Musculoskeletal Pain During Perimenopause: More Than “Just Getting Older”
- Rebecca Brown
- Mar 3
- 3 min read
If you’re a woman in your 40s or early 50s and noticing:
Increased joint stiffness
Achy shoulders or hips
Slower recovery after exercise
Soreness without a clear injury
Ongoing discomfort despite “normal” scans
You are not imagining it.
Research shows that musculoskeletal pain significantly increases during the menopausal transition.
A large systematic review found that approximately 71% of perimenopausal women experience musculoskeletal pain.
That’s nearly three out of four women!
What Changes During Perimenopause?
Perimenopause is the transitional phase leading up to menopause. During this time, estrogen levels don’t simply decline — they fluctuate.
Estrogen plays a role in:
Regulating inflammation
Supporting muscle repair
Maintaining collagen and connective tissue integrity
Influencing bone turnover
Modulating how the nervous system processes pain
When estrogen becomes unstable, these systems can become less predictable.
Research shows that perimenopausal women have significantly higher odds of musculoskeletal pain compared to premenopausal women.
This suggests that the menopausal transition itself may be an independent risk period for musculoskeletal discomfort.
Is It Inflammation, Muscle Loss or Something Else?
The answer is likely: a combination.
Musculoskeletal pain during perimenopause does not have one single cause. It reflects changes occurring across multiple body systems at the same time.
1. Changes in Pain Processing
Estrogen does more than regulate reproduction — it also interacts with the nervous system.
Estrogen influences:
Neurotransmitters such as serotonin and dopamine
Endogenous opioid pathways (the body’s natural pain-relief system)
Descending inhibitory pain pathways in the brain and spinal cord
During perimenopause, fluctuating estrogen levels may alter how pain signals are processed and regulated. This can reduce the efficiency of the body’s internal “pain dampening” systems and lower pain thresholds.
This doesn’t mean pain is psychological.
It means the nervous system’s sensitivity may temporarily increase due to hormonal variability.
2. Inflammatory Shifts
Estrogen has recognised anti-inflammatory effects.
It helps regulate inflammatory mediators such as cytokines and supports balance within immune signalling pathways.
As estrogen levels fluctuate and later decline:
Pro-inflammatory cytokines may increase
Tissue sensitivity can rise
Joint and tendon structures may feel more reactive
This low-grade inflammatory shift does not necessarily mean visible damage on imaging — but it can contribute to stiffness and aching.
3. Muscle and Connective Tissue Changes
Estrogen plays a role in:
Muscle protein synthesis
Satellite cell activity (important for muscle repair)
Collagen production and tendon structure
Mitochondrial function within muscle cells
As levels change, women may experience:
Reduced muscle recovery capacity
Subtle decreases in muscle strength or power
Altered tendon stiffness
Reduced tolerance to load
This doesn’t mean tissues are failing — but they may respond differently to the same stimulus that previously felt manageable.
4. Sleep and Mood
Perimenopause is also associated with changes in sleep quality and mood regulation.
From a physiological perspective:
Sleep deprivation reduces pain inhibition
Poor sleep increases inflammatory markers
Anxiety and depressive symptoms can alter central pain modulation
Studies show associations between musculoskeletal pain and sleep disturbance, anxiety and depressive symptoms.
These are not “secondary” issues — they interact directly with how pain is processed in the brain and body.
Why Does Pain Sometimes Worsen After Menopause?
While overall pain prevalence increases in perimenopause, moderate to severe pain often continues to increase into postmenopause.
This likely reflects cumulative effects of:
Ongoing estrogen decline
Muscle mass reduction
Bone density changes
Increased inflammatory activity
In other words, the transition may begin the process, but structural and physiological changes over time can influence severity.
What This Means Clinically
Musculoskeletal pain during midlife is common, biologically plausible and worthy of attention.
Importantly:
Normal imaging does not mean symptoms are invalid.
Pain during this phase does not automatically indicate injury.
“Just ageing” is an incomplete explanation.
The menopausal transition represents a significant endocrine shift. Like any major physiological change, it can influence how tissues respond to load and how the nervous system processes discomfort.
What Can Help?
Although this research focused on prevalence rather than treatment, clinical practice and broader evidence suggest that:
Progressive resistance training supports muscle and bone health
Graded load management improves tissue tolerance
Sleep optimisation improves pain regulation
Stress management supports nervous system stability
Medical discussions about hormonal management may be appropriate for some women
The goal is not to stop moving.
The goal is to move strategically.
And with the right support, adaptation can be guided — not feared.
Reference:
Lu, Chang-bo, Liu, Peng-fei, Zhou, Yong-sheng, Meng, Fan-cheng, Qiao, Tian-yun, Yang, Xiao-jiang, Li, Xu-yang, Xue, Qian, Xu, Hui, Liu, Ya, Han, Yong, Zhang, Yang, Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis, Neural Plasticity, 2020, 8842110, 10 pages, 2020. https://doi.org/10.1155/2020/8842110
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