Musculoskeletal Syndrome of Menopause: A Missing Piece of the Menopause Conversation?

Most people associate menopause with hot flushes, mood changes and disrupted sleep.

But ask many women in their 40s and 50s about their biggest challenge and you may hear something very different:

• "My joints ache."

• "My feet hurt when I get out of bed."

• "I can't recover from training like I used to."

• "Everything feels stiff."

• "My shoulder has frozen for no reason."

For years, these symptoms were often dismissed as "just ageing."

Today, researchers are beginning to recognise something more specific and a growing body of evidence has led to the emergence of a term known as Musculoskeletal Syndrome of Menopause (MSM): a collection of muscle, tendon, joint and bone-related symptoms linked to the hormonal changes of menopause.

While the term itself is relatively new, the symptoms are anything but.

What Is Musculoskeletal Syndrome of Menopause?

Musculoskeletal Syndrome of Menopause is an umbrella term used to describe the wide range of musculoskeletal changes that can occur during the menopause transition.

These may include:

• Joint pain (arthralgia)

• Muscle aches and stiffness

• Tendon pain

• Frozen shoulder

• Plantar fasciitis

• Reduced muscle strength

• Loss of muscle mass (sarcopenia)

• Reduced bone density

• Osteopenia and osteoporosis

• Increased injury risk

• Reduced physical function

Recent estimates suggest that musculoskeletal symptoms affect up to 70% of women, making them among the most common menopausal complaints and for many the most challenging to come to terms with - limiting their ability to engage in social activities or undertake daily household tasks. 

Why Does Menopause Affect Muscles and Joints?

The answer largely revolves around oestrogen.

Many people think of oestrogen as purely a reproductive hormone.

In reality, oestrogen receptors exist throughout the body, including:

• Skeletal muscle

• Tendons

• Ligaments

• Cartilage

• Bone

• Connective tissue

  
  

When oestrogen levels begin to fluctuate and decline during perimenopause, the effects can be widespread.

Oestrogen helps:

• Regulate inflammation

• Support collagen production

• Maintain muscle mass

• Preserve bone density

• Influence pain perception

• Support connective tissue health

As levels fall, women may experience increased pain sensitivity, slower recovery, reduced tissue resilience and accelerated loss of muscle and bone.

Common Reported Symptoms

One of the challenges with MSM is that symptoms often appear gradually. Women commonly describe:

Morning Stiffness

Getting out of bed becomes noticeably harder.

The first few steps may feel uncomfortable before loosening up with movement.

Wandering Joint Pain

Unlike osteoarthritis, pain may appear in different joints at different times.

• Hands one week....Shoulders the next....Then knees or feet.

Increased Tendon Problems

Physiotherapists often report seeing increases in:

• Achilles tendinopathy

• Tennis elbow

• Golfer's elbow

• Rotator cuff issues

• Plantar fasciitis

Loss of Strength

Weights that once felt manageable suddenly feel heavier....Recovery takes longer....Progress stalls.

Increased Injury Risk

Many active women report developing injuries despite no major change in training volume.

How it Impacts Women's Lives

This is not simply about discomfort. Musculoskeletal symptoms can affect:

• Ability to exercise

• Confidence

• Sleep quality

• Work performance

• Daily activities

• Mental wellbeing

Many women who have always identified as active find themselves reducing exercise because movement becomes uncomfortable. Unfortunately this can create a vicious cycle. Less activity leads to:

• Further muscle loss

• Reduced bone loading

• Reduced cardiovascular fitness

• Increased body fat

• Worse metabolic health

At precisely the stage of life when exercise becomes most important for both physical and mental resilience. 

What Do We Know?

Current evidence supports several observations: 

✓ Oestrogen plays an important role in musculoskeletal health.

✓ Musculoskeletal symptoms increase significantly during perimenopause.

✓ Muscle mass declines more rapidly during the menopausal transition.

✓ Bone loss accelerates after menopause.

✓ Resistance training improves muscle mass, strength and bone health.

✓ Menopausal hormone therapy (MHT/HRT) may improve symptoms in some women.

What Don't We Know Yet?

Despite growing awareness, there are still important unanswered questions that researchers are still trying to determine:

• Why some women develop severe symptoms while others don't

• Whether certain exercise approaches are superior

• The exact relationship between hormones and tendon health

• Which women benefit most from HRT for musculoskeletal symptoms

• Whether early intervention can reduce long-term injury risk

The science is evolving rapidly, therefore MSM is currently best viewed as a useful clinical framework rather than a fully understood medical diagnosis.

FACT: Exercise Is Still One of the Most Powerful Tools

The solution is not to stop exercising. In fact, complete rest often makes symptoms worse. The goal should be adaptation following some simple protocols: 

1.Prioritise Strength Training

Strength training remains one of the most effective interventions available.

Benefits include:

• Preserving muscle mass

• Supporting bone density

• Improving function

• Enhancing insulin sensitivity

• Improving confidence

Aim for two to four sessions per week.

2.Respect Recovery

Many women notice they can no longer recover from high-intensity training as quickly as they did in their 20s and 30s.

This is not weakness.

It is physiology.

More recovery days may be required.

3.Don't Chase Fatigue

Many women benefit from reducing the "all-out" mindset: the objective becomes consistent quality training rather than maximum exhaustion.

4.Daily Movement

Walking remains hugely valuable: regular movement improves joint lubrication, circulation and recovery while supporting cardiovascular health.

Training Modifications During Flare-Ups

If symptoms worsen, consider temporary regressions rather than stopping altogether.

Joint Pain

Instead of:

• Deep barbell squats

Consider:

• Box squats

• Leg press

• Split squats

• Supported machine work

Shoulder Pain

Instead of:

• Heavy overhead pressing

Consider:

• Landmine press

• Incline press

• Cable press variations

Tendon Pain

Reduce:

• Plyometrics

• Sprinting

• High-impact work

Temporarily increase:

• Controlled tempo strength work

• Isometric exercises

• Lower-impact conditioning

Severe Fatigue

Reduce:

• Training volume

Before reducing:

• Training frequency

Maintaining routine often matters more than maintaining intensity.

Nutrition Matters More Than Ever

Exercise alone is not enough. Women should prioritise:

Protein

Aim for approximately 1.2–1.6g per kilogram of bodyweight daily to support muscle maintenance and recovery.

Calcium

Critical for bone health, particularly after menopause.

Vitamin D

Deficiency is common and contributes to poor musculoskeletal health.

Omega-3 Fats

May support inflammation management and recovery.

Does HRT Help? 

HRT remains an individual medical decision. However, growing evidence suggests that declining oestrogen contributes directly to many musculoskeletal symptoms.

Some women report significant improvements in pain, stiffness and recovery following appropriately prescribed HRT. Research is ongoing and responses vary considerably between individuals. Any decision regarding HRT should be made in consultation with a qualified healthcare professional.