As women, transitioning into menopause is a natural stage of life that brings more than just the cessation of menstrual cycles—it can also usher in significant bodily changes, including some that can be painful enough to impact our daily lives. Menopausal joint pain is one of the most unexpected, yet debilitating symptoms that women can face.
Each year, more than 47 million women globally enter menopause, and many will experience symptoms that go beyond the commonly discussed hot flashes and mood swings. One such challenge, often not discussed as much as other menopausal symptoms, is Musculoskeletal Syndrome of Menopause (or MSM).
This syndrome encompasses joint pain and body aches in menopause, muscle weakness, and reduced bone density—issues directly linked to the declining estrogen levels. Research indicates that more than 70% of menopausal women experience musculoskeletal discomfort1, with 25% facing severe or even disabling impairments.
Through this article, I'll shed light on the musculoskeletal challenges of menopause that often go unnoticed. We'll cover the causes of these symptoms and offer practical strategies to help you preserve your strength and vitality during and beyond your menopausal years.
In this article:
Symptoms of Menopausal Joint Pain
Joint pain in menopause will affect as many as 70% or more of women, with a quarter of them becoming disabled by the symptoms.
These symptoms can look like:
- Achy joints
- Stiff joints
- Shooting pains
- Twinges
- Swelling
- Popping and cracking sounds with movement
- Decreased range of motion
- Muscle aches
- Neck and back pain
The menopause joint aches and pains are part of a condition known as The Musculoskeletal Syndrome of Menopause.
What Is Musculoskeletal Syndrome of Menopause?
Musculoskeletal Syndrome of Menopause (MSM) describes a cluster of symptoms that occur during menopause, including joint pain, muscle weakness, decreased bone density, loss of cartilage, and increased body fat along with trouble losing weight (especially weight gain in the abdomen, also called menopause belly).
MSM symptoms stem from the significant decrease in estrogen that occurs during menopause. Estrogen is a hormone that's not only involved in reproductive health but also supports musculoskeletal health.
“Musculoskeletal” refers to the body's muscles, bones, joints, tendons, ligaments, and cartilage. This system helps you move, lift things, coordinate body parts, and go about your daily life, which is how the condition gets its name.
Why Do You Experience Joint Pain with Menopause?
Body aches in menopause, along with joint pain and swelling can be related to declining estrogen levels and sarcopenia (the natural decline of muscle tissue).
The decline in estrogen during menopause can lead to five factors2 that together characterize MSM:
- Inflammation
- Muscle mass loss (sarcopenia)
- Bone density reduction
- Reduced regeneration of stem cells
- Cartilage degradation
Together, these factors can significantly impact a woman’s mobility and overall quality of life. In fact, MSM is sometimes called “musculoskeletal pain syndrome” due to the discomfort it can cause.
Related: Best Supplements for Estrogen.
Symptoms of Musculoskeletal Syndrome of Menopause
Musculoskeletal syndrome of menopause symptoms3 are different from those of just joint pain, as they also encompass the loss of muscle, changes in body composition, and the effect on a woman’s balance.
Women experiencing MSM experience symptoms such as:
- Joint pain and stiffness: Pain commonly affects the knees, hips, and hands.
- Muscle aches and loss of strength: This can interfere with daily activities and decrease overall physical function.
- Decreased bone density: As bones become weaker, this heightens the risk of fractures and osteoporosis.
- Sarcopenic obesity: This describes an increase in fat mass, especially around the belly/abdomen, while muscle mass simultaneously diminishes.
- Reduction in physical mobility and balance: All of the symptoms above lead to poor physical health and increased risk of falls.
What Causes Musculoskeletal Syndrome of Menopause
The primary cause of musculoskeletal syndrome of menopause is lower estrogen levels. Estrogen is integral to regulating inflammation, preserving muscle and bone mass, maintaining joint and cartilage health, and ensuring overall musculoskeletal strength.
As estrogen levels decline, the body's ability to perform these functions diminishes, leading to the symptoms associated with MSM described above.
Here's more about how musculoskeletal syndrome of menopause is experienced and what's happening in a woman's body that causes this condition to develop:
1. Increased Inflammation
Estrogen exhibits anti-inflammatory effects by modulating the immune response and reducing the production of pro-inflammatory cytokines, which are signaling proteins that can exacerbate inflammation. For example, estrogen regulates various cells within the immune system, such as macrophages and T-cells, to promote a more anti-inflammatory or tolerant state.
Lower estrogen levels can lead to the body's inflammatory response increasing—and when inflammation is triggered, joint pain and muscle stiffness, as well as other issues affecting gut health and cognitive function, can occur.
Chronic inflammation is also a risk factor for many other chronic diseases, such as cardiovascular disease (the number one cause of death4 in women, especially menopause) and diabetes.
2. Sarcopenia (Reduced Muscle Mass)
The loss of muscle mass, or sarcopenia, is a direct consequence of reduced estrogen levels. It affects muscle function and strength, making physical activities more challenging. Some menopausal women not only experience muscle loss but also weight gain and obesity at the same time, called sarcopenic obesity.
3. Decreased Stem Cell Regeneration
Estrogen influences the health and function of stem cells in muscle and bone; therefore, menopause can cause changes in the regenerative capacity of these tissues.
Estrogen specifically promotes the proliferation of satellite cells—muscle stem cells that are crucial for muscle repair and regeneration. As estrogen decreases, these cells' ability to regenerate diminishes, affecting performance, muscle recovery, and growth of lean muscle mass.
Getting enough exercise can help stimulate these satellite cells, even as estrogen levels fall. Nutritional support through a balanced diet rich in antioxidants and protein also helps protect these cells from environmental damage.
4. Loss of Bone Density
Estrogen helps in the absorption and metabolism of calcium and vitamin D, which are two nutrients that are crucial for bone health. Its reduction accelerates bone density loss, increasing the risk of osteoporosis.
Regular screenings for bone density, which you can do with help from your healthcare provider, can help catch potential problems early and treat bone loss as early as possible.
5. Cartilage Wear
Estrogen helps maintain the health of joint cartilage, which is the flexible, tough connective tissue that protects bones and joints, absorbs shock during movement, and provides structure to parts of the body.
The decline in estrogen can lead to increased cartilage wear, which is why menopausal women often experience a surge in joint pain and conditions like osteoarthritis. These aches and pains can unfortunately reduce motivation to be active, although this is one of the best strategies for keeping the musculoskeletal system healthy!
How to Address Menopausal Joint Pain
While menopause and painful joints are experienced by many women, there are options for managing symptoms and in some cases, preventing it.
1. Nutrient-rich diet (With Plenty of Protein, Calcium, and Antioxidants)
Following an anti-inflammatory diet—rich in nutrients like protein, omega-3 fatty acids, fiber, antioxidants, and calcium—is important for supporting bone and muscular health5 during menopause, as well as gut health, immune function (which can help to limit inflammation), and mental well-being.
In one study6 among menopausal women, when the women followed a healthy diet and exercise program for 12 weeks, on average, participants experienced significant improvements in pain, fatigue, and depression.
Here's what to focus on:
- Omega-3s: These healthy fats, found in fish like salmon and sardines as well as walnuts and seeds, are known for their anti-inflammatory properties. They can help reduce joint pain and prevent cartilage degradation.
- Antioxidants: These disease-fighting compounds, found in fruits and vegetables like berries and leafy greens, help to support cellular health and fight oxidative stress and inflammation that can damage tissues.
- Protein: To counteract sarcopenia, incorporating a diet rich in protein and engaging in regular strength training are essential7. Adequate protein intake supports muscle repair and growth, while resistance training stimulates muscle fibers to adapt and strengthen. Here’s how to start your day with enough protein.
- Calcium and vitamin D: Calcium and vitamin D are vital for bone health; a diet rich in these nutrients, alongside weight-bearing exercises, can help slow bone density loss8. These nutrients have additional benefits too, including supporting heart health and immune function.
Among the best foods for managing joint aches in menopause include:
- Protein sources like fish, grass-fed meat, poultry, yogurt, eggs, beans and legumes
- Leafy greens like spinach and kale
- Veggies like peppers, mushrooms, carrots, etc.
- Nuts and seeds like almonds, chia seeds, and flaxseeds
- Dairy products
- Whole grains, such as brown rice, quinoa, and oatmeal
- Soy products, such as tofu, which provide isoflavones that can help in balancing hormones and maintaining bone density
- Berries and citrus fruits
- Herbs and spics like turmeric, ginger, and cinnamon (which are rich in antioxidants)
2. Regular Exercise (Including Strength-Training)
Research shows that regular exercise, especially strength training and weight-bearing activities, is one of the best ways to combat muscle loss9, improve bone density, and enhance joint function and mobility during menopause. Activities like yoga and Pilates can also help maintain flexibility and reduce pain while supporting strength.
Find a type of exercise you enjoy and commit to doing it regularly! This might mean a combination of walking outside, doing yoga, lifting some weights, and dancing—whatever it is, prioritize doing it for about 30 minutes or more each day (or 150 minutes a week) so you stay as mobile and strong as possible.
When joint pain is an issue, swimming can be a great way to continue movement without putting weight on the joints.
Working with a physical therapist and, in some cases, a personal trainer can help you ensure you’re moving in the best way for your body.
3. Supplements to Support Immune Function and Bone Health
In addition to eating a healthy diet and moving your body, certain supplements can provide another layer of support in keeping your muscles, joints, and bones healthy:
- Omega-3s (such as Omega Plus): As mentioned above, omega-3 fatty acids help manage inflammation and support joint health. In one study10 involving overweight or obese postmenopausal women, participants were given supplements rich in DHA, a type of omega-3 fatty acid, with or without combining it with resistance training. The results showed that DHA supplements improved heart health indicators, such as lowering diastolic blood pressure and reducing triglycerides, and also enhanced muscle quality.
- Magnesium (such as Magnesium Plus): Magnesium is an essential mineral that is needed to support hundreds of muscle, bone, and nerve functions, including bone density when combined with vitamin D11. Magnesium for menopause is also helpful because it assists in sleep and helps your body cope with stress and muscular tension more easily.
- N-Acetyl Cysteine (NAC): NAC supplements offer antioxidant benefits that can help muscle recovery and joint health. NAC can also help maintain the health and function of stem cells and support cellular defense mechanisms12 that contribute to muscle and tissue regeneration during menopause.
- Vitamin D3/K2: The combination of these two nutrients (found in my Vitamin D3/K2 drops) is critical for bone health and calcium metabolism, as studies show that vitamin D deficiency during the menopausal transition or in the postmenopausal period can aggravate health risks such13 as osteoporosis, sarcopenia, and cardiovascular diseases. Vitamin D has been shown to help reduce symptoms associated with musculoskeletal disorders14 and offers benefits for adults with sarcopenia, too.
- Glucosamine and chondroitin: These two compounds offer benefits for cartilage health and can potentially alleviate joint pain or osteoarthritis symptoms15. Because they can help you to stay active with less discomfort, they may be able to assist in maintaining a healthy weight, which further reduces pressure on your joints and slows the progression of cartilage wear, making them a valuable menopause joint pain treatment.
- Resveratrol: In a study investigating the effects of resveratrol, a type of phytoestrogen, on postmenopausal women, results showed that women taking resveratrol experienced significant reductions16 in pain and enhancements in well-being, including better quality of life, compared to those taking a placebo. These improvements were also linked to enhanced cerebrovascular function. You'll find resveratrol in my Balance Women's Hormone Support formula, which also features B vitamins, antioxidants, and hormone-supporting herbs.
For more information on supplements that can help manage menopausal symptoms, refer to this article: Best Menopausal Supplements According to a Hormone Expert.
4. Avoid Smoking and Excessive Alcohol
Quitting smoking and cutting back on alcohol consumption can further protect joint and bone health while also potentially helping to prevent weight gain (since alcohol is essentially a source of “empty calories”).
Stick to one drink per day or less and consider joining a smoking cessation program or trying tools like mindfulness practices if you currently smoke.
5. Consider Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) can be an effective treatment to manage MSM since it supplies the body with a synthetic form of estrogen, thus alleviating many of the associated symptoms of low estrogen. However, HRT is not suitable for everyone due to potential risks such as those actively undergoing treatment for breast cancer or an active clot.
While vaginal estrogen isn’t contraindicated in those conditions, it isn’t often enough to overcome the joint pain in menopause or musculoskeletal syndrome of menopause.
If you're dealing with MSM and looking for support, it's crucial to discuss your options, including HRT, with a knowledgeable healthcare provider to make an informed decision about the best approach based on your health history.
Key Takeaways on Strategies to Manage Musculoskeletal Syndrome of Menopause (MSM)
- Can menopause cause muscle aches and pains? Absolutely! In fact, up to 70% of menopausal women deal with issues like joint pain.
- During menopause, lower estrogen levels have a major impact on musculoskeletal health. In some cases, hormonal changes coupled with an unhealthy lifestyle can lead to MSM.
- If you're in menopause and dealing with joint pain, loss of bone density, stiffness, weight gain, and weakness, there are steps you can take to get your health back on track.
- Prioritize a healthy diet (with enough protein, calcium, vitamin D, and antioxidants), exercise, and consider utilizing supplements such as vitamin 3, magnesium, NAC, and omega-3 to mitigate the effects of MSM.
References
- https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2380363#abstract ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430266/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710408/ ↩︎
- https://www.cdc.gov/heart-disease/about/women-and-heart-disease.html ↩︎
- https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1281903 ↩︎
- https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1281903 ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430266/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/39206904/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10707386/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308734/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468838/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982320/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/39206904/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610094/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332715/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/28350759/ ↩︎
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