Achy Joints in Perimenopause? Meet the Musculoskeletal Syndrome of Menopause

When your body starts to feel different

Many women in their forties and fifties notice new aches: stiff hands in the morning, a sore shoulder that will not settle, knees that complain on the stairs, or workouts that feel harder than they used to. It is easy to put it down to getting older or overdoing it. For many women, it is also connected to menopause, and there is now a name for it.

A name for a pattern women have described for years

In 2024, orthopedic surgeon Dr. Vonda Wright and colleagues published a review in the journal Climacteric proposing the term musculoskeletal syndrome of menopause. It describes the collection of muscle, bone and joint signs and symptoms that are associated with the loss of estrogen during the menopause transition.

A name matters. When aches in a shoulder, a hip, a heel and a wrist are seen as one pattern rather than four separate complaints, it becomes easier to talk about them with your prescriber and to look at the bigger picture. The review describes these symptoms as very common during the transition.

What it can include

The syndrome brings together symptoms that often show up side by side:

• Joint aches and stiffness, sometimes in several joints at once
• Muscle aches, and a loss of muscle mass and strength
• Frozen shoulder, a painful stiffening of the shoulder joint
• Tendon and bursa inflammation, such as tendinitis and bursitis
• Changes in bone density

You may recognize one of these or several. Either way, they are worth mentioning to your prescriber rather than putting up with them quietly.

Why estrogen matters to muscles, bones and joints

Estrogen is not only a reproductive hormone. Receptors for it are found throughout the musculoskeletal system. Estrogen helps maintain bone by slowing the natural breakdown of bone, it supports the collagen in connective tissue such as tendons and ligaments, and it plays a part in maintaining muscle mass and strength. As estrogen levels fall through perimenopause and after menopause, those supports change, and many women feel it.

Everyday habits that support muscles and bones

Much of what supports the musculoskeletal system is within reach, and it is worth starting wherever you are:

• Strength training. Muscle and bone both respond to being loaded. A physical therapist or qualified trainer can help you build a routine that suits your joints.
• Enough protein through the day. Muscle needs it to repair and grow. Your prescriber or a dietitian can help you work out what is right for you.
• Calcium and vitamin D. Talk with your prescriber about whether your diet covers what you need, or whether a supplement makes sense.
• Staying active between workouts. Walking, mobility work and simply moving often all help.

Questions to bring to your prescriber

• Could my joint, muscle or tendon symptoms be related to perimenopause or menopause?
• Should my bone density be checked?
• Which lab work makes sense for me? Our page on labs for bioidentical hormone therapy explains what prescribers often look at.
• If we are already talking about hormone therapy, how do these symptoms fit into that conversation?

Your prescriber knows your history and is the right person to weigh your options with you.

How we can help

If your prescriber prescribes a compounded hormone preparation, we prepare it in our PCAB-accredited pharmacy in Johnson City, Tennessee, made to order at the strength your prescriber specifies. Estradiol and estriol can be prepared as a hypoallergenic cream, an olive oil base topical or a vaginal preparation, with oral capsules for progesterone and DHEA. Our women's health page shows everything we prepare, and our guide to bioidentical hormone replacement therapy explains how compounded hormones work.

We are licensed in all 50 states and the District of Columbia, and we have a 48-hour compounding time on most preparations. Shipping time is additional. Already have a prescription somewhere else? You can transfer it to us. Call 423-975-0597 for current pricing and shipping options for your state.

Source

Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466–472.

This article is for education and reflects what we see in clinical practice; it is not medical advice. Decisions about your care rest with your prescriber. Compounded preparations are not reviewed or approved by the FDA for safety or efficacy.