joint pain and menopause

Difficulty getting up from the sofa or getting out of bed? Aches and pains in your joints? Taking longer to recover from injuries? Menopause may be a natural part of the female ageing process, but it can bring discomfort and pain in a number of ways which can affect your quality of life. 40% of women aged between 45 and 65 report experiencing joint pain in menopause.The good news is, there are options that are proven to significantly reduce joint pain in menopause, starting with simple routines in your home. At Rowena Health Menopause Specialist Clinic we can help you with this and here is some more information to support you.

Why do we get it?

Oestrogen helps to decrease inflammation and keep the joints lubricated.

Recent studies have suggested that a decrease in oestrogen not only reduces your natural bone density but also affects your tendon health and muscle strength. This could mean it takes longer to recover from injury.

As oestrogen levels fall, joints can become more inflamed and painful, and symptoms from pre-existing arthritis may become worse. The neck, shoulders, elbows, hands, spine and knees are most commonly affected in menopause.

Could it be osteoarthritis?

There are many different types of arthritis, arthritis means inflammation of the joints. Osteoarthritis is a condition which affects the structure of the joint, and this is the difference between it, and the joint aches experienced, due to hormonal changes in menopause, although both of these conditions can co-exist.

Many women will develop osteoarthritis, but it is certainly not the cause of all muscle aches and joint pain in menopause.

This is an excellent video which explains clearly what osteoarthritis is.

What happens to the joint?

In osteoarthritis, the cartilage in the joint thins, and the surface becomes rougher so the joint doesn’t move as smoothly as it should. When cartilage becomes worn or damaged, all the tissues within the joint become more active than usual, as the body tries to repair this damage. The repair processes don’t always work well and changes to the joint structure can sometimes cause or contribute to symptoms such as pain, swelling or difficulty in moving the joint normally.

Extra bone may form at the edge of the joint, these bony growths are called osteophytes and can sometimes restrict movement or rub against other tissues. In some joints, especially the finger joints, these may be visible as firm, knobbly swellings. The lining of the joint capsule (called the synovium) may thicken and produce more fluid than normal, causing the joint to swell. Tissues that surround the joint and help to support it may stretch so that after a time the joint becomes less stable.

Osteoarthritis is the most common type of arthritis in the UK and is common in people over 50 years. This is around the same time that many women start to go through the menopause. Almost all of us will develop osteoarthritis in some of our joints as we get older, though we may not even be aware of it. It’s most likely to affect the joints that bear most of our weight, such as the knees , hips, and feet. Joints that we use a lot in everyday life, such as the joints of the hand, are also commonly affected and other common joints are the neck and low back.

Main symptoms

The main symptoms of osteoarthritis are pain and sometimes stiffness in the affected joints. The pain tends to be worse when you move the joint or at the end of the day. Your joints may feel stiff after rest, but this usually wears off fairly quickly once you get moving. Symptoms may vary, depending on what you are doing, or for no obvious reason. There is no blood test to diagnose osteoarthritis, and x-rays are not usually helpful. Osteoarthritis can be diagnosed by a Dr, without an x-ray, if you are over 45 years old, AND you have activity related joint pain AND have no, or less than 30 minutes of early morning joint stiffness.

At a physical examination

If you have osteoarthritis, your Dr may find:

• tenderness over the joint
• creaking or grating of the joint – known as crepitus
• bony swelling
• excess fluid
• restricted movement
• joint instability
• weakness or thinning of the muscles that support the joint

In Osteoarthritis, it is not very common for the joints to be swollen, red or warm. Please tell your doctor if a joint suddenly swells up or becomes red or hot. 

Whether it is mild osteoarthritis or menopausal joint and muscles aches, what can be done to help?

There are several things that will help with joint pain in menopause, and osteoarthritis.

Home treatments

• Gentle stretching, especially before and after exercise. Stretching gently first thing in the morning can help if you are suffering with stiffness in the joints.
• Using ice packs on or hot water bottles on sore joints and muscles
• Having hot baths
• Gently keeping active, within the limits of pain

Weight control

If you are carrying extra body weight this can put pressure on your joints. Controlling your weight can really help with musculoskeletal pain, it’s best to start exercising gently and to do a mixture of aerobic and resistance, or strength exercises. Chair based exercises are a fantastic way to start, if mobility is a problem. Some women find seeing a nutritionist helps them understand ways to change their diet to help.

Stress reduction

Practicing mindfulness and meditation, to relieve stress, as anxiety and depression can add to musculoskeletal pain. Aches and pains can feel worse when you are tired and emotional. If you are struggling to sleep, then addressing this can help you cope better with pain.

Can diet help?

A healthy balanced is really important.

• Protein – found in meat, fish, eggs, beans etc this is needed for repair.
• Oily and tinned fish like salmon, sardines, mackerel- these contain omega 3 fatty acids and Vitamin D, and tinned fish with bones are high in calcium. There’s some research to suggest that oily fish, or oils produced from fish, may help with the symptoms of some forms of arthritis, especially rheumatoid arthritis. But increasing your intake of oily fish or taking a supplement might also be worth trying if you’re interested in using diet to manage osteoarthritis.
• Diary products like milk, cheese, yoghurt – these contain calcium, potassium, phosphorus, magnesium and vitamins D and K.
• Vitamin E can play a role in the treatment of arthritis by preventing damage in the cells of your bones and joints. It may also have anti-inflammatory properties.

Movement and exercise

• It’s so tempting to stay still to avoid pain in your muscles and joints, but physical activity is so important. Pain can be helped by slowly progressing with movement. Be gentle with your body and if necessary see a personal trainer or physiotherapist for advice.
• NICE recommend exercise as a core treatment in osteoarthritis.
• Strength and resistance work is important, as well as balance exercises. Doing these 2-3 times a week for 20 minutes is so important.
• Aerobic exercise – any physical activity that raises your heart rate and gets you breathing more heavily. Walking is a fabulous exercise, walking briskly so that you are needing to remove a layer of clothing and are a bit out of breath, for 2.5 hours a week will get you out in the daylight and will also reduce your risk of cardiovascular disease by 1/3. This does not need to be done all at once, but can be broken down to manageable chunks, like 30 minutes a day. Cycling and swimming are also excellent. Whatever you love to do!
• Chair based seated exercises are possible if you have a painful joint which affects your mobility.
• Hydrotherapy -the warmth in a hydrotherapy pool is soothing and relieves pain and stiffness, while the water supports your weight but still offers some resistance for muscle-strengthening exercises.
• Physiotherapy can be very helpful.
• These are some exercises for healthy joints to help reduce pain. There are ones for the hips, knees, back, neck, hands, shoulders, ankles and wrists.

Choosing the right choice of exercise programme for you can be hugely support during the time of perimenopause and menopause. It can have positive effects on both your physical and mental health. Be aware not to push your body too hard, especially during the time of hormonal transition.

Cognitive Behavioural Therapy

CBT is a fantastic skill, it helps you challenge negative thoughts which can become a vicious cycle causing stress, low mood and anxiety. It can be used for management of pain, hot flushes and sleep problems.

Yoga and pilates

These help with strength and mobility, yoga helps to relax your body physically and the stretching and flexibility could help ease muscle aches. Pilates is a good way of improving strength and posture.

Hormone Replacement Therapy

This is shown to reduce all the symptoms of menopause by 70-80% and is very effective at relieving menopausal joint pains, in addition to lifestyle changes, they work best as a holistic approach to menopause, together. It can be beneficial for arthritis as well as menopause related pain.

What painkillers might help?

You can use over-the-counter medicines to help reduce inflammation and painful joints. Your pharmacist will be able to advise you on which one’s may suit you best and are safe to take with any prescribed medication or medical history.

Topical NSAIDS (non steroidal anti-inflammatory drugs) are recommended, like ibuprofen gel.

Topical Capsaicin is found to be helpful for joint pain.

High-quality evidence paracetamol does not give any clinically meaningful benefit in pain in hip or knee OA, but you can try it.

Your Dr will be able to help you if these are not effective. Some people need to use stronger painkillers, a TENS machine or a steroid joint injection.

Supplements to help joints?

Women often ask about supplements and complementary or alternative therapies to help with menopausal symptoms. This link discusses what we currently know.

Glucosamine is an amino sugar made from shellfish or prepared in the laboratory. It’s available in two forms: glucosamine sulphate and glucosamine hydrochloride. You can buy both from high-street retailers. There is no real evidence to support the use of this in osteoarthritis.

Chondroitin is a dietary supplement and a vital part of cartilage. Studies suggest that chondroitin is safe and may give small/medium improvements in pain, but further high-quality studies needed to confirm this to support it’s use. Studies have found that taking chondroitin can prevent cartilage breaking down and can also stimulate its repair mechanisms. We don’t recommend this for osteoarthritis.

Curcumin may help relieve joint pain and reduce the risk of osteoarthritis, via and anti-inflammatory action.

Acupuncture there is not enough evidence to support this for osteoarthritis.

In summary

As oestrogen levels fall in perimenopause and menopause many women are affected by painful muscles and joints. This can have a significant effect on their quality of life, and in my experience, is one symptom they report improves dramatically with HRT. Osteoarthritis may affect women, alongside the joint and muscle pains associated with the falling oestrogen in perimenopause and menopause. Exercise and movement are really important and form the basis of treatment, start slow and increase as you can.

Do come and see us at Rowena Health Menopause Clinic, we offer menopause consultations online from the comfort of you home, via video link, if you are in the UK and we’d be delighted to support you. Click here to book an appointment.

Last updated: September 2023 Dr Carys Sonnenberg Rowena Health Menopause Specialist

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