#044 - The Musculoskeletal Syndrome of Menopause: What Every Woman (and Man) Needs to Know
If you’re a woman in your late 30s or above who feels stiffer, weaker, or more injury-prone than you used to, you’re not imagining it. In fact, research shows that up to 71% of peri- and postmenopausal women experience musculoskeletal symptoms, including joint pain, muscle loss, reduced stamina, and slower recovery. This isn’t random. It’s part of a predictable pattern the medical community now calls the musculoskeletal (MSK) syndrome of menopause.
What Is the MSK syndrome of menopause?
The MSK syndrome describes a constellation of changes in muscle, bone, joint, and connective-tissue changes that emerge as women transition through perimenopause and into menopause, driven largely by hormonal shifts but expressed through several interconnected biological drivers. The key drivers of this syndrome are:
1. Chronic low-grade inflammation
Estrogen helps to regulate inflammation by inhibiting the release of pro-inflammatory chemicals which degrade muscle tissue. So, as estrogen declines, women experience increased joint sensitivity, more stiffness, and slower healing. This inflammatory shift amplifies pain—particularly in the hands, hips, knees, shoulders, and feet—and drives chronic soreness that many women chalk up to “just getting older.”
2. Sarcopenia (accelerated muscle loss)
Women lose muscle gradually from their 30s, but the rate doubles after menopause thanks to lower estrogen and testosterone causing lower muscle protein synthesis, slower muscle repair, decreased baseline strength and power output. This loss of muscle doesn’t makes joints less supported, increases injury risk, worsens balance, and slows metabolism.
3. Bone loss (osteopenia/osteoporosis)
Estrogen and testosterone are essential for healthy bone remodeling. Even active women can lose almost 1% of bone mass per year without intervention. Bone and muscle decline together, which accelerates the sense of “fragility” many women describe.
4. Degenerative joint changes (osteoarthritis)
Estrogen also protects cartilage, tendons, ligaments, synovial fluid, and collagen structure. So, when estrogen drops, joints become drier, less lubricated, and more susceptible to degenerative changes. Women are more likely than men to develop osteoarthritis, and symptoms often worsen around menopause—not because of wear-and-tear, but because the biology supporting joint tissue has shifted.
The big picture: why does this matter?
When these 4 drivers combine, women feel the effects everywhere:
· more stiffness in the morning
· slower recovery after workouts
· joint pain
· more frequent injuries
· decreased performance in activities they’ve done for years
The good news: we can overcome this with simple & safe interventions
1. Strength training
Strength training is probably the most powerful intervention across ALL drivers:
· reduces inflammation
· rebuilds muscle
· protects joints
· stimulates bone growth
· improves metabolic flexibility
Extensive exercise physiology evidence shows that lifting heavy weights in lower repetitions (i.e., progressive overload) is the most effective way to build muscle. This is why resistance training should be a non-negotiable for women in midlife and beyond. So, in short: LIFT HEAVY!
2. Hormone replacement therapy (HRT)
HRT directly addresses the root cause for MSK syndrome of menopause by replacing the declining hormones and mitigating the devastating MSK effects. HRT works because it:
· reduces inflammation
· supports muscle and tendon health
· protects bone
· reduces joint pain
· improves sleep and recovery
For many women, HRT makes exercise and strength training effective again and resolves their pain.
3. Daily movement & mobility
Short daily mobility sessions often significantly reduce pain and improve MSK via:
· joint lubrication
· tendon elasticity
· circulation
· stiffness
4. Proper nutrition
The right nutrition will support muscle building and lower inflammation. The most effective changes to incorporate:
· prioritize protein
· add creatine
· reduce ultra-processed foods
· increase vegetables & omega-3s
· stay hydrated
Proper nutrition usually means that we don’t need to take vitamin supplements. However, vitamins to consider supplementing are vitamin D (especially in dark, northern parts of the world), and some new evidence on vitamin K2.
Why Men Should Care
When women suddenly struggle with pain, fatigue, or movement, understanding the MSK syndrome allows men to support the experience. Men can help by:
· normalizing strength training for women
· encouraging HRT conversations
· understanding why recovery needs change
· being allies in a stage of life that has been ignored far too long
Future Proof takeaway
The MSK syndrome of menopause is common, real, but highly modifiable. With smart training, HRT (where apprioriate), good nutrition, recovery, women can stay strong, athletic, and pain-free for decades to come.
Thank you
Dr Kate Whitehouse
Reference: Vonda J. Wright, Jonathan D. Schwartzman, Rafael Itinoche & Jocelyn Wittstein (2024) The musculoskeletal syndrome of menopause, Climacteric, 27:5, 466-472, DOI: 10.1080/13697137.2024.2380363