Hormones, Joints, Bladder and Bones: The Full Picture

Oestrogen is a hormone that affects almost every system in the body. As levels fluctuate during perimenopause and decline after menopause, many women notice changes in their muscles, joints, bones, bladder and pelvic floor. These changes are real, common and—most importantly—there is a lot we can do to help.

Understanding why these changes happen can help women feel more confident about seeking support instead of assuming they simply have to "put up with it."

Hormones influence your whole body

Oestrogen receptors are found in many tissues throughout the body, including:

• muscles
• tendons
• ligaments
• cartilage
• bones
• the bladder and urethra
• pelvic floor muscles
• the brain
• the cardiovascular system (Cauley, 2021).

This means changing hormone levels can influence far more than reproductive health.

For many women, the first noticeable changes are actually physical rather than menstrual.

Why do my joints suddenly ache?

Many women are surprised when previously pain-free joints begin to feel stiff or sore.

Research suggests that more than 50% of women experience musculoskeletal symptoms during the menopause transition (Wright et al., 2024).

You may notice:

• morning stiffness
• sore hands or feet
• aching knees or hips
• neck or shoulder pain
• tendon pain around the elbows, hips or heels
• slower recovery after exercise.

Oestrogen appears to influence collagen production, inflammation, tendon health and pain sensitivity (Daly et al., 2023; Leblanc et al., 2017). While researchers are still learning exactly how these changes occur, there is growing recognition of the Musculoskeletal Syndrome of Menopause, which describes the widespread effects of hormonal change on muscles, joints and connective tissues (Wright et al., 2024).

The encouraging news is that regular exercise—particularly progressive resistance training—has been shown to improve muscle strength, physical function and quality of life during and after menopause (ACSM, 2024).

Protecting your bones

Bone is constantly being broken down and rebuilt. Before menopause, oestrogen helps keep this process balanced.

After menopause, bone is broken down faster than it can be rebuilt. Women can lose up to 10% of their bone density in the first five years after menopause, making this one of the fastest periods of bone loss during adult life (Eastell et al., 2019).

Because osteoporosis develops silently, many women don't realise they have reduced bone density until they sustain a fracture.

The good news is that bones respond remarkably well to the right type of exercise. Heavy resistance training and appropriately prescribed impact exercise have consistently been shown to improve or maintain bone density and reduce fracture risk (Giangregorio et al., 2022; Watson et al., 2018).

Your bladder and pelvic floor change too

Many women notice they suddenly need to rush to the toilet more often, wake overnight to urinate, or begin leaking during coughing, sneezing or exercise.

These symptoms are not simply a normal part of ageing.

Lower oestrogen levels affect the bladder, urethra and surrounding tissues, contributing to what is now known as the Genitourinary Syndrome of Menopause (GSM) (Kingsberg et al., 2017; The Menopause Society, 2023).

Symptoms can include:

• urinary urgency
• increased frequency
• recurrent urinary tract infections
• vaginal dryness
• discomfort with intimacy
• bladder leakage.

Pelvic floor muscle training remains the first-line treatment for many bladder symptoms, while local vaginal oestrogen may also be appropriate for some women following discussion with their GP or specialist (NICE, 2024).

Muscle becomes even more important

Around menopause, women naturally begin losing muscle mass and strength—a process known as sarcopenia.

Muscle is essential for much more than lifting weights. It helps:

• protect your bones
• reduce falls
• improve balance
• support healthy joints
• improve insulin sensitivity
• make everyday activities easier.

Research consistently shows that women who continue strength training through midlife maintain greater independence, better bone density and improved physical function than those who become less active (ACSM, 2024; Daly et al., 2023).

The body is adaptable

Perhaps the most important message is this:

Hormonal changes are inevitable, but losing strength, confidence and independence is not.

The female body continues to respond to exercise throughout life. Muscles become stronger. Bones adapt to loading. Balance improves. The pelvic floor can become stronger and more coordinated.

It is never too late to start.

How can a pelvic health physiotherapist help?

As pelvic health physiotherapists, we don't just assess the pelvic floor.

We look at the whole person.

That means considering your strength, bone health, movement patterns, bladder function, exercise goals and the impact hormonal changes may be having on your body.

Whether you're noticing joint pain, bladder changes, reduced confidence in exercise or simply wondering where to begin, an individualised assessment can help you understand what's happening and develop a plan to keep you active for years to come.

Menopause is a significant life transition—but with the right support, it can also be an opportunity to build a stronger, healthier future.

References

American College of Sports Medicine. (2024). ACSM Position Statement: Resistance Exercise for Health and Performance.

Cauley, J. A. (2021). Estrogen and bone health across the lifespan. The Lancet Diabetes & Endocrinology, 9(11), 714–726.

Daly, R. M., Gianoudis, J., & Beck, B. R. (2023). Exercise recommendations for women across the menopause transition. Journal of Clinical Medicine, 12, 4308.

Eastell, R., Rosen, C. J., Black, D. M., Cheung, A. M., Murad, M. H., & Shoback, D. (2019). Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 104(5), 1595–1622.

Giangregorio, L. M., McGill, S., Wark, J. D., et al. (2022). Too Fit To Fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International, 33, 821–835.

Kingsberg, S. A., et al. (2017). The Women's EMPOWER Survey: Identifying women's perceptions regarding vulvar and vaginal atrophy and its treatment. Menopause, 24(4), 409–416.

National Institute for Health and Care Excellence (NICE). (2024). Menopause: Diagnosis and Management (NG23 update).

The Menopause Society. (2023). The Menopause Guidebook (10th ed.).

Watson, S. L., Weeks, B. K., Weis, L. J., Horan, S. A., & Beck, B. R. (2018). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with low bone mass: The LIFTMOR trial. Journal of Bone and Mineral Research, 33(2), 211–220.

Wright, N. C., et al. (2024). Musculoskeletal syndrome of menopause: Recognition, diagnosis and management. Menopause, 31(4), 421–432.