The Body Aches Of Menopause-There Is Hope!

Menopausal Musculoskeletal Pain: A Manageable Condition

In my menopause practice, I see more women complaining of musculoskeletal pain than hot flashes, and many feel significantly better on HRT. This is one of my favorite menopausal symptoms to treat because the response to therapy can be so dramatic.

Estradiol isn’t just about managing hot flashes or preventing osteoporosis—it also plays a role in muscle, joints, and intervertebral disks. Understanding the musculoskeletal syndrome of menopause allows us to proactively address these changes rather than simply accepting them as part of aging.

If you’re struggling with joint pain, stiffness, or muscle loss in midlife, consider whether estrogen deficiency might be contributing—and know that treatment options exist to help keep you strong, mobile, and possibly pain-free for years to come.

More than 75% of women experience musculoskeletal symptoms around menopause. These symptoms—ranging from joint pain and stiffness to muscle loss and osteoarthritis progression—are not just signs of aging. Instead, they may represent a largely unrecognized syndrome influenced by the loss of estrogen. Dr. Vonda Wright recently introduced the term musculoskeletal syndrome of menopause in Climacteric, highlighting the potential impact of hormonal changes on the body’s structural and functional integrity.

What’s Causing This Pain?

For years, musculoskeletal pain in midlife women has often been misattributed to aging, autoimmune conditions, or osteoarthritis. However, growing evidence suggests that estrogen withdrawal can be a contributing factor. Estrogen receptors exist in bones, muscle, cartilage, tendons, ligaments, and joint fluid. Just as the loss of estrogen in (peri)menopause leads to hot flashes, brain fog, and vaginal dryness (among many other symptoms), it may also impact musculoskeletal tissue, leading to pain and functional decline. As estrogen declines, women may experience:

• Arthralgia (joint pain)

• Loss of muscle mass (sarcopenia)

• Decreased bone density (osteopenia/osteoporosis)

• Progression of osteoarthritis

• Tendon and ligament stiffness

• Increased risk of frozen shoulder

  
  

Hormone Replacement Therapy (HRT): A Potential Game Changer

One of the most promising clinical observations is how some musculoskeletal symptoms respond to hormone therapy. Many women on estradiol replacement report significant improvements, sometimes a complete resolution of joint and muscle pain.

Personally, I noticed that my own nightly hip pain, which required stretching before bed, completely disappeared after six months of estradiol therapy. Additionally, I used to go to physical therapy modify my exercise due to discomfort, but I no longer need to—my strength and flexibility have dramatically improved and my pain is gone. The difference? Estrogen replacement.

Testosterone supplementation may also be beneficial, as it supports muscle mass, recovery and is anti-inflammatory. While other causes like rheumatoid arthritis may need to be ruled out, trying estradiol first can be a simple and effective approach for some women.

Frozen Shoulder and Estrogen

Recent research by Jocelyn Wittstein, M.D., and colleagues at Duke Health suggests that postmenopausal women on hormone replacement therapy may have a lower risk of developing adhesive capsulitis (frozen shoulder) than those who do not receive estrogen. Their retrospective cohort study analyzed the medical records of nearly 2,000 postmenopausal women aged 45–60 who presented with shoulder pain and stiffness.

Key findings from the study:

• Only 3.95% of women on hormone replacement therapy were diagnosed with adhesive capsulitis, compared to 7.65% of those not receiving estrogen.

• The results were not statistically significant due to sample size, but they suggest a potential link between estrogen deficiency and frozen shoulder.

• Estrogen plays a role in bone growth, inflammation reduction, and connective tissue integrity—all of which may impact shoulder mobility.

  
  

According to Dr. Wittstein, these findings warrant further investigation, as hormone therapy may be protective against this painful condition. Given that frozen shoulder disproportionately affects older women, estrogen loss could be one of several contributing factors in its development.

Testosterone and Ligament/Tendon Health

In men, low testosterone is known to contribute to tendon and ligament rupture. Women actually have more testosterone than estrogen, and testosterone levels also decline with age. Given testosterone’s known role in tissue repair and strength, it is reasonable to suggest that testosterone replacement may be beneficial for women's ligaments and tendons as well. This is an area worth further research and consideration in menopausal care.

The Role of Early Hormone Use

Dr. Wright suggests that hormones may be used to prevent the musculoskeletal syndrome of menopause. Personally, I think she is on to something, and I imagine that my patients who begin HRT earlier in perimenopause may experience better outcomes, including a reduction in musculoskeletal symptoms. Early intervention could be key in maintaining strength, flexibility, and overall joint health as women transition through menopause.

The Importance of Mobility and Strength

Maintaining musculoskeletal health through menopause and beyond is essential for quality of life. Use it or lose it. Loss of muscle and bone mass accelerates without proactive intervention, increasing the risk of fractures, disability, and loss of independence.

Our goal should be to stay mobile, strong, and functional well into our 80s and 90s. Imagine being able to get down on the floor and stand up with ease at 90—that’s the longevity we should be striving for.

Additional Strategies for Musculoskeletal Health

• Anti-inflammatory Diets: The Mediterranean diet is my favorite for reducing inflammation and supporting musculoskeletal health. Some women also benefit from gluten-free or dairy-free diets.

• Physical Therapy: Some joint pain will improve with targeted PT and strength training. What’s fascinating is how many women need less PT after starting HRT, because their underlying musculoskeletal issues improve.

• Weight-bearing Exercise: Resistance training and weight-bearing activities are non-negotiable for preserving muscle and bone strength.

• Supplements & Lifestyle Factors: Vitamin D, magnesium, turmeric and collagen may provide additional support for bone and joint health.

  
  

Addressing New Body Aches and Pains

If body aches and pains are new for you as you go through perimenopause and menopause, it is very possible that they will improve with HRT, particularly estradiol. I would love to help guide you through this journey and hopefully help you achieve significant relief. Stiffness and soreness are not just something to accept—they are something to address, and you may be surprised at how much better you feel after just a few months of HRT (or even sooner).