Why Perimenopause and Menopause Cause Joint Pain — And What to Do About It

Roberta Bas

A Common Story

I had a patient recently who is waking up every morning with stiffness in their back and their hip and they are perimenopausal, possibly postmenopausal. And this is such a common theme that I have with so many of my clients — so in Pilates or those that I'm seeing one to one — pain and joint stiffness is a really common symptom of perimenopause and postmenopause.

Yet it is so often mistaken for other things. And women are struggling with it for so long before getting help or realising it is not just a musculoskeletal problem. So they might go to a normal physio and get treatment for that particular joint pain. And it doesn't really help that much, because it's down to hormones and the effect that has on the body. So that's what we're going to talk about today — all about joint pain.

Now, if you are struggling with joint pain, then you will know that it can affect your sleep, it can affect your ability to do exercise, it can affect your work life, whether you are sitting at a desk, whether you are doing something more manual. It affects every element of your life. It is very common in menopause. But why? What is happening?

What's Happening Hormonally

As we go through perimenopause, our oestrogen is reducing, but not at a steady rate. So it goes up and down — some days it's really high, some days it's really low compared to our progesterone. Our progesterone and oestrogen work together. So think of a lawn: the oestrogen is our fertilizer, makes the grass grow. Our progesterone is our lawnmower that keeps that grass under control.

If we have an imbalance, we get either really high grass or we get really patchy lawn. So we need it to be nice and stable and regular, and then we don't tend to get symptoms or any hormonal issues. As soon as we go through perimenopause, we get up and down of our oestrogen and our progesterone steadily decreases. We also need to throw testosterone in there as well because that can affect some of our symptoms too.

But let's mainly think about the oestrogen, because when our oestrogen is high in the body, it acts as an anti-inflammatory. So you may have taken anti-inflammatories like ibuprofen or naproxen — they work by reducing inflammation within the body. Oestrogen is our natural version of that. And it helps to keep any inflammation within the body under control. If we have little micro traumas in the day, we might get inflammation and pain from that — our oestrogen helps to reduce that.

Unfortunately, when our oestrogen declines, we start to get problems because we have more inflammation within the body. Now that causes not only joint pains, it can cause things like brain fog and other issues — but we're talking mainly about our joints and muscles today.

What Happens to Your Connective Tissue

As we go through and our oestrogen decreases, our connective tissue — so our tendons and our ligaments — becomes stiffer. Our collagen changes, and that makes up all of our connective tissue and our skin. Our turnover of collagen decreases and the makeup of our collagen changes. So this is why our skin becomes slacker and we get wrinkles — it's not as taut as it was. But our connective tissue also becomes stiffer. So our tendons and our ligaments become stiffer. Our muscles also become tighter.

Now, if you don't know: muscles insert into bone via the tendons, and our muscles contract and relax to move our limbs and our joints. Our ligaments support around the joints — so most joints have several different ligaments that support them to keep them nice and stable. Our joints, depending on what type, often have a capsule that goes around them, and within there we have synovial fluid that keeps our joints moving — so it acts a bit like an oil, keeps everything moving smoothly.

That changes as we get older so that our joints become less lubricated, our ligaments and our tendons and everything becomes stiffer. So then we start to get pain because our joints aren't moving in the same way as they did before. We get knots in the muscle. It takes a while for us to get moving in the morning.

Morning Stiffness — When to Get It Checked

So this one particular patient who has problems with her back and her hip — she takes half an hour, an hour to get moving. By the time she's gotten in the car to go to work, then it gets better. Sometimes that can be indicative of an inflammatory problem, so something like ankylosing spondylitis or inflammatory arthritis or rheumatoid arthritis — it's quite common to get that stiffness in the morning. But that has been ruled out for this particular patient.

So if you are getting stiffness that lasts more than half an hour in the morning, particularly if it is in the back or in multiple joints — and rheumatoid arthritis is often in both wrists and the hands — it is worth looking into and getting a blood test to rule out any inflammatory problem. But if you're also perimenopausal or postmenopausal, it could definitely be down to hormones.

Which Areas Are Most Commonly Affected

There are certain places in the body that are prone to getting problems during perimenopause, and it's often the tendons. The tendons of the rotator cuff in the shoulder are quite often irritated — you get tendinopathy. Also on the outside of the hip, you can get what we call GTPS, which is Greater Trochanteric Pain Syndrome. It's a bit of an umbrella term, so it can be the tendon — our glutes or bottom muscles insert around that area, so it can be them that you're getting irritation in the tendons. It can also be the bursa, which is like a little sack of fluid that sits between the tendon and the bone, and that can become inflamed as well. That can cause pain when laying on your side or walking.

The other thing that can be problematic, particularly when walking, is our Achilles — so the back of the heel can become inflamed and you get tendinopathy there. Plantar fasciitis — so the connective tissue that goes underneath the sole of the foot — can also become irritated and become tighter and then we can get pain there. Tennis elbow. Basically anywhere where there is a tendon that gets used a lot can cause a problem during peri and postmenopause.

The Role of Sleep

The other thing that can affect this is our poor sleep. During perimenopause and often into postmenopause, we can have problems with our sleep — particularly with night sweats, or anxiety waking us up, or just general insomnia or restless legs, sleep apnoea — there are many things that can affect our sleep.

If we don't sleep properly, our body doesn't repair. So during the day we move and we have lots of micro trauma. As I was saying about that causing inflammation — if we haven't got the oestrogen, then we have more problems with our inflammation. But also if we're not sleeping, the body normally repairs itself overnight and those micro traumas of the day get repaired. If we're not sleeping properly, they don't get repaired. And then they're ongoing and we get more micro traumas, more micro traumas, and then we end up with tendinopathy or other joint or muscle problems.

The Role of Muscle Strength

Our muscles become weaker as we get older — we lose muscle mass, and it's the muscles that help to support the joints. So you've got our ligaments, which are our passive structure: they don't move anything, they just stabilise. But we've got loads and loads of muscles. We've got our deep muscles that help to stabilise the joints. And so we need that balance on one side of the joint or the other.

With the back, for example, we have our deep core muscles, and they help to stabilise the joints of the back and the hips and the pelvis — it gives us that strong foundation. And we have then our big chunky muscles of the back that extend the back, and then we've got our abdominals that help us bend forward. There needs to be a balance between muscles working in opposition to help keep the joints stable and happy. If there's weakness in those deeper stabilising muscles, then the joints can move in the wrong way, and then that can cause more inflammation, that can cause pain. So then we get in that vicious cycle.

So we need to find a way to improve not only how our body moves but also the hormone balance, so that we can help improve our sleep, help reduce inflammation within the body, as well as strengthening our muscles.

What You Can Do: Sleep and Posture

So how do we do this? Now, often when we wake up with stiffness in the morning — if it's not an inflammatory problem — it can be due to our posture at night time. It could be that our mattress isn't good. So looking at our posture when we're sleeping: do we need pillows between the knees? Do we need to hug a pillow? Do we need to have a mattress topper? Do we need a new mattress?

I know it can be difficult to pad yourself out too much at night time, because then we end up getting hot and having night sweats. But it's trying to get yourself into the best possible posture. Also — are we waking due to pain? Are we waking due to sleep apnoea? So maybe getting that investigated. If you're stopping breathing, if you're snoring a lot, then it might be worth going to the GP to get that investigated.

Thinking generally about quality of sleep — I've done several episodes about how to improve sleep quality so go back and listen to those. But it is trying to have that wind down routine, making sure you're having a regular bedtime and get up time, trying to do a mind dump before bedtime so that you're not waking up with a busy head.

What You Can Do: Exercise

If you are waking up with night sweats or having hot flushes in the daytime, one of the best things for that is actually to do resistance exercise. And funnily enough, resistance exercise is also going to help stabilise all the joints by building up our muscles.

We also want to get some stretching exercises because if our muscles have become tighter, if all of our connective tissue structures have become tighter, then we need to get them moving. So we want to include exercise into our routine. That needs to be some strengthening — that could be weights, it could be bodyweight, it could be things like Pilates. I teach Pilates, so I think Pilates is great for most things. But it is getting that body moving. Some stretching exercise — we do stretches within Pilates, but also things like yoga, or just a general stretching routine, is really good.

We also want to work on our balance because that will help with our stabilising muscles. So building up some regular exercise — even if it's going for a walk and then doing a few bodyweight exercises — is going to be a really great way to help with joint pain. There may be specific exercises depending on which area of the body is affected that you need to do, and that's where coming in for an assessment is helpful. But just getting out and doing some general exercise is going to be beneficial as well.

What You Can Do: Hydration and Diet

It's not just exercise and sleep. We also need to think about drinking enough. We need to hydrate our body. If we are not drinking enough, then we get dehydrated — and that's not just causing headaches and us being a bit thirsty. It's also going to mean we haven't got that lubrication between all of our connective tissue and in our joints. We need to provide enough hydration for the body to function properly.

Also thinking about foods: certain foods may or may not help with the joint problems. We are more prone to getting wear and tear as we get older as well, because the joints have worn slightly — but also due to the lack of anti-inflammatories from our oestrogen and everything moving in a different way. Certain foods can make any arthritis worse, so citric foods can have an effect. If we are not eating enough protein, we're not going to be able to build our muscles.

Looking at maybe an anti-inflammatory diet — so if we're having lots of sugar, alcohol, anything that breaks down into simple carbohydrates, that can increase our inflammation within the body. So maybe cutting out some of those things will help with the joint pain. Having some healthy fats and proteins and good quality fibre — that's all going to help.

What You Can Do: Load Management

Looking at what you're doing day to day, it's also about load management. So it might be that you need to change how you're moving. If you do have a manual job, maybe you need to take more regular breaks or build in some stretches. Maybe if you're sat at a desk all day, you need to get up and get moving — and that will help reduce postural related pain as well.

Getting the Right Support

The first thing really is to get an assessment. So if you are getting joint pain that's been ongoing, then it is best to see somebody that specialises in menopausal joint pain. Now that could be a regular physio just to get specific things treated — but if they know about menopause, then that's going to be more beneficial, because then you can address the underlying cause, not just that particular joint pain.

I've seen many people over the years and you just treat their rotator cuff problem — it kind of gets a little bit better, but if you're not addressing the person as a whole, they're not going to get the same outcome.

So if you do need more support — I offer online appointments as well as in person — then check out the website, the links will be in the show notes. Or find somebody local to you that can help. Go and ask them if they know anything about menopause as well as joint pain, as that will be beneficial. You can also try and see a GP to see if there are any medical options.

But just know — it's not all about getting older, and these are not things that you have to put up with. It's not just a perimenopausal thing you have to cope with. There are things that can be done. So don't sit on symptoms. Make the effort. Do some changes to your lifestyle. Find somebody that can help you. And just don't put up with it.

So until next time, take care and I'll see you soon.