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Joint pain is a common perimenopausal and menopausal symptom. Discover causes and treatments of joint pain in menopause. Here in this post, we will see how hormones play a role in joint pain during menopause, the factors contributing to it, and tips for managing joint pain during menopause.
Have you ever woken up feeling like your joints are really stiff and hard to move?
Or do you find your joints are disproportionately sore to the amount of work or exercise you have done?
You're not the only one. According to studies, around 40% of menopausal women experience joint pain.
Surprisingly, when talking about menopause symptoms, you will often hear things like hot flashes, mood irritability, or insomnia but not joint pain.
The Relationship Between Hormones, Joint Pain and Menopause
Many women believe, or are told, that joint pain during menopause is just something that happens with age. However, the reality is somewhat different. Hormones, especially estrogen, but also progesterone and testosterone appear to play a significant role in keeping bones and joints healthy (Sex steroids, Cartilage and Bone 2012).
Estrogen helps replace old bone cells and prevents inflammation and pain in joints. It also helps muscles, tendons, and ligaments stay strong. When estrogen levels are adequate, as they are during the menstrual cycle pre-menopausally, your bones and muscles function efficiently.
During perimenopause, women experience a drop in their estrogen levels, which can cause a number of changes including:
joint inflammation
breakdown of cartilage
loss of collagen fron tendons and ligaments that support joints.
Any joint can be impacted during menopause, but common joints to be affected includes the small joints in the hands and feet, but also the knees, elbows, back and neck.
When it comes to joint health, the research shows clearly a hormonal influence.
Cartilage, which cushions your joints contains both alpha and beta estrogen receptors indicating the importance of estrogen in mainiting cartilage integrity.
Data from a joint health clinic in London, showed that 60 percent of the women attending experienced the onset of joint pain symptoms within 4 years of menopause (Hand Osteoarthritis, Menopause and MHT 2016).
Similar associations also seen among women with early menopause and women who use anti-estrogens such as aromatase inhibitors (anastrozole, exemestane and letrozole) for cancer treatment (Sex Hormone Levels and Osteoarthritis 1996).
Research shows that adequate estrogen is important for maintenance of collagen in ligaments and tendons that support joint stability and movement.
Loss of estrogen at menopause contributes to increased cartilage damage in joints and bone loss of bone that sits behind the joint cartilage. In other words, loss of estrogen at menopause accelerates the degenrative processes that we typically associate with injury or aging (Estrogen, Cartilage and Bone 2010).
It is likely that joint pains occuring in women in perimenopause or menopause due to lower hormone levels are the beginings of the processes of early osteoarthritis which are not yet radiologically evident on x-ray in many cases.
Conditions Contributing to Joint Pain in Menopausal Women
Osteoarthritis
Osteoarthritis (OA) is an inflammatory condition where the cartilage and synovial fluid in the joints reduces over time. It was recognised as early as 1925 that there was an 'athritis of menopause' with joint pain onset close to menopause.
Post-menopausal women are almost twice as likely as men to develop knee and hand osteoarthritis (OA) (Sex Differences in Osteoarthritis 2005).
The osteoarthritis associated with menopause is related to estrogen deficiency as well deficiencies of other ovarian hormones.
Research shows that the use of estrogen, progesterone, testosterone or selective estrogen receptor modulators (SERMs) such as raloxifene all have been shown in laboratory research to inhibit cartilage breakdown that occurs in osteoarthritis (Hand Osteoarthritis, Menopause and MHT 2016).
Other factors that contribute to your risk of osteoarthritis include:
Genetics: Some women may be genetically predisposed to developing joint pain during menopause.
Age: As we get older, our bones and joints naturally become weaker and more prone to pain.
Body weight or BMI: Higher body weight can put more pressure on joints
Diet: A diet high in processed foods, sugar and saturated fats can contribute to joint inflammation.
Previous injuries: Women who have had previous injuries or surgeries on their joints may experience more joint pain at menopause.
Joint-related factors: such as previous joint injury or abnormal loading of the joint (Risk Factors for OA).
Knee malalignment: This is the strongest predictor of progression of knee OA.
Rheumatoid Arthritis (RA)
Rheumatoid arthirits is an autoimmune disease – the type of disease in which the body's own immune cells start attacking the joints causing inflammation.
The first signs of rheumatoid arthritis are joint pain, joint stiffness, and swelling, especially in the morning, and fatigue.
Rheumatoid arthritis usually starts between ages 25 and 45 but can happen later, too. Perimenopausal hormonal fluctuations are associated with an increased risk of autoimmune processes due to the way the hormonal changes impact the immune system.
Psoriatic Arthritis
Psoriatic arthritis is another type of auto-immune arthritis. Often it can involve the skin as well as the joints, with people with psoriaiss expereincing a rash or psoriatic plaques.
Dropping estrogen levels during menopause might increase the risk of psoriatic arthritis flares so medications to manage this may need to be adjusted.
Fibromyalgia
Fibromyalgia causes widespread muscle and joint pain, along with severe tiredness, sleep issues, memory problems, and mood changes.
It makes the body feel pain more intensely by affecting how the brain and spinal cord react to pain. It often starts after events like physical injury, stress, or illness.
Fibromyalgia is more common in females as compared to males, esepcially in 30s to 50s. There appears to be a link between the hormonal changes of perimenopause, menopause and the development of widespread pain. Symptoms of fibromyalgia can get worse during menopause.
Perimenopausal symptoms can also be misdiagnosed as fibromyalgia. It is worth trialling hormone replacement therapy (HRT) to see if your symptoms resolve with adequate hormones in your body.
Musculosketal Syndrome of Menopause
The combination of falling estrogen, progesterone and testosterone that occurs through peri and menopause contributes to widespread changes in the musculoskeletal system and all contribute to pain. These include:
osteoporosis (thinning of the bones)
osteoarthritis (loss of cartilage integrity)
sarcopenia (loss of muscle mass and strength)
plantar fascitis
frozen shoulder
The following tips can help you reduce inflammation and pain.
Tips for Managing Menopausal Joint Pain
Joint pain during menopause can be managed by using hormone replacement therapy, making lifestyle changes, taking supplements, medications and non-medication therapies.
1. Hormone Replacement Therapy For Joint Pain During Menopause
Estrogen therapy is a treatment often used for menopausal symptoms like hot flashes. Estrogen helps keep your joints healthy, so hormone therapy might help with joint pain during menopause.
According to the NAMS 2022 Hormone Therapy Position Statement, we don't have enough proof to say for sure if estrogen helps with osteoarthritis.
Some studies say it does, some say it doesn't, and some even link it to more back pain. The reason for mixed results is because studies use different HRT preparations and doses, and start at different stages ie early perimenpause, late perimenopause or post-menopause.
It is likely that the benefits of HRT depend on finding the optimal dose and timing for hormone therapy.
There are many women who have experienced a reduction or elimination of joint pains with use of menopausal hormone therapy.
Seeing a knowledgeable doctor early on to get the right treatment is really important. You don't have to wait for hot flashes to start. Musculoskeletal issues during menopause are real and should be addressed right away.
When the processes in joints, and supporting joints in ligaments and tendons are being driven by estrogen deficiency that promotes:
loss of collagen,
loss of cartilage and
immune-driven inflammation.
It is best to halt and slow these processes to prevent joint pain, improve mobility and improve the quality of life.
Resaerch that looks at animal models of joint health and menopause suggests that cartilage health may be best improved with early initiation and higher doses of estrogen treatment especially regarding prevention of osteoarthritis (Osteoarthritis and estrogen Treatment 2023).
In other words HRT is more effective ant slowing progression of osteoarthritis than reversing the breakdown of cartilage once it has occurred.
If you are prescribed estrogen therapy and you still have a uterus and do not have a Mirena IUD, you will also need to use a progestogen to support your uterine lining and prevent excess growth.
2. Lifestyle Changes and Exercises to Improve Joint Health
Modifying your lifestyle, such as exercising, eating well, etc., can ease menopause related joint pain and lower your chances of getting arthritis and weak bones in old age.
Here are some lifestyle changes that can help reduce menopausal joint pain:
1. Regular Exercise: Move your Body
Even though moving might be painful, it's good for your joints. Lifting weights or doing resistance exercises keeps muscles strong, reduces swelling, and makes joints move easier.
Even though it might seem strange, studies show it can actually reduce pain in the joints. A review from 2020 found that doing strength exercises can make knee pain from osteoarthritis better. Just make sure you warm up properly before starting so your joints are ready to move smoothly.
2. Eat Healthy
Improve your diet and eat healthily. Focus on fruits, veggies, whole grains, fish, and good fats. Foods like nuts, green veggies, olive oil, and fish can help your joints. Avoid or limit processed and refined foods like white bread, fried foods, and sugary drinks.
Arthritis patients whose diet is high in refined sugar often experience achy and stiff joints. A high sugar intake is associated with higher glycated proteins in the joint fluid. These proteins contribute to the breakdown of joint cartilage (Hypergylcaemia Promotes Knee Osteoarthritis 2021). Cutting down on extra sugar is crucial as it can cause reduce inflammation in the joints.
3. Apply Ice Or Heat Pad on Joints
Using ice and heat can help with sore joints. Heat, like from a heating pad or warm water, can make the pain feel better for a while. And if your joints are swollen, using an ice pack can help reduce the swelling and ease the pain.
4. Manage Your Stress And Relax
Did you know that chronic stress can actually worsen your joint pain?
When you're under stress for a persistent time, your body remains in fight or flight mode– which means there is an increased level of cortisol in the body. This hormone can aggravate joint inflammation.
Stress reduction practices are important for managing pain and improving long-term health. So, find ways to chill out: Read good books, listen to light music, enjoy your hobbies, etc. You can also talk to a therapist or try calming activities like deep breathing, walking, meditation, or yoga.
5. Maintain Weight
Increased weight can put more pressure on your hip, knee, and ankle joints, causing more joint pain. It can be challenging to lose weight. The hormonal chnages of perimenopause and menopause also can promote weight gain.
Talk to your health provider about lifestyle strategies, medications or surgery if needed that will help support management of weight.
6. Quit Smoking
Smoking disrupts your joint and bone health as well as having numerous other health risks. Get support to quit smoking, the sooner the better to prevent permanant degenerative joint changes.
3. Supplements For Joint Pain In Menopause
Supplements can help manage joint pain, especially when used in combination with other treatments. Here are some supplements that may help ease menopause related joint pain.
Each supplement has its own recommended dose. If you have joint problems, you might need to try different brands or doses to see what works for you.
Here are a few supplements you can take to reduce joint pain during menopause:
1. Fish oil
Fish oil contains healthy omega-3 fats like those in fish such as salmon. These fats reduce inflammation and can ease joint discomfort.
2. SAMe ( S-adenosylmethionine)
It's a natural substance in the body that fights inflammation and protects cartilage. Evidence suggests that SAMe is effective in reducing functional limitations and, to a lesser extent, pain in osteoarthritis. It works like Advil but without some side effects.
3. Curcumin
It's the active part of turmeric, a spice often used in Indian food. It can help with pain and swelling. If you don't like turmeric in your food, you can take it as a supplement.
4. Glucosamine and Chondroitin Sulfate
These are found in natural cartilage and are thought to ease joint pain. Chondroitin is more effective than placebo at reducing joint pain and glucosamine appears to ease joint stiffness. (Glucosamine & Chondroitin for Joint Pain 2018).
5. Vitamin D
It's important for many health reasons, including supporting strong bones. It can also help with joint problems.
6. Collagen
Studies from 2022 found that collagen supplements, especially when combined with regular exercise, can help with pain and strength.
Before trying any new supplement, talk to your doctor. They can check if it's safe for you and if it might help your joint pain based on your health history.
4. Pain relief For Joint Pain
Simple Pain Relief
Over-the-counter pain relievers like ibuprofen, paracetamol (acetaminophen) or aspirin are typically the first course of treatment for joint pain. They can help reduce inflammation and provide temporary relief from the discomfort associated with menopausal joint pain.
Physical therapy
Working with a physical therapist can help strengthen muscles, improve flexibility and reduce stress on your joints. A therapist can also show you exercises to do at home.
Steroid injections
In some cases, steroid injections may be recommended for severe joint pain. These injections can help reduce inflammation and provide pain relief for up to 3 months. Unfortunately they can contribute to progression of osteoarthritis in the joint and can have a number of side effects including: increased blood sugar levels, weight gain, mood swings and high blood pressure.
Joint Surgery
If other treatments are not effective, your doctor may recommend surgery as a last resort. Joint replacement surgery is a common procedure for menopausal women with severe joint pain. This involves replacing the damaged joint with an artificial one. It's important to note that joint replacement surgery is a major procedure and carries some risk, so it should be considered carefully with your doctor.
5. Other Strategies For Reducing Joint Pain
Using Heat
A hot shower or bath can help relax tense muscles in your neck. you can also try a heating pad, hot water bottle, or even ten minutes with a damp warm cloth on the area for relief.
Capsaicin Cream
This cream has a pain-relieving substance from the pepper plant. You can get it in many drugstores without a prescription. Spread a small amount on the painful area and rub it in three to four times a day. The pain may feel worse at first, but that's normal.
Make sure to wash your hands and don't rub your eyes or get it in your mouth as it can burn/sting.
Strapping joints to provide support
Using a bandage or brace to support the affected joint can provide pain relief. It is best to speak with your doctor before using this method.
Try Acupuncture
Acupuncture is a treatment where tiny needles are put in your skin at special points. A 2018 case study has shown that acupuncture helps with pain relief. Make sure the person doing it uses clean needles and is an expert in this field.
Conclusion
Menopausal women experiencing joint pain can suffer significantly.
If your joints hurt a lot during perimenopause or after menopause and it's making your daily life hard, it's important to talk to your healthcare provider. They can discuss hormone repalcement therapy and also organise investigations if needed.
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