The Musculoskeletal Syndrome of Menopause: Why Your Joints Hurt and What to Do About It

One patient Dr. Penhollow evaluated was an avid hiker who climbed Camelback Mountain most weekends. She arrived convinced her joints were failing. Her knees ached, her hips were stiff, and she wondered whether her hiking years were over. Her evaluation pointed somewhere else, to an undiagnosed menopausal transition, and her symptoms improved with appropriate hormone care rather than with anything in a regenerative workup.

Midlife joint stiffness is often explained away as normal aging. For many women, that explanation is incomplete. In 2024, Wright and colleagues formally described the cluster of joint, muscle, bone, and tendon changes that accompany falling estrogen and named it the Musculoskeletal Syndrome of Menopause in the journal Climacteric. They reported that more than 70 percent of women in the menopause transition will experience musculoskeletal symptoms and that 25 percent will be disabled by them.

This article covers six tissue-level effects of the menopausal transition on the musculoskeletal system. They are recognized across clinical medicine, yet they are rarely explained during a brief office visit. It applies to women in their late thirties, forties, and early fifties who have body aches, morning stiffness, frozen shoulder, or heel pain, and who have been told it is just aging.

This article was written by Dr. Tammy J. Penhollow, DO, who is double board-certified in Anesthesiology and Pain Medicine and completed fellowship training in Pain Medicine at Stanford. She founded Precision Regenerative Medicine™ in 2019 in Scottsdale, Arizona, and chose to practice exclusively in regenerative medicine. The practice is direct pay, which keeps every treatment decision between physician and patient.

Why Midlife Joint Pain Deserves More Than a Quick Fix

Joint aches during perimenopause are often managed with rest, anti-inflammatory pills, or a quick injection. After an acute injury, rest has its place. The difficulty is that these approaches address the symptom and not the hormonal and tissue-level changes that may sit behind it. A quiet joint is not the same thing as a protected joint.

Dr. Penhollow does not use corticosteroid injections. Corticosteroids suppress the local healing response, and they are chondrotoxic, meaning they can be toxic to cartilage cells in laboratory studies. You can read more in her article on why corticosteroid injections are not as benign as patients are told: https://precisionmedprp.com/why-corticosteroid-injections-are-not-as-benign-as-youve-been-told/

H2: Six Musculoskeletal Effects Patients Should Understand

1. Changes in cartilage and connective tissue.Estrogen is one of the signals that helps regulate cartilage cells and the collagen in tendons and ligaments. When estrogen declines, these tissues are affected, and the authors of the 2024 review list progression of osteoarthritis among the musculoskeletal findings linked to falling estrogen. Pain relief and joint protection are not the same thing, which is one reason a full evaluation matters.
2. Frozen shoulder (adhesive capsulitis).Adhesive capsulitis causes marked stiffness, night pain, and a rapid loss of shoulder range of motion. It is often seen in women in their forties and fifties, frequently without any preceding injury, and it is named among the menopause-related musculoskeletal findings. Evaluating the joint capsule and the surrounding tendons helps guide care.
3. Plantar fasciosis (heel pain).Heel pain with the first steps of the morning is one of the two most common isolated presentations Dr. Penhollow sees in perimenopausal patients, along with frozen shoulder. The plantar fascia is a thick band of collagen that supports the arch under body weight. Chronic heel pain is typically a degenerative thickening of that band rather than simple inflammation. When foot mechanics change, shock absorption can change with them, and added load may travel upward to the knees, hips, and lower back.
4. Bone density loss.Bone is a dynamic tissue that is constantly remodeled in response to hormonal signals and mechanical loading. In the 2024 review, women lose on average about 10 percent of their bone mineral density during perimenopause. Weaker bone beneath the joint cartilage may reduce the support the cartilage depends on, and it is relevant to osteoarthritis progression and fracture risk.
5. Loss of muscle mass (sarcopenia).The same review reports a reduction in muscle mass of about 0.6 percent per year after menopause. Muscle absorbs and distributes the forces of daily movement. With less muscle, more of that force reaches the joints, tendons, and the discs in the spine, which can increase wear and leave women feeling structurally fragile.
6. The mistake of backing off strength training.When joints begin to hurt, the usual advice is to rest, stop lifting, or switch to gentle stretching. For midlife female physiology, that advice often runs in the wrong direction. Bone, tendon, and muscle respond to progressive mechanical loading, and appropriate muscle strengthening for joint pain is one of the most important protective steps available. Loading should be progressed gradually and tailored to your joints with your physician’s guidance.

What a Regenerative Evaluation Considers During Menopause

Patients who come to Precision Regenerative Medicine™ with midlife joint pain receive a thorough musculoskeletal and biological assessment before any treatment is considered. Dr. Penhollow’s evaluation covers:

• Review of hormonal timing, perimenopausal symptoms, and prior steroid exposure
• Review of injection history and whether relief has diminished over time
• Diagnostic ultrasound of tendons, joint capsules, and joint fluid
• Physical assessment of joint mechanics, kinetic chain function, and muscular deficits
• Laboratory evaluation, including hormonal status and other markers relevant to joint health
• Bone density considerations
• Physician-directed prehabilitation through the Joint Boost System™ for joint and extremity conditions and the Tower of Power Spine® system for spine conditions
• Timing and sequencing, so the body is as ready as possible before any autologous therapy is considered

Practical Next Steps

You have the right to see a physician who takes menopausal care seriously. If you are in the menopause transition and your joints hurt, these steps are reasonable places to start

• Ask for a thorough evaluation that includes your hormonal status and comprehensive labs
• Discuss menopausal hormone therapy with your prescribing physician as a legitimate clinical option, based on your history and risks
• Begin or continue progressive strength training, adjusted to your joints
• Seek a joint evaluation that looks at mechanics and imaging as well as symptoms