Joint pain in midlife: is it menopause?

Is it menopause?

Possibly, but not always. A review of musculoskeletal pain and menopause notes that joint and muscle pain and arthritis are all more common in women, become more frequent with age, and in some women appear to be linked with the start of menopause. The same review is candid that, although the link looks strong, a direct cause-and-effect connection between low estrogen and joint pain hasn’t been proven.¹

Interest is growing. In 2024, a group of orthopedic researchers proposed a new umbrella term, the “musculoskeletal syndrome of menopause,” to cover joint pain, loss of muscle and bone, and worsening osteoarthritis around the transition. They estimated that more than 70% of women will have musculoskeletal symptoms during the transition.² It is a proposed term from one review, not an official diagnosis, but it reflects how often women report these symptoms. The International Menopause Society chose “Chronic Pain at Midlife” as its theme for World Menopause Day 2026.³

What the research says about hormones and joints

Joint pain is very common at this stage of life: in the Women’s Health Initiative, the large NIH-funded trial, about three in four women in the estrogen-alone arm reported joint pain when they joined.⁴

The Menopause Society’s 2022 position statement reviewed the WHI and other trials. It concludes that women in the WHI and other studies had less joint pain or stiffness with hormone therapy than with placebo, and that more research is needed on estrogen and joint health. It notes that in the WHI’s combined estrogen-plus-progestin trial, some women had more joint discomfort after stopping hormones. It also says the evidence is too inconsistent to draw strong conclusions about estrogen and osteoarthritis.⁵

One practical point: joint pain isn’t among the uses the FDA lists for menopausal hormone therapy, which are hot flashes and night sweats, vaginal and urinary symptoms, and (for some products) preventing osteoporosis.⁶ If you’re a candidate for hormone therapy for those reasons, ask whether your joints might benefit too. See our hormone therapy guide.

Don’t miss other causes

Persistent joint pain is worth getting looked at rather than assuming it is “just menopause.” The review of joint pain at menopause walks through other common causes clinicians consider, including different types of arthritis.¹

Rheumatoid arthritis (RA) is one to know about. According to the NIH’s arthritis institute, common RA symptoms include:⁷

• Joint pain at rest and when moving, with tenderness, swelling and warmth
• Stiffness that lasts longer than 30 minutes after waking or after resting
• Symptoms on both sides of the body, for example both hands

If you notice signs like these, book an appointment rather than waiting it out.

What has good evidence

For osteoarthritis of the hand, hip and knee, the American College of Rheumatology and Arthritis Foundation guideline made strong recommendations for:⁸

• Exercise
• Weight loss, for people with knee or hip osteoarthritis who are overweight
• Self-management programs
• Tai chi
• Topical anti-inflammatory gels (NSAIDs) for knee osteoarthritis
• Canes and certain braces or hand supports

It made weaker, “conditional” recommendations for options including yoga, balance exercises, cognitive behavioral therapy, acupuncture and heat or cold.⁸ Medications, including over-the-counter pain relievers and injections, are in the guideline too, but which is safe for you depends on your health, so ask your clinician or pharmacist. The guideline itself stresses shared decision-making that takes your values, preferences and other health conditions into account.⁸

One encouraging detail: several of the strong recommendations, like exercise, tai chi and self-management programs, are things you can start without a prescription, ideally with guidance on what suits your joints.⁸

Muscle and bone are part of the story

Joints don’t work alone. SWAN body-scan data show lean mass (mostly muscle) starts to decline at the beginning of the menopause transition.⁹ The Menopause Society’s 2022 statement says loss of muscle and bone is related to aging, estrogen loss and the transition, and that frailty later in life is a real health risk.⁵ It also notes that systematic reviews found hormone therapy neither helped nor harmed muscle mass, so other approaches, like exercise, matter most here.⁵

Keep moving, and add strength

When joints hurt, it’s tempting to rest, but exercise is one of the osteoarthritis guideline’s strong recommendations.⁸ The physical activity guidelines also stress that any amount of activity has some health benefits, so you don’t have to start big.¹⁰ US physical activity guidelines recommend that adults get 150 to 300 minutes of moderate activity, like brisk walking, each week, plus muscle-strengthening activity at least two days a week.¹⁰

Strength work also matters for bones. ACOG notes that women lose bone more rapidly in the first 4 to 8 years after menopause, and that weight-bearing exercise and strength training help keep bones and muscles strong.¹¹ Start where you are.

Bring this to your appointment

Note which joints hurt, how long you’re stiff in the morning, and any swelling, for two weeks. Our printable tracker has a row for joint and muscle aches, alongside hot flashes and sleep, so you can see whether they move together.

Sources

1. Watt FE. Musculoskeletal pain and menopause. Post Reprod Health, 2018. pubmed.ncbi.nlm.nih.gov
2. Wright VJ et al. The musculoskeletal syndrome of menopause. Climacteric, 2024. pubmed.ncbi.nlm.nih.gov
3. International Menopause Society. World Menopause Day 2026. www.imsociety.org
4. Chlebowski RT et al. Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial. Menopause, 2013. pubmed.ncbi.nlm.nih.gov
5. The Menopause Society. The 2022 hormone therapy position statement. Menopause, 2022. pubmed.ncbi.nlm.nih.gov
6. FDA. FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies, 2025. www.fda.gov
7. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH). Rheumatoid Arthritis. www.niams.nih.gov
8. Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol, 2020. pubmed.ncbi.nlm.nih.gov
9. Greendale GA et al. Changes in body composition and weight during the menopause transition (SWAN). JCI Insight, 2019. pubmed.ncbi.nlm.nih.gov
10. US Department of Health and Human Services. Physical Activity Guidelines for Americans: Top 10 Things to Know. odphp.health.gov
11. ACOG. The Menopause Years (FAQ). www.acog.org

Information for better conversations, not a diagnosis. We’re not clinicians; we read the research and show our sources. See our disclaimer.