Explore why menopause can contribute to joint pain, tendon problems and changes in musculoskeletal health, and what MSK physiotherapists and fitness professionals need to know to better support women through midlife.
Aching joints. Stiff shoulders. Tendon pain that won't settle. An old injury that suddenly flares up for no obvious reason.
For many women in midlife, these musculoskeletal symptoms are a familiar part of the menopause transition. Yet too often, they are dismissed as an inevitable consequence of ageing, investigated in isolation or treated without considering the hormonal changes that may be contributing to them.
For musculoskeletal (MSK) physiotherapists and other health and fitness professionals, this presents an important opportunity: to recognise the potential impact of menopause on musculoskeletal health and adapt how we assess, support and educate women.
Research is helping to bring this issue into sharper focus. In a 2024 paper published in Climacteric, Wright and colleagues explored the concept of musculoskeletal syndrome of menopause (MSM), proposing a name for the cluster of musculoskeletal symptoms and changes associated with the menopause transition.
Their work raises an important question for clinicians: what changes when we stop viewing menopause-related joint pain as a collection of unrelated problems and start considering the bigger picture?
Wright and colleagues highlight the substantial burden of musculoskeletal symptoms during the menopause transition. Their paper reports that more than 70% of women experience musculoskeletal symptoms as they move from perimenopause into post-menopause, with around a quarter experiencing symptoms that are disabling.
These figures matter for MSK physiotherapists. Joint pain, muscle aches, stiffness and tendon problems are common reasons why women seek help, but the potential contribution of menopause may not always be recognised during assessment.
And this isn't just a postmenopausal issue. Symptoms can emerge during perimenopause, when fluctuating hormone levels coincide with changes in sleep, recovery, activity levels and overall wellbeing.
Oestrogen has a range of effects throughout the body, including on tissues involved in musculoskeletal health and on the pathways that influence pain. Oestrogen receptors are present in tissues such as muscle, tendon, ligament, cartilage and bone. Changes in oestrogen levels may therefore contribute to changes in pain sensitivity, tissue function and musculoskeletal health.
The relationship is complex, however. Not every joint or tendon problem in midlife is caused by menopause, and symptoms still require an appropriate clinical assessment.
The challenge is to recognise menopause as a potentially relevant part of the clinical picture, rather than overlooking it altogether.
In their 2024 paper, Wright et al. introduced the term musculoskeletal syndrome of menopause (MSM) to describe a broader pattern of musculoskeletal symptoms and changes associated with the menopause transition.
The concept brings together problems that are often assessed and managed separately, including:
These features do not necessarily share one cause, and MSM should not be used as a catch-all diagnosis for every musculoskeletal complaint in a menopausal woman. Instead, the concept encourages clinicians to consider whether hormonal changes may be contributing to a wider pattern of symptoms.
For MSK physiotherapists, this means looking beyond the painful joint or tendon in front of us and asking whether menopause-related factors could also be influencing the presentation, recovery or patient's experience of pain.
A name can help make an overlooked issue easier to recognise, discuss and research.
Consider genitourinary syndrome of menopause (GSM). Symptoms such as vaginal dryness, urinary discomfort and recurrent urinary tract infections were often discussed separately. Grouping them under a recognised clinical term helped bring greater attention to their shared context and the treatment options available.
The concept of MSM offers a similar opportunity for musculoskeletal care. It provides a framework for discussing the potential relationship between menopause and musculoskeletal symptoms, rather than leaving women to navigate seemingly unrelated problems without an explanation.
For physiotherapists, recognition matters because it can influence the questions we ask, the advice we give and the support we offer.
It may prompt us to ask about menstrual changes, other menopause symptoms, sleep, recovery and changes in exercise tolerance. It can also help us understand why a woman who has previously exercised confidently may now be struggling with pain, reduced strength or a loss of confidence in movement.
Importantly, recognising a possible menopause connection does not replace a thorough MSK assessment. Red flags, differential diagnoses, relevant comorbidities and other contributing factors remain central to good clinical practice.
Menopause should be part of the clinical conversation, not an assumption that explains everything.
Understanding the potential impact of menopause on musculoskeletal health can help physiotherapists take a more informed, individualised approach to assessment and management.
Menopause may not be mentioned during an MSK consultation, particularly if the patient has booked an appointment for a specific problem such as shoulder pain, tendinopathy or knee pain.
A sensitive, relevant question about menstrual changes or other menopause symptoms may reveal useful context. It can help establish whether the patient is in perimenopause or post-menopause and whether symptoms have changed alongside other aspects of their health.
Persistent joint pain or tendon symptoms should not automatically be attributed to hormonal changes. Equally, menopause should not be overlooked simply because the presenting complaint appears to be a familiar MSK condition.
Consider the patient's wider presentation, including sleep, fatigue, stress, activity levels, previous injuries, medication, medical history and changes in training or recovery.
This broader perspective can help inform clinical reasoning and support shared decision-making.
Appropriately prescribed exercise remains central to musculoskeletal health during midlife and beyond.
Progressive resistance training can help develop or maintain muscle strength, while suitable weight-bearing and impact activities can support bone health when appropriate for the individual. Aerobic activity, balance work and mobility exercises can also contribute to function and confidence.
The right programme will depend on the patient's symptoms, goals, capacity and clinical presentation. For someone experiencing pain, that may mean adjusting exercise selection, load, volume or progression rather than avoiding movement altogether.
The aim is not to blame every setback on menopause or to push through pain regardless. It is to help women find a safe, sustainable route back to the activities that matter to them.
Being told that pain is simply part of getting older can leave women feeling unheard and uncertain about what they can safely do.
A more helpful conversation acknowledges the symptoms, explores possible contributing factors and explains the options for managing them.
Menopause may be one part of the explanation, but it does not mean pain is inevitable, untreatable or something women simply have to accept.
Physiotherapists are well placed to support movement, function, strength and rehabilitation. Depending on the patient's needs, collaboration with a GP, menopause specialist or other healthcare professional may also be appropriate.
Women can discuss menopause symptoms and possible treatment options, including hormone replacement therapy (HRT), with a suitably qualified prescriber. HRT decisions require an individual assessment of potential benefits, risks and preferences; physiotherapists should work within their scope of practice and avoid presenting HRT as a universal solution for musculoskeletal pain.
As awareness of menopause and musculoskeletal health grows, so does the need for professionals who understand how the menopause transition may affect exercise, rehabilitation and long-term physical health.
For MSK physiotherapists, menopause-informed practice can strengthen clinical conversations, improve patient education and help identify when a wider perspective or referral may be useful.
For personal trainers, strength coaches and other exercise professionals, understanding menopause can help inform exercise programming, communication and appropriate signposting, while recognising the boundaries of their professional scope.
This knowledge is particularly important when supporting women who have become less active because of pain, are worried about lifting weights or feel that their bodies are no longer responding to exercise in the way they once did.
Menopause-informed practice is not about treating every woman in midlife as though she has the same needs. It is about understanding the evidence, asking better questions and adapting support to the individual.
If you work with women in midlife, understanding the relationship between menopause and musculoskeletal health is an important part of providing informed, effective support.
Menopause Movement offers training to help health and fitness professionals develop their menopause knowledge and apply it in practice. Whether you are an MSK physiotherapist, personal trainer, strength coach or another professional working with women, menopause education can help you feel better equipped to recognise relevant symptoms, have informed conversations and support women to stay active.
Explore the Menopause Foundation course for fitness professionals, and the POGP menopause training courses that are suitable for Pelvic health and MSK physiotherapists to learn more about developing your menopause-informed practice. You can also use our Menopause Movement Directory to find professionals with menopause-related expertise.
Menopause does not have to mean giving up the activities women love. With the right assessment, appropriate exercise and informed support, we can help women maintain strength, confidence and independence through midlife and beyond.
Let's make menopause-related musculoskeletal health a more visible part of physiotherapy and exercise practice.
Have you noticed a change in how you assess or manage joint pain and tendon problems in women during midlife? We'd love to hear your experiences.
Reference: Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024.
October 2026
