The Musculoskeletal Syndrome of Menopause: Why Physiotherapy Matters
For many women, the midlife years bring unexpected physical changes.
You may notice that you do not recover from exercise as quickly as you once did. New aches appear, familiar symptoms become harder to manage or your strength and energy feel different. You may also have watched older relatives experience osteoporosis, falls, joint pain or a loss of independence and wondered whether there is anything you can do differently.
Increasing attention is being given to the ways perimenopause and menopause may affect muscles, bones, joints and connective tissues. A recently proposed term – the musculoskeletal syndrome of menopause – brings these experiences together and encourages health professionals to consider hormonal change as one part of the clinical picture.
Most importantly, experiencing physical changes during menopause does not mean that decline is inevitable. Exercise, physiotherapy and appropriate medical care can help you remain strong, active and confident.
What Is the Musculoskeletal Syndrome of Menopause?
The term musculoskeletal syndrome of menopause was proposed in a 2024 medical paper to describe a collection of musculoskeletal symptoms and conditions seen during the transition from perimenopause to postmenopause.
It is a developing clinical concept rather than a formal diagnosis. Its purpose is to draw attention to symptoms that have historically received limited recognition and may otherwise be dismissed as “just ageing.”
The proposed syndrome includes:
Muscle and joint pain
Loss of muscle mass and strength
Reduced bone density
Changes in tendon and ligament health
Increased risk of some musculoskeletal conditions
Changes in physical function and recovery
Musculoskeletal symptoms are common during midlife. One review estimated that approximately 71% of perimenopausal women experience some form of musculoskeletal pain.
That does not mean every pain or injury during midlife is caused by menopause. Symptoms may also be influenced by previous injuries, activity levels, sleep, stress, work demands, general health, medications and age-related changes.
A thorough assessment remains important.
What Role Does Oestrogen Play?
Oestrogen has effects throughout the body – not only within the reproductive system.
It is involved in:
Bone turnover
Muscle function and adaptation
Connective-tissue biology
Inflammatory processes
The way pain is experienced
During perimenopause, hormone levels fluctuate before eventually settling at lower levels after menopause. These changes may contribute to musculoskeletal symptoms, but the relationship is complex and still being researched.
The connection is clearest in bone health: declining oestrogen can accelerate bone loss around menopause. The relationship between hormonal change, pain, tendon problems and arthritis is less straightforward, and more research is needed to understand cause and effect.
What Symptoms Might Women Notice?
Experiences vary considerably. Some women notice little change, while others develop new or more persistent symptoms.
These may include:
Generalised muscle or joint aches
Joint stiffness
Reduced strength
Lower confidence with lifting or exercise
Slower recovery after unfamiliar activity
Shoulder, hip, elbow or heel pain
Persistent back pain
Changes in balance or physical function
Concern about bone density or osteoporosis
Symptoms such as frozen shoulder, carpal tunnel syndrome, tendinopathy and osteoarthritis may be seen more frequently around midlife, but their development usually involves several factors. Menopause should be considered without assuming it is the sole cause.
New, severe or unexplained symptoms may also require assessment by a GP to exclude other medical causes.
Why Physiotherapy Matters During Midlife
Physiotherapy can help determine what is contributing to your symptoms and identify practical ways to improve movement and capacity.
Assessment may include:
Your symptoms and how they affect your life
Current activity and exercise levels
Strength and mobility
Joint and tendon function
Balance
Previous injuries
Relevant health conditions and medications
Your goals and concerns about movement
Treatment is then tailored to the individual rather than based on menopause alone.
A physiotherapist may help you:
Understand your symptoms
Manage pain or stiffness
Modify activity without unnecessarily stopping it
Rebuild strength after injury or reduced activity
Progress exercise safely
Improve balance and confidence
Return to meaningful work, recreation or sport
Identify when medical review or further investigation is appropriate
Strength Training Through Menopause
Progressive resistance training is one of the most useful forms of exercise for maintaining muscle strength and physical function through midlife and beyond.
Strength training may involve:
Free weights
Weight machines
Resistance bands
Bodyweight exercises
Pilates equipment
Home-based exercises
The program needs to become progressively challenging as your body adapts. However, this does not mean every woman should immediately begin lifting heavy weights.
Your starting point should consider your exercise experience, current symptoms, bone health, medical history and confidence. The aim is to build capacity over time.
Walking, Pilates, yoga, swimming and cycling also offer valuable health benefits. Some forms can contribute to strength, depending on how they are performed and progressed. For optimal bone health, additional resistance and weight-bearing impact exercise may be required where appropriate.
Bone Health and Menopause
Bone loss can accelerate during the menopausal transition, but bone density is only one part of fracture prevention.
A comprehensive approach may include:
Progressive resistance training
Weight-bearing and impact exercise where appropriate
Balance training
Adequate calcium, protein and vitamin D
Reducing smoking and excessive alcohol intake
Medical assessment of osteoporosis risk
Medication when clinically indicated
Women with osteoporosis can usually remain active and participate in resistance training, but exercises may need to be modified according to fracture history, balance and individual risk.
Our article Exercise for Bone Health During Menopause explains these exercise components in more detail.
Lifestyle and Medical Support
Musculoskeletal health does not exist in isolation. Sleep, nutrition, stress, recovery and overall activity can all influence how you feel and function.
Helpful strategies may include:
Eating enough protein and meeting calcium requirements
Checking vitamin D when clinically appropriate
Making space for sleep and recovery
Building regular movement into your week
Progressing exercise rather than repeatedly starting at an unsustainable level
Discussing significant or persistent menopausal symptoms with your GP
Menopausal hormone therapy may be appropriate for some women and has recognised effects on bone health. Decisions about hormone therapy should be made with a suitably qualified medical practitioner after considering your symptoms, health history, preferences, benefits and risks.
It should not be assumed that hormone therapy will resolve every musculoskeletal symptom.
A New Stage, Not the End of the Road
Women are sometimes told that pain, weakness and reduced capacity are simply part of getting older. That message can lead to fear, frustration and unnecessary withdrawal from activity.
Menopause is a significant biological transition, but it does not mark the beginning of inevitable physical decline.
Your muscles remain responsive to exercise. Your balance can improve. Your confidence can grow. Bone health can be supported, and painful conditions can be assessed and managed.
The appropriate response is not always to slow down. Often, it is to understand what has changed and find a better way to move forward.
How FutureReady Physio & Wellness Can Help
At FutureReady Physio & Wellness, we take the time to understand your symptoms, health, lifestyle and goals.
We can help you:
Make sense of new or changing musculoskeletal symptoms
Build or return to strength training
Exercise with pain, arthritis or a tendon problem
Support bone health and balance
Develop a realistic and progressive exercise plan
Identify when additional medical input may be needed
You do not need to wait until every ache has disappeared before becoming active. With appropriate guidance, midlife can be an opportunity to build strength, confidence and capacity for the years ahead.
Your body is adaptable. Start where you are and build the future you want.
Reference
Wright, V. J., Schwartz, J. I., Kaempfer, D. M., Faella, M., & VandenBerg, C. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472. https://doi.org/10.1080/13697137.2024.2380363