2001; Chlebowski et al., 2013). The decline in ovarian sex steroids — primarily oestradiol and, to a lesser extent, testosterone — exerts multifaceted effects on bone remodelling, muscle metabolism, and connective tissue integrity. These changes may mimic or exacerbate degenerative or inflammatory joint conditions, leading to diagnostic uncertainty and under-treatment.

Menopause effects on muscle and bone health

Common Musculoskeletal Complaints in the Menopause

1. Hip and Knee Pain

Women frequently notice aching or stiffness in weight-bearing joints such as the hips and knees. Oestrogen deficiency contributes to joint discomfort through:

• Reduced collagen synthesis, leading to loss of cartilage elasticity and hydration.

• Low-grade inflammation within the joint capsule.

• Decline in muscle strength and tone, placing greater stress on the joints.

  
  

This may present as morning stiffness, difficulty rising from a chair, or pain when climbing stairs. Some studies suggest that postmenopausal women are at increased risk of developing osteoarthritis of the hip and knee (Sniekers et al., 2008).

2. Wrist and Hand Symptoms

Wrist and hand discomfort — including carpal tunnel syndrome, tendonitis, or general joint pain — are also more prevalent after menopause. The decline in oestrogen alters fluid balance in tendons and connective tissues, while reduced collagen turnover increases stiffness and vulnerability to strain. Women on aromatase inhibitors for breast cancer often experience similar symptoms due to profound oestrogen suppression, reinforcing this hormonal link (Felson et al., 2001).

3. Muscle Aches and Weakness

Sarcopenia — the loss of muscle mass and strength — accelerates after menopause. Both oestrogen and testosterone play important roles in maintaining muscle protein synthesis, mitochondrial function, and overall physical performance. Low hormone levels contribute to reduced endurance, slower recovery after exercise, and greater susceptibility to injury.

The Role of Oestrogen and Testosterone in Musculoskeletal Health

Oestrogen

Oestrogen has widespread effects on the musculoskeletal system:

• Bone: Regulates bone turnover by inhibiting osteoclast-mediated bone resorption and supporting osteoblast activity. Its loss accelerates bone loss and increases fracture risk (Riggs et al., 2002).

• Cartilage and Connective Tissue: Enhances collagen production, maintains hydration, and preserves cartilage elasticity.

• Muscle: Modulates mitochondrial energy production, reduces inflammation, and improves muscle repair and strength (Enns & Tiidus, 2010).

  
  

Testosterone

Although often associated with men, testosterone is vital for women’s musculoskeletal health:

• Muscle Mass: Promotes muscle fibre growth and protein synthesis.

• Bone Density: Contributes to cortical bone strength and trabecular maintenance.

• Energy and Recovery: Supports physical performance and recovery from exercise or injury.

Low testosterone in women can contribute to fatigue, reduced muscle tone, and decreased physical capability (Davison et al., 2005).

Benefits of Hormone Replacement Therapy (HRT)

HRT can play an important role in alleviating menopausal musculoskeletal symptoms and protecting long-term bone and muscle health:

• Joint and Muscle Symptoms: Randomised trials and observational studies show improvement in joint pain and stiffness among women using oestrogen-based HRT (Chlebowski et al., 2013; Leveille et al., 2001).

  
  

• Bone Health: Oestrogen-containing HRT remains the most effective therapy for preventing osteoporosis-related bone loss and fractures (NICE NG23, 2015).

  
  

• Muscle Function: Some evidence indicates improved muscle strength and reduced sarcopenia risk with HRT, particularly when started around the time of menopause (Ronken et al., 2021).

  
  

Transdermal oestrogen, often combined with micronised progesterone, offers a safe and effective option for many women, with additional benefit where testosterone supplementation is clinically indicated (e.g. low libido, reduced muscle mass, or fatigue).

Supplements and the Evidence Base

While lifestyle and diet play a key role in musculoskeletal health, the evidence for supplementation is mixed:

Supplement	Evidence Summary
Vitamin D	Supports bone and muscle function. Deficiency is common in the UK, especially in winter. NICE recommends supplementation for adults, particularly postmenopausal women. (Bolland et al., 2018)
Calcium	Essential for bone health, but excess supplementation without vitamin D may increase cardiovascular risk. Dietary intake is preferred. (Harvey et al., 2023)
Magnesium	May aid muscle relaxation and reduce cramps, though evidence in menopausal populations is limited. (Veronese et al., 2021)
Omega-3 fatty acids	Some anti-inflammatory effects that may help with joint pain, but results are inconsistent. (Abedi et al., 2020)
Collagen peptides	Emerging evidence suggests possible benefits for joint and skin health, but data remain limited and of variable quality. (Zdzieblik et al., 2015)

Overall, HRT remains the only intervention that directly addresses the hormonal cause of menopausal musculoskeletal decline. Supplements may provide supportive benefits when combined with regular resistance exercise, adequate protein intake, and weight-bearing activity.

Summary

Menopausal decline in oestrogen and testosterone can significantly affect the musculoskeletal system, leading to joint pain, stiffness, and muscle weakness. HRT can relieve symptoms, preserve bone and muscle health, and improve quality of life when prescribed safely and individually. Supplements can play an adjunctive role, but evidence for their effectiveness is modest compared with hormone replacement.

A holistic approach — combining personalised HRT, physical activity, nutrition, and joint care — offers the best protection for musculoskeletal health through the menopause and beyond.

Menopause Consultations

References

• Abedi, P. et al. (2020). The effect of omega-3 fatty acids on menopausal symptoms: A systematic review and meta-analysis. Climacteric, 23(6), 556–562.

• Bolland, M.J. et al. (2018). Calcium and vitamin D supplements and health outcomes: an umbrella review. Osteoporosis International, 29, 2639–2648.

• Chlebowski, R.T. et al. (2013). Menopausal hormone therapy and joint symptoms. Menopause, 20(6), 600–608.

• Davison, S.L. et al. (2005). Androgen levels in adult females: changes with age, menopause, and oophorectomy. Journal of Clinical Endocrinology & Metabolism, 90(7), 3847–3853.

• Enns, D.L. & Tiidus, P.M. (2010). The influence of oestrogen on skeletal muscle: sex matters. Sports Medicine, 40(1), 41–58.

• Felson, D.T. et al. (2001). The effect of postmenopausal oestrogen therapy on hand osteoarthritis. Arthritis & Rheumatism, 44(6), 1488–1494.

• Harvey, N.C. et al. (2023). Calcium and bone health: update from the International Osteoporosis Foundation. Osteoporosis International, 34, 783–798.

• Leveille, S.G. et al. (2001). The effect of oestrogen replacement therapy on arthritis and musculoskeletal pain: women’s health and aging study. Journal of Women’s Health, 10(8), 757–762.

• NICE NG23. (2015). Menopause: diagnosis and management. National Institute for Health and Care Excellence.

• Ronken, S. et al. (2021). Menopausal hormone therapy and muscle function: systematic review and meta-analysis. Maturitas, 145, 34–45.

• Riggs, B.L. et al. (2002). Endocrine causes of osteoporosis. Endocrine Reviews, 23(3), 279–302.

• Sniekers, Y.H. et al. (2008). Association of oestrogen deficiency and osteoarthritis development. Arthritis Research & Therapy, 10(5), R106.

• Veronese, N. et al. (2021). Magnesium and health outcomes: an umbrella review. Nutrition, Metabolism & Cardiovascular Diseases, 31(12), 3299–3310.

• Zdzieblik, D. et al. (2015). Collagen peptide supplementation and body composition in postmenopausal women: A randomised trial. British Journal of Nutrition, 114(8), 1236–1244.