Menopause and Musculoskeletal Pain - why does Menopause feel so painful?

Did you know that about half of women in menopause will deal with joint pain or even arthritis? Researchers have recently given this cluster of symptoms a name: the musculoskeletal syndrome of menopause. It’s the catch-all for all the aches, stiffness, and injuries that show up when estrogen starts to decline.

What does this look like in everyday life?

• Achy joints (anywhere from “nagging” to “can’t get comfortable at night”)

• Frozen shoulder that seems to come out of nowhere

• Osteoarthritis progressing more quickly

• Loss of muscle tone, even if you’re active

• Tendon or ligament tweaks and injuries

• Plantar fasciitis that flares more often

More than 70% of women feel some version of this. Around a quarter experience symptoms severe enough to seriously disrupt daily life.

The musculoskeletal system isn’t just bones and muscles—it’s your entire support structure: tendons, ligaments, cartilage. It’s what gives you posture, stability, mobility, and strength. So when hormones shift, it’s no surprise the whole system feels shaky.

It’s Not Just in Your Head—But Your Brain Plays a Role

Something I hear from nearly all my students (and feel in my own body, too) is how pain ramps up in midlife—especially in the shoulders and hips. Science tells us this isn’t our imagination.

Here’s the twist: pain is created in the brain, not the body. That doesn’t mean it’s “made up.” It means your brain takes in signals from joints, muscles, emotions, stress, sleep, even your sense of safety in the world—and decides how much pain you feel. This is called the bio-psycho-social model of pain.

So if your estrogen is declining, you’re stressed, and you haven’t slept through the night in weeks thanks to hot flashes—it’s the perfect storm. Your brain amplifies pain signals. This in part, explains why menopause can feel so uncomfortable.

Six Big Factors Behind Menopausal Pain

1. Declining estrogen = more inflammation.
   Estrogen protects our joints and tissues. With less of it, flexibility decreases, arthritis can speed up, and inflammation fuels pain. Women are already twice as likely as men to develop osteoarthritis, and menopause makes that gap bigger.

2. Muscle and tendon strength changes.
   Estrogen helps maintain muscle mass and tendon resilience. Without it, we lose strength faster—making strength training even more important starting in perimenopause.

3. Nerve sensitivity goes up.
   Hormonal shifts make the nervous system more reactive, so small twinges can feel more intense.

4. Anxiety lowers pain tolerance.
   Menopause increases the risk of anxiety and depression. Both make us more sensitive to pain and less resilient to discomfort.

5. Proprioception (your sixth sense) gets fuzzy.
   Proprioception is your body’s ability to know where it is in space—your inner GPS. Estrogen decline stiffens collagen and muscle fibers, which can dull this sense. Fewer people talk about it, but it’s key to balance, coordination, and feeling “at home” in your body.

6. Sleep disruptions crank everything up.
   Hot flashes, night sweats, and anxiety often wreck sleep. And when you’re sleep-deprived, your nervous system has less capacity to buffer pain.

What You Can Do

The hard truth: we can’t stop estrogen from declining. The empowering truth: we can strengthen the systems that support our bodies through it.

• Strength training. Resistance work rebuilds muscle, protects joints, and strengthens bones. It’s also proven to reduce pain perception.

• Somatic practices. Yoga, mindful movement, and meditation calm the nervous system, ease anxiety, and reawaken proprioception. These practices reconnect you to your body in ways that build resilience.

• Sleep support. Prioritize habits that help you rest—because exhaustion makes everything worse.

• Seek expert care. Find a GYN trained by the Menopause Society; not every doctor has this specialty. Evidence-based guidance makes a difference.

• Consider HRT. For some women, hormone replacement therapy helps stabilize estrogen and reduce symptoms. Talk with a provider who understands your medical history.

The Takeaway

Menopause doesn’t have to mean living in pain. Understanding why these changes happen takes away the mystery (and self-blame). With the right mix of strength training, somatic practices, and supportive care, this season of life can be less about managing symptoms and more about building a new kind of strength—one that’s both physical and deeply embodied.

Somatic Yoga & Strength with Suzanne specializes in embodied movement and strength practices for an active life in midlife and beyond.

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Resources:

Pang, H., Chen, S., Klyne, D.M. et al. Low back pain and osteoarthritis pain: a perspective of estrogen. Bone Res 11, 42 (2023). https://doi.org/10.1038/s41413-023-00280-x

Does menopause elevate the risk of developing depression and anxiety? Results of a systemic review. https://pubmed.ncbi.nlm.nih.gov/36961547/

Arthralgia of Menopause - A retrospective review/https://pubmed.ncbi.nlm.nih.gov/37127408/ 

Bodies of Knowledge. Bo Forbes (2024).

Musculoskeletal Pain and Menopause: 

https://pubmed.ncbi.nlm.nih.gov/29412042/