HEALTH
As women approach menopause, many experience a variety of symptoms, ranging from hot flashes, night sweats, brain fog, weight gain/weight redistribution, sleep disturbances and much more. One common but often overlooked issue is joint pain and a reported 71% of perimenopausal women experience this kind of pain. (1) From an orthopedic perspective, the changes in hormones that occur during menopause can significantly impact the joints, leading to stiffness, discomfort, and even long-term mobility issues. Here’s a closer look at how menopause affects joint health and how you can manage these changes.
The average age of perimenopause is 47.5. The average age of menopause is 52.6 +/- 2.5 years. According to Dr. Vonda Wright, an orthopedic sports surgeon, researcher, longevity doctor and Associate Professor of Orthopedic Surgery at the University of Central Florida School of Medicine (UCF SOM), an estimated 70% of all midlife women will experience “musculoskeletal syndrome of menopause (MSM).” (7) This new established nomenclature includes (but is not limited to):
Musculoskeletal pain
Arthralgia
Loss of lean muscle mass
Loss of bone density = increased fracture risk
Increased tendon and ligament injury
Adhesive capsulitis and cartilage matrix fragility with the progression of osteoarthritis
The Role of Estrogen in Joint Health
Estrogen plays a vital role in maintaining joint health, and its decline during menopause is one of the primary reasons women experience increased joint pain. Estrogen helps keep the cartilage in the joints flexible and supports the production of synovial fluid, which lubricates the joints. As estrogen levels drop, the cartilage may begin to degrade more rapidly, leading to conditions like osteoarthritis, where the cartilage in the joints breaks down, causing pain, swelling, and stiffness.
“Estrogen is anti-inflammatory, and its receptors are all over the whole body, including your muscles, bones, joints, tendons and ligaments,” says Jocelyn Wittstein, MD, associate professor of orthopedic surgery at Duke University. “So, if its levels are going down, the bones and joints aren’t seeing as much estrogen, and this withdrawal could increase [joint pain] in the hands, shoulders and knees — really any joint.”
How Menopause Exacerbates Joint Pain
1. Decreased Cartilage Integrity: With lower estrogen, the protective effects on cartilage diminish, making joints more susceptible to wear and tear. This can lead to an increase in joint degeneration, particularly in weight-bearing joints like the knees, hips, and lower back.
2. Inflammation: Estrogen also has anti-inflammatory effects, and its reduction can trigger increased inflammation in the body. Inflammation is a primary driver of joint pain and stiffness, especially in pre-existing conditions such as osteoarthritis.
3. Osteoporosis: The decrease in estrogen during menopause accelerates bone loss, leading to osteoporosis. Weakened bones are more prone to fractures and can place additional strain on the joints. This weakening of bone structure contributes to an increased risk of joint pain and injury, particularly in the spine, hips, and wrists.
4. Weight Gain: Many women experience weight gain during menopause, which can add extra stress to the joints. The added weight, especially around the hips and knees, can exacerbate the pain from joint degeneration, putting further strain on the cartilage and soft tissues around the joints.
5. Muscle Weakness: Menopause can also lead to a reduction in muscle mass, as hormonal shifts affect the body’s ability to maintain and build muscle. Weak muscles around joints can increase instability and lead to more pain, as the joints may bear more weight and stress than they are designed to handle.
Orthopedic Approaches to Managing Joint Pain During Menopause
1. Physical Therapy: Strengthening the muscles surrounding the joints can help relieve pressure on the joints themselves. Physical therapists can design specific exercises to increase mobility, stability and flexibility, helping reduce pain and improve range of motion.
2. Exercise: Resistance training can help you develop and maintain strong muscles, and bones, while aerobic exercise works to strengthen your cardiovascular system.
I recommend doing some sort of resistance training with weights or simple functional movements using one’s own body weight three to four times per week and participating in some form of aerobic exercise such as walking, jogging, and running to build bone density and endurance for at least 150 minutes per week.
For a well rounded movement practice, be sure to incorporate stretching and balance work into your weekly routine. Yoga or pilates style workouts can check several boxes at once, including stretching, balance and body weight exercises.
If you are new to exercise, just start walking. If you’ve been only walking for a while, pick up some weights! Move your body.
3. Weight Management: Maintaining a healthy weight can help minimize stress on weight-bearing joints. A balanced diet, along with regular exercise, can help prevent excess weight gain and reduce joint strain.
4. Diet: Estrogen decline in menopause can contribute to inflammation. One of the best ways to decrease inflammation is through your diet.
Here are some anti-inflammatory options for your diet:
Omega 3s: Fatty fish, chia seeds, and walnuts. These foods are rich in Omega-3s. This reduces inflammation and joint pain.
Fruits and Vegetables: Berries are rich in antioxidants. Antioxidants help prevent tissue damage and inflammation. Vegetables are full of vitamins and other anti-inflammatory compounds. Examples include leafy green vegetables, tomatoes, and bell peppers.
Soy products: Edamame, tofu, and tempeh are all foods high in isoflavones. These mimic estrogen and may reduce menopausal joint pain symptoms.
Avoiding the following food groups helps lower inflammation:
Saturated fats: Fats typically found in animal products and seed oils. They contribute to inflammation in high amounts.
Sugars and refined flours: Found in processed foods, they increase pro-inflammatory chemicals. This leads to a higher level of the hormone insulin which increases inflammation.
Alcohol: Alcohol leads to increased oxidative stress and inflammation.
5. Stop Smoking: Stopping smoking is one of the best things you can do for your general health. Less smoke exposure will help build your bone strength and decrease inflammation.
6. Sleep quality: The quality of your sleep is an essential component of the menopause toolbox. People with menopause report having difficulty sleeping due to night sweats, restlessness, sleep apnea, or other conditions and find it hard to stay asleep. Without 7 to 8 hours of sleep a night, cortisol levels increase and cause inflammation in the body potentially leading to lowered defenses in the immune system and an increased risk of developing many chronic conditions such as sleep apnea and insomnia. We need to focus on sleeping more, because nothing is going to work until you allow your body the ability to restore itself. In addition, a good night’s sleep helps to manage your stress levels, which if ignored, can contribute to back and neck pain, especially during menopause. (3)
7. Supplements and Medications: Joint supplements such as glucosamine and chondroitin may help with cartilage repair and reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also provide short-term relief for inflammation and pain. In more severe cases, corticosteroid injections or even joint replacement surgery may be considered, depending on the severity of joint damage.
8. Hormone Replacement Therapy (HRT): For some women, HRT may help alleviate symptoms of menopause, including joint pain, by stabilizing estrogen levels. Highlights from the NAMS 2022 Hormone Therapy Position Statement include:
Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. (4)
When to Seek Help
Joint pain that persists or worsens despite lifestyle changes should be evaluated by an orthopedic specialist. An orthopedic doctor can assess the extent of joint damage through imaging studies, such as X-rays or MRIs, and recommend a personalized treatment plan that may include physical therapy, medication, or more advanced interventions like injections or surgery.
Conclusion
Menopause brings many changes, and joint pain is one of the most common challenges women face during this time. Understanding the connection between hormonal changes and joint health can help women take proactive steps to manage and reduce pain. From exercise to proper nutrition and medical interventions, there are many ways to address joint pain during menopause and maintain an active, healthy lifestyle.
If you’re experiencing joint pain during menopause, don’t hesitate to speak with an orthopedic specialist to develop a treatment plan tailored to your needs. Early intervention can help prevent further joint damage and improve your quality of life.
These are conversation starters for you to have with your spouse, your mother, your OBGYN and anyone else that will listen. Let’s start moving our body to be strong, not skinny.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710408/
https://www.arthritis.org/news/news-and-events/joint-pain-in-menopause
https://www.tandfonline.com/doi/full/10.3109/13697137.2010.483025
“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” has been endorsed by more than 20 well-respected international organizations. It can be viewed on the NAMS website [link to: https://www.menopause.org/docs/default-source/professional/nams-2022-hormonetherapy-position-statement.pdf]
https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024 Oct;27(5):466-472. doi: 10.1080/13697137.2024.2380363. Epub 2024 Jul 30. PMID: 39077777.
New Hope For Menopause: Experts Say Hormone Therapy Is Safe And Effective | The 'Pause Blog – The 'Pause Life by Dr. Mary Claire Haver
Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study. Bermingham, Kate M. et al. eBioMedicine, Volume 85, 104303.
