If you’re in perimenopause or menopause and suddenly feel achy, stiff, or sore in places that never bothered you before, you’re not imagining things — and you’re not “just getting old.”

Many women tell me they wake up feeling stiff, notice new joint pain in their knees or hips, or struggle with neck, shoulder, or back discomfort that seems to come out of nowhere. Often, imaging looks normal. Labs look “fine.” And yet, their bodies don’t feel the same.

The missing piece is often hormones — especially estrogen.

Why Musculoskeletal Pain Increases in Menopause

Estrogen plays a much bigger role in musculoskeletal health than most women realize. As estrogen levels decline during perimenopause and menopause, several important changes occur:

1. Increased Inflammation

Estrogen has natural anti-inflammatory effects. When levels drop, inflammatory pathways become more active, which can lead to joint pain, muscle soreness, and increased pain sensitivity.

2. Reduced Collagen Production

Collagen provides strength and elasticity to tendons, ligaments, cartilage, and fascia. Lower estrogen means slower collagen turnover and repair, contributing to stiffness and slower recovery after activity.

3. Tendon and Ligament Changes

Estrogen receptors are present in connective tissue. Declining estrogen can make tendons and ligaments less flexible and more prone to irritation or injury.

4. Loss of Muscle Mass

Menopause accelerates age-related muscle loss (sarcopenia). Less muscle support around joints increases mechanical stress, particularly in the knees, hips, and spine.

5. Sleep Disruption and Pain Sensitivity

Hot flashes, night sweats, and insomnia reduce restorative sleep. Poor sleep increases pain perception and slows tissue repair, creating a vicious cycle.

Common Areas Women Notice Pain

• Knees and hips
• Neck and shoulders
• Hands and fingers
• Lower back
• Feet and ankles

Many women describe it as “feeling like I aged overnight.”

What Actually Helps

The good news is that menopause-related musculoskeletal pain is treatable — especially when addressed early and comprehensively.

Hormone Therapy

For appropriate candidates, hormone therapy can help reduce inflammation, support connective tissue health, and improve pain, sleep, and overall function.

Strength Training

Resistance training is one of the most powerful tools for protecting joints, improving stability, and preserving muscle mass during menopause.

Anti-Inflammatory Nutrition

Reducing ultra-processed foods and increasing protein, omega-3 fats, and micronutrients can meaningfully lower systemic inflammation.

Acupuncture

Acupuncture can help reduce pain, improve circulation, and calm the nervous system, especially for neck, back, and joint discomfort.

Prolotherapy

Prolotherapy stimulates the body’s natural healing response to strengthen ligaments and tendons, particularly helpful for chronic joint instability or pain.

Platelet-Rich Plasma (PRP)

PRP uses your own growth factors to support tissue repair and regeneration and can be very effective for joint and tendon pain.

Targeted Supplements

Depending on the individual, omega-3 fatty acids, magnesium, vitamin D, and vitamin K2 can support musculoskeletal health.