More Than Hot Flashes: The Connection Between Menopause and Your Musculoskeletal Health

Welcome back, readers! This month, we’re diving into a topic that doesn’t always get enough attention: how perimenopause and menopause can affect your musculoskeletal health. Your musculoskeletal system includes your bones, muscles, joints, tendons, and other tissues that help you move.

As the title suggests, menopause is about more than hot flashes, night sweats, and changing periods. The hormonal changes that happen during the menopausal transition can affect the whole body, including the tissues involved in movement and physical function.

Maybe you’ve noticed that you’re feeling more achy than you used to, that an old injury seems to be bothering you again, or that your body doesn’t seem to recover from exercise the way it once did. Maybe what used to feel easy now requires a little more recovery time. Sometimes I even wonder, “What is going on with my body?”

These experiences can be part of the bigger picture of the menopausal transition.

First, let’s talk about what perimenopause and menopause is. Menopause is a normal biological transition that occurs as ovarian hormone production declines, particularly estrogen. Perimenopause is the stage leading up to menopause, when hormone levels can fluctuate. Perimenopause typically begins in one’s 40s, although it can occur sooner or later, and everyone’s experience is different. Some people experience very few symptoms, while others notice significant changes that affect their sleep, mood, exercise, and overall quality of life

And this is where things get interesting from a physiotherapy perspective. So, what does estrogen have to do with movement you ask?

Estrogen has effects throughout the body, including on tissues involved in physical function. As estrogen levels change during the menopausal transition, this can coincide with changes in muscle mass and strength, bone health, and connective tissues such as tendons and cartilage. Research suggests that estrogen plays a role in maintaining tendon and cartilage health (Cowan et al., 2022) and preserving muscle strength (Greising et al., 2009). These changes may help explain why some people notice new or changing musculoskeletal symptoms during this stage of life.

If you are going through menopause or perimenopause, you may start to notice some changes. Such as:

– Changes in muscle strength, bone/ muscle mass
– Increased joint or tendon discomfort
– Changes in activity tolerance or recovery
– Feeling more sensitive to pain

Research also points to a higher prevalence of certain musculoskeletal conditions during and after the menopausal transition, including conditions such as bursitis, greater trochanteric pain syndrome, and frozen shoulder.

So… Bre, are you saying every ache and pain because of menopause? No (and this is an important distinction)!

Not every new pain or injury during midlife is “because of menopause.” Hormonal changes can be one piece of the puzzle, but there are many other factors that influence how our bodies feel and respond to physical activity. Things like tissue load tolerance, changes in strength or muscle activation, biomechanics, previous injuries, sleep, stress, and other medical conditions can all play a role. Often, there isn’t one single explanation for why something hurts.

This is why looking at the whole person and completing a thorough assessment is so valuable. I think it is incredibly important that your healthcare provider understands your experience through perimenopause and menopause. Knowing what is happening in your body can help us better understand the whole picture.

As physiotherapists, our role is not to “treat menopause.” Our role is to help you understand your body, build physical capacity, support your health, and help you stay active through these stages of life. We have a whole team (physiotherapists, massage therapists, a psychologist, and a personal trainer) here to support you!

Bre Maughan
Registered Physiotherapist (MScPT, BScKin)
Bragg Creek Physiotherapy
www.braggcreekphysio.com