Menopause · Chronic Pain
Disclosure: Dr. Etelzon practices at Pain Doctors Medical, the practice linked in this article. This is a guest article by a credited contributor, written for education and not as medical advice. See our Editorial Policy.
Many women in their forties, fifties, and sixties notice that aches they once brushed off now linger. Knees stiffen after sitting. The lower back flares after a long day on your feet. Sleep grows thin, and simple tasks like carrying groceries or getting up from the floor take more effort than they used to. These changes often arrive alongside hot flashes, mood shifts, and a drop in energy, so the pain can seem like a separate problem. For many women, hormones connect the two.
This article explains how declining estrogen can affect joints and muscles, what the research shows so far, and why a hormone-focused evaluation can be a useful step before surgery or long-term pain medication. It also covers what to discuss with your doctor, because hormone decisions depend on each woman's health history.
Estrogen does far more than regulate the menstrual cycle. Estrogen receptors are found throughout bone, cartilage, tendons, and muscle tissue, and the hormone plays a role in regulating inflammation. When estrogen levels drop during perimenopause and after menopause, these tissues can respond in ways that show up as pain and stiffness. Tendons may feel less resilient. Inflammation may take longer to settle. Muscle may lose strength and mass over time, leaving joints to carry more of the load.
Many women do not connect these changes to hormones at all. They assume the stiffness is simply wear and tear. Understanding the hormonal side gives women and their doctors another piece of the puzzle.
In 2024, a group of clinicians published a paper in the journal Climacteric that introduced the term "musculoskeletal syndrome of menopause." The term groups together symptoms such as joint pain, muscle aches, stiffness, reduced muscle mass, bone loss, and tendon problems. The paper reports that more than 70 percent of women experience some of these symptoms during the transition from perimenopause into postmenopause, and that around one in four report severe effects on daily life.
A named pattern helps in practical ways. It gives women language to describe their feelings and gives clinicians a reason to ask about hormonal history when a patient presents with joint or muscle pain in midlife.
The evidence is still developing. Observational studies have produced mixed results, and researchers have not fully settled how much estrogen decline drives joint symptoms. One of the more useful data points comes from the Women's Health Initiative. In a randomized trial of estrogen alone among postmenopausal women who had undergone hysterectomy, women taking daily estrogen reported less joint pain than women taking a placebo after one year. The difference held through year three.
The trial did not test every woman or every treatment, so these findings should be read as one piece of a larger picture. They do suggest that estrogen's effects on the musculoskeletal system deserve serious attention, especially for women who already have pain that affects daily activity.
Many women move from over-the-counter pain relievers to prescription medication, and eventually to a conversation about surgery. Dr. Ilana Etelzon takes a different starting point. She looks at why the pain persists and what keeps it going. Hormone changes are one of the factors she checks, alongside sleep, activity, medication history, and the health of the painful area itself.
When hormones play a role, addressing that imbalance may change how the body responds to other treatments. Even when hormones are only one contributor, improving sleep and energy can make it easier to stay active while other options are considered.
Dr. Etelzon remembers one patient who worked as a surgical technician. Her symptoms reached well beyond the pain itself. In Dr. Etelzon's words:
"I had a patient who was a surgical tech. She was having hot flashes, difficulty sleeping, vaginal dryness, and tiredness. We started her on a combination of bi-est bioidentical cream and progesterone at night. She had improvement in her relationships, she functioned better throughout the day, and she had more energy to spend time with her grandchildren."
Dr. Ilana Etelzon, MD
Every patient responds differently. This case describes one person's experience and does not predict how any other woman will respond. It shows how a single approach to hormone balance can ripple through daily life, from family relationships to the simple energy needed for everyday activities.
A useful evaluation considers the whole person, not just the sore joint. Depending on the patient, it may include:
This broader view often reveals contributors that a single visit focused on one joint would miss. It also gives patients and doctors a shared starting point for choosing next steps.
The North American Menopause Society (NAMS) published its 2022 hormone therapy position statement in the journal Menopause. The statement says the benefits of hormone therapy outweigh the risks for most healthy women who are younger than 60 or within 10 years of menopause onset. It also confirms that hormone therapy remains an effective treatment for hot flashes and night sweats and can help prevent bone loss and fractures.
The same statement stresses that risk depends on several factors. These include:
Women who start hormone therapy after age 60, or more than 10 years after menopause onset, face greater absolute risks of heart disease, stroke, blood clots, and dementia. That is why age and timing matter so much in the decision.
Compounded bioidentical products deserve extra attention. The NAMS statement notes safety concerns with compounded bioidentical hormone therapy, including limited government regulation, possible dosing errors during preparation, limited data on safety and effectiveness, and the absence of a product label that spells out risks. Women considering these products should ask where the medication is made, how the dose is determined, and what evidence supports its use.
Clear answers to those questions help patients make informed choices. They also help doctors tailor treatment to each woman's needs.
While a full evaluation is underway, a few habits can support joints and muscles. None of these replaces medical care, but they can make a meaningful difference in daily comfort:
Start any new exercise plan with your doctor or a physical therapist, especially if you have existing joint damage or heart conditions.
Hormone-related care is one part of a broader plan. Depending on where the pain starts and what drives it, a physician may also discuss physical therapy, medication adjustments, and interventional options. Regenerative treatments such as platelet-rich plasma (PRP) injections are another path some patients explore. Interventional pain management offers targeted procedures for pain that has not responded to conservative care.
Patients who want to learn more can review the services and conditions covered at Chronic Pain Management for women, which explains how the practice approaches chronic pain.
Dr. Etelzon sees patients at four offices in New York and New Jersey: Brooklyn, Clifton, Newark, and Perth Amboy. Women who want to understand what is driving their pain can book a consultation at the office closest to them.
Pain Doctors Medical is a regenerative and interventional pain practice with four offices in New York and New Jersey. The practice focuses on identifying the underlying drivers of chronic pain and building care plans that help patients return to the activities they enjoy.
Joint and muscle pain in midlife is common and not always a sign that something is permanently wrong. Hormones are one piece of the picture. Understanding that connection can open the door to more options before surgery or long-term medication becomes the default. Start with a clear conversation with your doctor, bring specific questions, and build a plan that fits your health history and goals.
Dr. Ilana Etelzon, MD, is double board-certified in Physical Medicine and Rehabilitation and Interventional Pain Management and a Regenexx Certified Core Provider. She speaks English and Russian and treats patients at Pain Doctors Medical in Brooklyn, Clifton, Newark, and Perth Amboy. Dr. Etelzon practices at Pain Doctors Medical, the practice linked in this article.
Further reading from health authorities
General topic pages from authoritative organizations for further reading. They are suggested resources and are not a line-by-line citation of the statements in this article. Always confirm personal medical decisions with a healthcare professional.