Joint pain and body aches in perimenopause and menopause: causes explained - Part 1 of a two-part series

Pain can become more noticeable during the menopause transition. You might wake up with stiff joints, find an old back problem flaring more often, experience more migraines or develop pain during sex.

These symptoms deserve attention. Hormonal changes can contribute, but pain during midlife has many possible causes. Understanding how oestrogen influences both body tissues and pain processing helps explain why familiar pain may worsen and why new symptoms can appear.

Why can pain increase during perimenopause and menopause?

During perimenopause, oestrogen fluctuates, sometimes considerably, before settling at a lower level after menopause. Both fluctuations and sustained lower levels may influence pain.

A 2024 longitudinal study found that muscle and joint pain became more common and severe as women progressed through menopausal stages. However, body mass index, general health, anxiety and depression were also associated with symptoms. Hormones are one contributor within a wider picture, alongside ageing, existing conditions, sleep and physical activity.

How can declining oestrogen aggravate existing pain or contribute to new pain?

Oestrogen influences inflammation and joint tissues

Oestrogen receptors are present in many musculoskeletal tissues. Oestrogen signalling helps regulate inflammatory activity and the maintenance of cartilage and other joint structures. Lower levels may alter this balance, potentially increasing susceptibility to aching, stiffness and painful osteoarthritis.

This could help explain why a previously manageable joint problem becomes more troublesome. However, the relationship is complex: studies do not establish that oestrogen decline alone causes osteoarthritis or every episode of joint pain.

Muscles and connective tissues also change

Oestrogen contributes to muscle function and connective tissue maintenance. Its decline may affect muscle repair and the way tendons and ligaments adapt to loading. Alongside age-related changes and reduced activity, this may make familiar physical tasks more demanding.

These changes provide a possible explanation for new tendon discomfort or worsening symptoms around an existing injury. Researchers have proposed the term “musculoskeletal syndrome of menopause” to describe this collection of symptoms, although the mechanisms and individual risks remain under investigation.

The nervous system may process pain differently

Pain depends on how the nerves, spinal cord and the brain interpret signals, not only on the condition of the painful tissue. Oestrogen interacts with several pain-modulating systems, including the body’s own opioid pathways.

Changing hormone levels may therefore alter pain sensitivity, making an existing problem feel more intense without necessarily indicating greater tissue damage. Oestrogen can increase or reduce pain signalling depending on the circumstances although lower oestrogen does not consistently mean more pain for every woman.

Sleep disruption can amplify the experience

Night sweats, insomnia, stress and fatigue can interact with pain. Poor sleep can increase pain sensitivity, while pain can make restorative sleep much harder to achieve. This cycle may aggravate an existing condition even when the original injury has not changed.

What is the difference between acute and chronic pain?

• Acute pain is recent and often associated with an injury, illness or procedure. It may settle as the underlying problem resolves

• Chronic pain persists or recurs for more than three months. It may arise from an ongoing condition, such as osteoarthritis, or involve changes in pain processing. Chronic pain can also have sudden flares

Acute pain does not necessarily mean severe and chronic pain does not mean constant.

What are nociceptive, neuropathic and nociplastic pain?

Pain can be described by its underlying mechanism:

• Nociceptive pain: arises from actual or threatened damage to body tissues, such as a sprained ankle or an inflamed joint

• Neuropathic pain: arises from a disease or injury affecting the sensory nervous system. It may feel burning, shooting or electric

• Nociplastic pain: involves altered pain processing that cannot be fully explained by tissue damage or a nerve lesion. Fibromyalgia is a good example

These mechanisms can overlap. Burning or tingling alone does not establish nerve damage, and widespread pain should not automatically be labelled hormonal.

Why can migraines and painful sex change during menopause?

Oestrogen fluctuations can trigger migraine in susceptible women, making attacks less predictable during perimenopause. Some improve after natural menopause, while others continue.

Lower oestrogen also affects vaginal and urinary tissues, contributing to dryness, irritation and painful sex. These changes are part of genitourinary syndrome of menopause (GSM), but other causes of genital or pelvic pain still need assessment.

When should you seek help for pain during menopause?

New or worsening pain deserves assessment rather than being dismissed as “just menopause or getting older”.

Book a telehealth consultation with Kay Bellingham to explore contributing factors, review your medicines and supplements, and develop a personalised plan alongside your other healthcare practitioners.

In Part 2, we’ll explore how complementary medicines, including herbs and nutrients, can be effective in managing and resolving pain conditions.

References:

Huang F, et al. Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study. Pain. 2024;165(11):2644–2654. doi:10.1097/j.pain.0000000000003283.

Gulati M, Dursun E, Vincent K, Watt FE. The influence of sex hormones on musculoskeletal pain and osteoarthritis. Lancet Rheumatology. 2023;5(4):e225–e238. doi:10.1016/S2665-9913(23)00060-7.

Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466–472. doi:10.1080/13697137.2024.2380363.

Athnaiel O, Davidson N, Mangat J, Nasr NF, Knezevic NN. Gonadal hormone changes with aging and their impact on chronic pain. Cells. 2025;14(2):123. doi:10.3390/cells14020123.

Strand NH, et al. Pain during menopause. Maturitas. 2025;191:108135. doi:10.1016/j.maturitas.2024.108135.

Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean Journal of Pain. 2024;37(2):107–118. doi:10.3344/kjp.23326.

Waliszewska-Prosół M, et al. Menopause, perimenopause, and migraine: understanding the intersections and implications for treatment. Neurology and Therapy. 2025;14:665–680. doi:10.1007/s40120-025-00720-2.

Kaufman MR, et al. The AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause. Journal of Urology. 2025;214(3):242–250. doi:10.1097/JU.0000000000004589.