Joint Pain in Menopause: You’re Not Imagining It
Is your body starting to ache without reason? Have you noticed that your workouts aren’t feeling the same? Maybe your knees ache after a run, or getting out of that sweaty sports bra went from hard to impossible? Are injuries recurring and recovery is taking longer than ever?
Or worse- you’re not sleeping because the pain is keeping you up at night and it’s getting difficult to function during the day?
Your joints can take a big (painful) hit in menopause that’s frustrating and even a little scary!
Menopausal joint pain is real – over 50% of women going through menopause will have joint pain, stiffness or muscle soreness limiting their daily activities, training and quality of life. This typically starts in perimenopause and can continue well into postmenopause.
In addition to the pain and limitations, musculoskeletal symptoms in menopause can be difficult to diagnose as imaging and labs often come back normal. Without a diagnosis to label you with many practitioners won’t have solutions to recommend.
There’s nothing like being told “everything’s fine” when you don’t feel fine. I promise you – menopause related joint pain is not in your head!
There are multiple reasons joint pain, injuries and slow recovery show up in menopause and none of the solutions involve giving up your workouts, your active lifestyle, or quality of life.
Let’s talk about some of the *whys* and what you can do about it.
Hormonal Changes: The Missing Piece of the Puzzle
One of the bigger reasons for joint pain in perimenopause and menopause is shifting hormones. Estrogen is a natural anti-inflammatory and plays a critical role in the health of your joints, ligaments, and tendons. It’s also a key regulator of bone density, collagen, muscle function, and inflammation. When estrogen declines, your entire body is impacted resulting in increased joint pain, stiffness, slow healing and even injuries.
Here’s more of the nitty gritty on how changing estrogen levels impact your joints, muscles and bone:
- Joint Cushioning & Lubrication: Estrogen helps maintain cartilage—the smooth tissue that cushions joints and prevents bones rubbing against bone. It also plays a role in synovial fluid production, which keeps joints lubricated. As estrogens drop, cartilage thins and synovial fluid decreases, leading to joint stiffness, discomfort, and an increased risk of osteoarthritis.
- Bone Density & Strength: Estrogen supports bone remodeling, the process by which old bone is broken down and replaced with new, strong bone. When estrogen declines, bone resorption (breakdown) outpaces bone formation (rebuilding), leading to weaker bones and an increased risk of fractures and osteoporosis. This also causes pain and discomfort in weight-bearing joints like your knees and hips.
- Inflammation & Immune Response: Estradiol is anti-inflammatory, helping to regulate the immune system and prevent excessive inflammation. When estrogen levels decline, pro-inflammatory cytokines (chemical messengers in the immune system) increase, leading to systemic inflammation that can exacerbate joint pain and contribute to conditions like frozen shoulder or generalized joint stiffness.
- Lean Muscle & Recovery: Estrogen is vital for maintaining muscle mass and strength. It enhances the function of mitochondria (the energy powerhouses of cells) and supports muscle repair and recovery. With lower estrogen levels, muscles may become *weaker*, leading to imbalances that put extra strain on your joints, further increasing the risk of pain and injury. Less strength means poorer performance at the gym or on the trails and a reduction in your day to day capabilities – how many bags of groceries (or grandkids) can you carry?
- Ligaments & Tendons: Estrogen plays a crucial role in the health and elasticity of ligaments and tendons—the connective tissues that stabilize joints and support movement. When estrogen declines, these tissues become stiff and less flexible, making you more prone to microtears, strains, and injuries. There can also be reduced blood flow to tendons and ligaments slowing down the healing process – meaning injuries take longer to recover. The combination of decreased elasticity, slower repair and more inflammation can lead to an increased risk of conditions like tendonitis and plantar fasciitis
Every woman’s response to changing hormones is different, AND it’s important to remember that hormones are not the only factor in perimenopausal and menopausal joint pain – the decline in estrogen may be exposing joint inflammation and degeneration that was already present. It’s why you need to know your specific hormone profile AND consider other causes of joint irritation and pain.
Gut Health + Food Sensitivities: The Joint Inflammer You Didn’t See Coming
Your gut health is intimately connected to joint pain, as are food sensitivities. I’ve had people struggle to walk up the stairs after consuming a food sensitivity they’d been avoiding for months! Imbalances in your gut and food sensitivities can cause significant, whole body inflammation leaving you achy, swollen and irritable – your joints and your mood.
Identifying food sensitivities can be challenging on a normal day. Add in hormone changes typical for menopause that make you more sensitive to certain foods and things really get confusing.
The connection between gut health, estrogen, and inflammation is often overlooked, but it plays a crucial role in your joint health and physical comfort in menopause. Here’s what you need to be aware of:
- Your Microbiome: Your gut microbiome is the collection of bacteria residing in your digestive tract that influence digestion, immune function, and inflammation. It too is impacted by hormone changes in menopause. Estrogen helps regulate the diversity and stability of the gut microbiome and when estrogen declines, the balance of beneficial bacteria shifts, leading to dysbiosis—an imbalance of good and bad bacteria. Dysbiosis can trigger inflammation throughout the body, especially in the joints.
- Leaky Gut: An increase in gut inflammation can lead to “leaky gut” – where your gut barrier becomes too permeable. A healthy gut lining acts like a well patrolled border crossing, preventing harmful substances like undigested food particles and bacterial toxins from entering the bloodstream. Estrogen helps maintain the integrity of the gut lining and when estrogen drops, this barrier becomes more porous like cheesecloth. Once these inflammatory substances cross this leaky barrier and enter your bloodstream, they trigger immune responses that lead to widespread inflammation often targeting your joints (as well as causing brain fog)!
- Food Sensitivities: With changes in gut function, your microbiome and even the speed at which your bowels function, it’s common to develop new food sensitivities or experience stronger reactions to foods you’ve previously tolerated in menopause. Food sensitivities contribute to leaky gut and systemic inflammation. Unlike a food allergy, sensitivities don’t always cause immediate symptoms, making it difficult to pinpoint which foods are contributing to inflammation.
Navigating food sensitivities to manage joint pain isn’t about following a generic anti-inflammatory diet or labeling foods as “good” or “bad”, it’s about discovering what *nourishes* your body and what inflames it. Getting specific with your nutrition is a powerful strategy to managing menopause symptoms including perimenopause and menopause related joint pain.
Not to mention how much better it feels when you can get through your day without pain AND bloating! Don’t underestimate your diet as a potential player in your joint and body pain.
Sleep Disruptions: The Vicious Cycle of Pain and Inflammation
Sleep is one of the most powerful tools for recovery, yet many perimenopause and menopause women struggle with getting quality rest—especially when joint pain is involved! The relationship between sleep and pain is bidirectional: pain makes it harder to sleep, and poor sleep increases pain sensitivity and inflammation, creating a vicious cycle that can be difficult to break.
Here’s a bit more detail on how menopausal sleep changes can cause or worsen your joint pain:
- Hormones and Sleep: Estrogen and progesterone both play significant roles in sleep regulation. As these hormones decline, you may experience more night sweats, frequent awakenings, longer times to fall asleep and lighter, less restorative sleep. Since deep sleep stages are crucial for muscle and joint repair, sleep disruptions can slow healing and make existing pain feel more intense.
- Increased Pain Sensitivity: Poor sleep affects the body’s pain-regulating mechanisms. Research shows that even a single night of inadequate sleep can heighten pain perception by increasing activity in the nervous system’s pain pathways. Over time, chronic sleep deprivation can make even mild joint discomfort feel more severe, further interfering with daily activities and workouts.
- Inflammation and Recovery: During deep sleep, the body releases growth hormone and anti-inflammatory cytokines which are essential for tissue repair and reducing inflammation. When sleep is disrupted, this process is impaired, leading to prolonged muscle soreness, slower recovery from exercise, and increased joint stiffness and swelling.
- Cortisol and Stress Response: Sleep deprivation raises cortisol levels, which further increases systemic inflammation and contributes to joint pain. Elevated cortisol also breaks down muscle tissue, making it harder to maintain strength and stability around joints, exacerbating discomfort and stiffness.
Addressing sleep is a critical component of managing joint pain in menopause. Dialing in your sleep routines is essential, fix what you have control over and don’t wait to get help with other menopausal symptoms (like night sweats) if you’re not sleeping well.
But Can’t I Just Take Hormones and Be Done with It?
You might be asking yourself, If hormones are part of the issue, can’t I just take estrogen and move on? While I’m a big proponent of Menopause Hormone Therapy (MHT) and know it can be life-changing for some people, it’s not the only piece of the joint pain puzzle. If stress and inflammation remain high and disrupted gut health and food sensitivities are left unaddressed, joint pain may persist even with menopause hormone therapy (MHT).
It’s why I recommend a comprehensive, holistic and individualized approach to addressing menopausal joint pain. Your joint pain isn’t ONLY because of low estrogen.
Ready to Get Back to Feeling Your Best?
You don’t have to live with menopausal joint pain or give up the activities you love. It’s not about dieting, eating keto or intermittent fasting either. It’s about getting specific with your body.
My approach is a comprehensive, whole body one. You’re unique! Your healthcare needs to be customized to your body. The entire premise of my 6-month 1:1 functional health program (created specifically for perimenopausal and postmenopausal women), is the most comprehensive approach to evaluating and managing menopausal joint pain. Utilizing extensive functional lab testing, getting a thorough history and then building a customized, truly individualized plan addressing food sensitivities, gut health, adrenal health, thyroid status, detoxification, genetics and GOALS. You get the tools to fix what needs fixing and have a roadmap to being your best, feeling your best and staying in pursuit of what you love most!
I also offer individual visits where we can address things one at a time at a pace that feels comfortable for you.
If you’re ready for real answers and lasting solutions, let’s talk! Details on my 6-month program are HERE.