Musculoskeletal Syndrome of Menopause: What Helps

The short answer: Musculoskeletal syndrome of menopause is a proposed name for the joint pain, stiffness, muscle loss and tendon problems that can appear as oestrogen falls during perimenopause and menopause. It is not yet a formal diagnosis. Strength training, regular movement and, for some women, hormone therapy can help, so talk to your doctor about your options.

• The term "musculoskeletal syndrome of menopause" was proposed in a 2024 review. It describes a cluster of joint, muscle, tendon and bone problems linked to falling oestrogen (called estrogen in the US) [1].
• Aches and pains are common in the menopause transition. A meta-analysis of 16 studies found musculoskeletal pain in about 71% of perimenopausal women, though the studies varied a lot [3].
• Strength training is described as the least controversial approach, and regular movement is a sensible first step [1].
• Hormone therapy may modestly reduce joint pain for some women, but it is a decision to make with a doctor [4][6].
• A hot, swollen joint, a fever, or stiffness that lasts a long time after waking needs a doctor's check.

It is a proposed label, not yet a formal diagnosis. In 2024, four doctors writing in the journal Climacteric (Wright and colleagues) introduced the term "musculoskeletal syndrome of menopause" for the joint, muscle and bone problems that can come with the loss of oestrogen [1].

They defined it as "the collective musculoskeletal signs and symptoms associated with the loss of estrogen". The features they list include joint pain, loss of muscle mass and strength, loss of bone density, progression of osteoarthritis, more tendon and ligament injuries, and frozen shoulder [1].

Think of it as a name for a pattern many women notice. The authors say clinicians and patients often do not link these symptoms to falling oestrogen [1]. Harvard Health describes it as "a newly recognized condition" [2]. Because it is new, your own doctor may not use the term, and that is fine. What matters is that your symptoms are taken seriously and other causes are ruled out.

The most common signs are achy, stiff joints and sore muscles, often with tiredness. The NHS lists "muscle aches and joint pains" among the symptoms of the menopause [5].

Here is what you might notice, and where each sign fits in the 2024 review's list [1]:

Harvard Health adds that the pain can move around or stay in one area, such as the shoulder, and that fatigue is common [2].

Very common. A systematic review and meta-analysis of 16 studies (Lu and colleagues, 2020) found musculoskeletal pain in about 71% of perimenopausal women, with individual studies ranging from 50% to 89%. Perimenopausal women had higher odds of musculoskeletal pain than premenopausal women (odds ratio 1.63) [3].

The 2024 review goes further, estimating that more than 70% of women develop musculoskeletal symptoms and about a quarter are disabled by them [1].

Treat those numbers with care. In the meta-analysis, the studies differed greatly from each other, most were cross-sectional (one point in time), and many relied on women's own reports. That means it cannot prove that menopause causes the pain [3].

What this means: aches and pains in your 40s and 50s are common, you are not imagining them, and they have many possible causes.

The leading idea is that falling oestrogen affects your joints, muscles, tendons and bones. Harvard Health explains that oestrogen receptors are found in joints, ligaments, tendons and bones, so the drop in oestrogen at midlife can affect the whole musculoskeletal system, including muscle mass and bone density [2]. The 2024 review describes the syndrome as "largely influenced by estrogen flux" [1].

That is a working explanation, not a proven chain of cause and effect. The same review says much of the evidence on muscle and oestrogen comes from animal studies [1]. Other things can also add to aches in midlife, such as poor sleep and lower activity. Harvard Health notes that enough sleep helps control inflammation and how pain is perceived [2].

There is no fixed answer. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer, and they can change over that time [5]. The WHO says most women reach menopause between 45 and 55, and perimenopause can last several years [9].

The meta-analysis found perimenopausal and postmenopausal women had similar odds of musculoskeletal pain, so it may not simply disappear once your periods stop [3]. Strength training and movement are worth doing in either stage, and they matter more as you get older.

Only a doctor can tell, because the same aches can have other causes. Harvard Health says tests can rule out conditions such as osteoarthritis, thyroid problems and autoimmune disease, and that some medicines, such as statins, can add to aches [2].

One clue is how long morning stiffness lasts. The NHS says to see a doctor if joints stay stiff for more than 30 minutes after waking [7]. In rheumatoid arthritis, an inflammatory condition, morning stiffness often lasts longer than in osteoarthritis, and joints can become swollen, hot and tender, sometimes with tiredness, fever and weight loss [8].

Do not try to sort this out alone. If your symptoms match the warning signs further down, see a doctor.

Movement comes first, then sleep, then medical options. There is no single fix, and the best evidence on exercise specifically for menopausal joint symptoms is still limited.

Strength training. The 2024 review calls resistance training the least controversial approach and suggests heavier weights with fewer repetitions to build muscle power more effectively. It also says there is a lack of evidence on the best protocols for postmenopausal women [1].

General activity. The WHO says adults should aim for at least 150 minutes of moderate-intensity activity a week, and that muscle strengthening benefits everyone [10]. The NHS lists regular exercise among the ways to ease joint pain [7]. Walking, swimming, stretching and yoga are suggested by Harvard Health [2].

Sleep, heat and ice. Harvard Health lists enough sleep and heat, ice or massage as helpful extras [2]. For a sore joint, the NHS suggests a wrapped ice pack for up to 20 minutes every 2 to 3 hours, and says to rest the joint when you can but not stop moving it completely [7].

Painkillers. Ask a pharmacist or doctor which painkiller suits you [7].

Hormone therapy (HRT). HRT may help some women. In the Women's Health Initiative randomised trial of 10,739 women who had had a hysterectomy, estrogen-alone treatment gave a "modest but sustained reduction" in how often joint pain was reported: 76.3% in the oestrogen group against 79.2% on placebo at one year. Joint swelling was slightly more common with oestrogen (42.1% against 39.7%) [4]. The 2024 review adds that the role of hormone therapy in osteoarthritis is controversial and that dose and timing questions are unresolved [1].

So HRT is no magic fix for joint pain. If you are interested, the NHS advises talking to a doctor about your symptoms and which medicines might suit you [6].

Start with these three strengthening moves. They are common starting points, not a full programme. Begin gently and build up over weeks.

1. Step-up. 

Stand in front of a low, sturdy step. Step up with one foot, press through your heel until you stand tall, then lower slowly. Do 8 to 10 repetitions on each leg, 2 sets. Hold a rail if you need to. See our step-up exercise.

1. Glute bridge. 

Lie on your back with your knees bent. Squeeze your buttocks and lift your hips until your body forms a straight line from shoulders to knees. Hold for 2 to 3 seconds, then lower slowly. Do 8 to 10 repetitions, 2 sets. See our glute bridge exercise.

1. Side plank. 

Lie on your side, with your elbow under your shoulder and your knees bent. Lift your hips so your body forms a line. Hold for 10 to 20 seconds each side, 2 or 3 times. Straighten your legs for a harder version. See our side plank exercise.

Two or three short sessions a week is a manageable start. When an exercise feels easy, add a few repetitions, a small weight or a slightly longer hold.

Stop if you feel sharp pain, a joint locks or gives way, or swelling in a joint is worse the next day. Ease off, rest, and ask a doctor or physiotherapist if it keeps happening.

Kai, Loosn's AI physio coach, can help you pace and progress these around your own aches. It does not replace an assessment if your symptoms are severe, getting worse or unusual.

For the bigger picture on joint aches in the years before your periods stop, see our guide to why your joints ache in perimenopause. If you want to build strength, our guide to strength training in your 40s and 50s shows where to start.

Emergency: call your local emergency number or go to the emergency department if [7]:

• you have very bad joint pain after a fall or injury
• you cannot walk or put weight on the joint
• the joint looks out of place
• you have tingling or numbness around the joint after an injury

(Common emergency numbers are 999 in the UK, 911 in the US and Canada, 112 across the EU and 000 in Australia.)

Urgent: get seen today (UK: call 111 or ask for an urgent GP appointment) if [7]:

• the skin around a joint is swollen and hot
• you have joint pain and feel generally unwell, with a high temperature, or feel hot, cold or shivery

See a doctor soon if [7][8]:

• your joints stay stiff for more than 30 minutes after waking
• joint pain disrupts your daily activities or sleep
• pain or swelling is getting worse or keeps returning
• pain has not improved after 2 weeks of home treatment
• you are losing weight without trying
• you want to discuss HRT or other treatments for menopause symptoms [6]

Loosn is not a substitute for assessment when symptoms are severe, getting worse or unusual.

Is musculoskeletal syndrome of menopause a real condition? 

It is a newly proposed name, introduced in a 2024 Climacteric review for the joint, muscle, tendon and bone problems linked to falling oestrogen [1]. Many doctors may not use the term yet, but the symptoms are real and common, and they deserve a proper check.

Can menopause cause joint pain all over my body? 

It can. Harvard Health describes widespread joint and muscle pain, stiffness and fatigue linked to falling oestrogen [2]. Other causes, such as arthritis or thyroid problems, can look similar, so see a doctor if pain is widespread, worsening or comes with swelling or fever.

Does HRT help menopause joint pain? 

It may help a little. In a large randomised trial, women taking oestrogen alone reported joint pain slightly less often than those on placebo [4]. HRT carries risks as well as benefits, so the decision belongs with your doctor, who can weigh your age, health and symptoms [6].

What is the best exercise for menopause aches and pains? 

There is no single best exercise. The 2024 review calls resistance (strength) training the least controversial approach [1], and the WHO recommends at least 150 minutes of moderate activity a week [10]. Combine walking with simple strength moves, and build up slowly.

How long do menopause aches and pains last? 

It varies. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer [5]. In one meta-analysis, postmenopausal women had similar odds of musculoskeletal pain to perimenopausal women, so it may not stop when periods do [3].

Is there a test for musculoskeletal syndrome of menopause? 

Not a single test. Harvard Health says tests can rule out conditions such as osteoarthritis, thyroid problems and autoimmune disease, and that a response to oestrogen therapy can help support the diagnosis [2]. Your doctor decides what to check based on your symptoms.

If your aches have no warning signs, the Loosn app gives you gentle strengthening exercises and a daily plan from Kai, Loosn's AI physio coach. Download the Loosn app, and join our newsletter for midlife movement tips.