[A note before we begin: What follows reflects my perspective as a nurse educator and women’s health advocate. This information is informed by the research literature on perimenopause and the personal experiences of women navigating it. These are complex issues that present differently in every person. For that reason, this is in no way a clinical prescription. Please take what resonates with you, leave what doesn’t, and bring any specific concerns you have to your provider. This is simply one informed voice, offered with the hope that some part of it may be of help to you.]
By Leigh Anne Hulva, BSN, RN— Women’s Health Educator
Joint pain may appear during menopause as estrogen levels fluctuate and decline, often causing stiffness, aching, and discomfort in several joints at once. Women experiencing new midlife joint pain should also consider other causes, but hormonal changes may be part of the picture.
Meet Rachel*: Where Joint Pain Appears in Perimenopause
Rachel has been running the same route through the same neighborhoods in Nashville for over eleven years. She runs four miles, three times a week. Serious illnesses aside, this is non-negotiable to her. It keeps her happy, healthy, and sane. It’s her time, at her rhythm, and it keeps everything straight in her mind. Plus, it helps keep her jeans fitting just right.
But sometime around her 47th birthday, her body began filing complaints.
At first it was her knees. They had a stiffness that seemed to take longer to resolve than it used to. Then her hips started adding their two cents. Rolling over in bed at night sometimes woke her, with pain through one or both hips that got worse over several months. Then—most annoyingly of all—her hands started pulling stunts. She started having trouble opening and closing them first thing in the morning.
It made her feel so old. She was forty-seven, after all, not seventy-seven. She thought she’d have a couple more decades before the “aches and pains of old age” settled in.
She mentioned the problem to her GP, who gave her the not-quite-satisfying recommendation to switch to lower-impact exercise. “Normal wear and tear of age,” he had declared. But Rachel wasn’t ready to give up her thrice-weekly run. It was part of the rhythm of her life, a big part of what helped her stay as mentally fit as she was.
So she decided to mention it to her gynecologist at her next scheduled visit, after the usual business was done.
“This has been going on for about a year, you say?” the doctor asked. When Rachel said yes, the doctor nodded and said, “So this started around the time your periods became irregular?” Again, Rachel thought about it and said yes. Her gynecologist said, “This might be perimenopause. Estrogen does a lot of work for the joints. When levels start to fluctuate, joints often are the first to notice.”
As Rachel was driving home, she thought, “Well, nobody told me about this part.”
[* Case studies are fictionalized composites of the real experiences of women, drawn from both personal and professional encounters with women navigating life’s transitions.]
Why Perimenopause Can Cause Joint Pain
Joint pain is one of the most commonly reported symptoms of perimenopause, and one of those symptoms that is most commonly blamed on something else. Unlike hot flashes or night sweats, joint pain doesn’t really announce itself as being hormone-related. People blame the pain on overuse, aging, or last week’s exercise, and then dismiss it.
But for many women in perimenopause, painful joints are a direct result of declining estrogen. As we’ve discussed in many previous articles, estrogen is not just a reproductive hormone. It plays a role in many (most) of the body’s systems, including the musculoskeletal system. For joint health, it helps maintain cartilage, supports the production of synovial (lubricating) fluid, and helps regulate inflammation.
As estrogen fluctuates and declines in perimenopause, these functions are affected. The result is, as Rachel experienced, stiffness after periods of rest, aching in multiple joints at once, and a new “creakiness” that feels decidedly different from the muscle soreness of overexertion.
How Estrogen Affects Joint Health
Cartilage Maintenance
Cartilage is the smooth tissue that cushions the ends of bones where they meet in joints. Cartilage contains estrogen receptors, which means it is directly affected by estrogen levels. Among other things, estrogen supports collagen production, which gives cartilage its cushioning and resilience.
As estrogen declines, cartilage maintenance is affected. The protective cushioning of joints is slowly worn away. This is why women have a higher lifetime risk of osteoarthritis, and the reason this risk increases significantly after menopause.
Joint Lubrication
Synovial fluid is the lubricating fluid inside joints that reduces friction between moving surfaces. Estrogen also influences it, as estrogen receptors are located in the joint lining. Adequate synovial fluid keeps joints moving smoothly and painlessly, but insufficient amounts lead to discomfort and a “grinding” sensation that many perimenopausal women report. Since estrogen helps regulate inflammation inside the joint, its decline can leave the joint environment less well maintained, leading to those inconvenient—and even painful—stiff mornings.
That morning stiffness that Rachel noticed in her hands? The time it took for her fingers to work “normally” again? Those are classic symptoms of hormone-related joint changes.
Inflammation Regulation
Estrogen helps regulate inflammation in certain systems. As estrogen declines in middle age, some of the anti-inflammatory protection it provided to joints is lost. This can lead to low-grade inflammation and symptoms like swelling, pain, and stiffness. This is why perimenopause joint pain can feel like early arthritis. Of course, it’s important to rule out other causes of joint pain before settling on perimenopause as its cause.
What Perimenopausal Joint Pain Feels Like
Perimenopausal joint pain has a somewhat recognizable pattern that can help differentiate it from other causes of joint pain or discomfort. It tends to affect multiple joints at once (for example, Rachel’s knees, then hips, then hands) rather than a single joint. It is often worse in the mornings (or after periods of rest) and improves with movement. It might be better on some days and worse on others in a way that, for some women, corresponds to their hormonal fluctuations.
Hands do deserve a special mention here, as they are so often the first to be involved in perimenopausal joint pain. The classic symptom of waking to find that it’s difficult to make a fist, possibly even uncomfortable, is very common. Within a few minutes of gentle movement, normal range of motion should return. If you take these symptoms to a GP, they might first think of rheumatoid arthritis. It doesn’t hurt anything to get tested for other possible causes, but keep in mind that perimenopausal joint pain is often easily treated.
Signs That Your Joint Pain Might Be Related to Perimenopause
- Multiple joints are affected simultaneously, rather than an isolated joint
- Symptoms begin in your mid-to-late 40s without any specific cause or injury
- Morning stiffness in joints that improves with gentle movement
- Symptoms that seem to worsen alongside other perimenopausal symptoms
- A sense that your body has changed specifically and recently rather than over many years
- Symptoms that don’t respond to the rest-and-recover strategy that works for injuries
Other Causes of Joint Pain to Rule Out
While perimenopause is a common (and often underrecognized) cause of joint pain in middle-aged women, it is not the only cause. New joint pain deserves a full evaluation. Rheumatoid arthritis occurs primarily in women and can also begin in middle age with symptoms that can overlap with perimenopausal joint pain. Generally, rheumatoid arthritis has a more severe progression and involves significant swelling, but it should be ruled out.
Test thyroid function, as imbalances can cause muscle and joint pain. Vitamin D deficiency (which is far more common than previously thought) has been associated with musculoskeletal pain.
A reasonable first step for a woman experiencing joint pain for the first time is to talk with her doctor and have blood work done that includes inflammatory markers, thyroid function, and vitamin D levels. The right diagnosis matters because it determines your treatment.
Managing Perimenopausal Joint Pain: What Helps
Hormone Therapy
For women with joint pain that is clearly hormonal in origin, menopausal hormone therapy (MHT) can address the underlying problem rather than simply managing symptoms. Research suggests that hormone therapy is well-established as being protective against osteoporosis. Some observational studies also suggest it may be associated with a lower risk of osteoarthritis, although the evidence here is less consistent. Some women do notice meaningful improvement in joint pain while on hormone therapy, which makes clinical sense given estrogen’s role in cartilage health and joint lubrication.
For women who are appropriate candidates and whose joint pain is affecting their quality of life— especially if there are other symptoms of perimenopause in the picture— hormone therapy is certainly worth discussing with your provider as part of your treatment plan.
Exercise (The Right Kind!)
Rachel’s GP wasn’t completely wrong about choosing lower-impact exercise. Exercise, including weight-bearing exercise, is one of the most research-backed interventions for joint (and bone!) health. Strength training, in particular, strengthens the muscles around the joints, which can take some of the load off the joint surfaces and reduce wear and tear.
The goal, of course, isn’t to avoid movement, but rather to move in ways that support rather than strain the joints. Rachel’s 12-mile week might need tweaking to replace some higher-impact running with lower-impact swimming or cycling. She may also benefit from incorporating strength training to replace some running, which can support joint health in the short term and bone health in the long term.
Anti-Inflammatory Eating
Anti-inflammatory nutrition means eating a varied, balanced diet of whole, fresh foods to help your body fight cell damage. It involves eating minimally processed foods and avoiding refined sugars and excessive alcohol. It can also (if your provider agrees) mean supplementing with omega-3 fatty acids, for which meaningful evidence supports their role in reducing joint inflammation (among other benefits).
Protect Your Joints!
As joints age, those warm-ups and cool-downs become more important. You might have gotten away with skipping out your front door straight into a miles-long run in your 20s, but these days, your body needs and deserves a bit more grace.
Meet morning joint stiffness with gentle movement, a warm shower, or simple stretching or yoga. If you do experience an injury, give it ample time to rest. Try not to overdo it on days when you feel especially pain-free so as to avoid the resulting overtaxed joints. Rachel has tweaked her exercise regimen to include less running, more swimming, and gentle weight training to help build muscles that will support her joints as they age.
Conclusion
Rachel did choose to start menopausal hormone therapy, as other perimenopausal symptoms began giving her grief as well. Along with her new exercise regimen, she also tries to add anti-inflammatory foods to her diet. After reading about omega-3 fatty acids and talking to her provider, she decided to add them as a supplement, along with a vitamin D supplement after blood tests showed her levels were well below the recommended range. Rachel’s knees and hips still occasionally share their opinions, but she’s already feeling better.
If midlife joint pain is holding you back, now is the time to find a healthcare provider with experience treating women in middle age. If this article resonates with you, consider talking to your doctor about potential treatments. Find a provider who helps you figure out how to move forward into your best life!
Frequently Asked Questions (FAQs) about Perimenopause and Joint Pain
Can perimenopause cause joint pain?
Yes, joint pain is a common (and frequently underrecognized) symptom of perimenopause. Estrogen plays a significant role in joint health, and when levels begin fluctuating (and then declining), joint pain can show up. Estrogen supports cartilage maintenance, regulates synovial (lubrication) fluid, and helps curb inflammation. Declining estrogen can cause stiffness, pain, and a general “creakiness” in the joints.
How do I know if my joint pain is from perimenopause or from arthritis?
The two can have overlapping symptoms, which is why it’s important to see a medical provider before drawing conclusions yourself. Your provider will want to rule out several things (rheumatoid arthritis, thyroid function issues, vitamin D deficiency) before settling on decreasing estrogen as the cause. Perimenopausal joint pain typically begins in the mid-to-late 40s, involves several joints at once, and isn’t caused by any sudden injury.
Does hormone therapy help with joint pain during perimenopause?
For many women, yes. Research has shown that hormone therapy is associated with a reduced risk of osteoarthritis and that it can cause significant improvement in joint pain. This makes sense, given estrogen’s role in maintaining cartilage, lubrication, and inflammation regulation. For women who are appropriate candidates for hormone therapy (especially when they’re experiencing other symptoms of perimenopause), hormone therapy is certainly worth discussing with a provider as part of their treatment program.
Author Bio
I’m Leigh Anne Hulva, BSN, RN- a registered nurse, women’s health educator, mother of teenage daughters, and passionate advocate for women navigating perimenopause and menopause. I recently completed the Harvard Medical School course on Women’s Health, and in these pages I relish sharing what I learned there alongside what I know from lived experience. I bring to this work not only my training, but also the personal experience of navigating the very transition I write about. It is my privilege to share both, because this work is personal to me. I hope it feels that way to you, too.
I have been on the other side of this conversation, and I understand how much it matters to feel truly heard. At Nashville Concierge Medicines, Dr. William Conway, MD, supervises my work, and I work directly under his licensure as a nurse educator.
