Muscle and Joint Pain in Menopause

What's up with that?

Muscle and joint pain are common concerns in the menopause transition and menopause. They seem to peak closer to the final menstrual period and right after menstruation stops. As muscle pain and joint pain also increase with age, teasing out what is menopause and what is aging or other medical conditions is important so people can get the right therapy and so important medical conditions don’t go undiagnosed.

If you are between ages 45 and 55, muscle and joint pain are more common in general. However, if we look at a 49 year old who is still having her period regularly compared to a 49 year old whose last period was 3 months ago, the one who is just entering menopause is is more likely to have muscle and joint pain than the one who is still having regular periods. Muscle and joint pain appear to be about twice as common around the final menstrual period than they are at other age-matched times, so there is definitely a menopause component.

We know that changes in estrogen clearly have a role in developing muscle and joint pain. For example, muscle and joint pain are very common side effects experienced by people taking aromatase inhibitors for breast cancer, and these drugs result in dramatic reductions in estrogen levels. We also know that when the ovaries are removed before menopause, and estrogen levels drop dramatically, there is a subsequent negative impact on cartilage.

Even so, the role of estrogen, and the other hormones that change during menopause, is complex and not fully understood. Estrogen is anti-inflammatory which may have a role in protecting joints, but this is complicated. For example, estrogen can reduce flares of rheumatoid arthritis, an autoimmune condition that causes joint pain and damage, but it can flare lupus, another autoimmune condition that can cause arthritis. 

Joint tissue, such as cartilage, ligaments, synovium, and subchondral bone, all have estrogen receptors, and estrogen is even made locally in some of these tissues. The fact that many tissues make estrogen locally is often forgotten in discussions about menopause.

Estrogen can also impact pain tolerance, either by direct effects on the nervous system, or via sleep disturbances due to hot flashes, or possible via other mechanisms.

There are a few factors associated with an increased risk of muscle and joint pain around menopause: anxiety, stress, higher body mass index, and poor sleep. It’s important to point out that none of these are related to estrogen levels. Basically, it’s complicated.

So if you have muscle or joint pain and are in your 40s or early 50s, what is the first step?

The first thing is to look for causes of muscle and/or joint pain other than menopause. Attributing muscle or joint pain to menopause is what we call a diagnosis of exclusion, meaning we have to rule out other causes first. Some of the more common causes of muscle and/or joint pain include the following: