The Musculoskeletal Syndrome of Menopause

When these problems cluster together, researchers call it the “musculoskeletal syndrome of menopause.” It includes joint pain, tendinopathy (tendon irritation), frozen shoulder, sarcopenia (loss of muscle), and bone loss (osteopenia/osteoporosis). These changes can affect work, sport, caring roles and sleep—but the good news is there’s a lot we can do.

What’s going on inside the body?

Oestrogen helps keep many body tissues healthy—not just the reproductive system. It influences pain pathways in the brain and spinal cord, and it helps muscles, bones and connective tissues repair and adapt to load. When oestrogen declines in the peri- and post-menopausal years, the risk of widespread musculoskeletal pain, osteoarthritis flares, and tendon overload rises.

Tendons and ligaments have oestrogen receptors, which means they can respond to hormonal changes. Lower oestrogen is linked to reduced collagen turnover and stiffer, less compliant tendons. This helps explain why mid-life women commonly report Achilles, gluteal or rotator-cuff pain without a big injury.

Common features

• Joint and muscle pain: Often widespread or shifting, sometimes worse after new or heavier activity.
• Frozen shoulder (adhesive capsulitis): More common in mid-life women; early assessment helps recovery.
• Tendinopathy: Shoulder, hip (gluteal), elbow and Achilles pain are frequent in this life stage.
• Sarcopenia (muscle loss): Strength and muscle mass decline faster around menopause.
• Bone loss: Oestrogen drop increases bone turnover; about half of post-menopausal women will have an osteoporosis-related fracture over their lifetime without prevention.

What helps?

A personalised program that includes progressive strength training, impact (if appropriate), and balance work can improve bone density and function and lower fall risk. A landmark trial (LIFTMOR) in post-menopausal women with low bone mass showed that brief, supervised, heavy resistance and impact training improved spine and hip bone density and strength safely.

Diet matters too. Getting enough protein supports muscle repair, and adequate calcium and vitamin D help bones. Australian guidance emphasises food-first calcium and vitamin D when needed, alongside targeted exercise.

For some women, menopausal hormone therapy (MHT) is appropriate. It’s the most effective treatment for hot flushes and helps prevent bone loss and fractures when started near menopause. Decisions about MHT are individual and should be made with a GP or menopause specialist.

Take-home message

The musculoskeletal syndrome of menopause is common—and manageable. If new pain or stiffness is limiting your activities, a pelvic health or musculoskeletal physiotherapist can assess your load tolerance, guide graded exercise, and coordinate care with your GP.

 

References

1. Greendale, G. A., & Nazem, T. G. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(1), 1–8. https://doi.org/10.1080/13697137.2023.2284456
2. Szoeke, C., Dennerstein, L., & Guthrie, J. (2023). Sex hormones and musculoskeletal pain in midlife women: A systematic review. The Lancet Rheumatology, 5(7), e423–e432. https://doi.org/10.1016/S2665-9913(23)00123-4
3. National Health and Medical Research Council. (2023). Menopause Care Clinician Toolkit (NSW Health). Retrieved from https://www.health.nsw.gov.au/
4. Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-intensity exercise for bone health in postmenopausal women with low bone mass: The LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284
5. The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028