How Menopause Affects Your Joints and Bones

Menopause can affect both your joints and your bones, but the two are different processes. The most important distinction is:

  • Joints: menopause can be associated with more joint aches, stiffness and musculoskeletal pain. The exact mechanisms are still being studied, and menopause does not automatically mean you will develop arthritis.
  • Bones: the evidence is much stronger. Falling oestrogen during the menopause transition accelerates bone loss, decreases bone strength and increases the risk of osteopenia, osteoporosis and fractures.

1. How menopause affects your joints Joint and muscle pain is a recognised menopause symptom. You may notice:

  • aching knees
  • stiff hips
  • sore shoulders
  • aching hands or fingers
  • wrist pain
  • lower-back pain
  • morning stiffness
  • general muscle aches
  • joints feeling less flexible
  • pain after sitting or resting for a long time NICE specifically lists joint and muscle pain as a menopause-associated musculoskeletal symptom. A very large 2026 systematic review involving 93,021 women found that muscle or joint pain was reported by approximately:
  • 40% of premenopausal women
  • 57% of perimenopausal women
  • 59% of postmenopausal women The researchers found a significantly higher risk of musculoskeletal pain during and after the menopause transition. However, they also emphasised that the studies were observational and that the exact causes of the pain cannot yet be established with certainty.

2. Why can menopause cause joint pain? The leading explanation is the decline and fluctuation of oestrogen. Oestrogen receptors are found in many tissues involved in musculoskeletal health, including tissues within and around joints. When ovarian oestrogen production falls, it can influence:

  • inflammatory signalling
  • pain sensitivity
  • cartilage metabolism
  • connective tissues
  • tendons and ligaments
  • muscles
  • bone turnover This is why researchers increasingly view menopause as affecting the whole musculoskeletal system, rather than just the reproductive system. However, there is an important scientific caveat: We know that joint and muscle pain becomes more common around menopause, but it has not been conclusively proven that declining oestrogen directly causes every case of joint pain or arthritis. Other factors occurring at the same time include ageing, changes in body weight, reduced muscle mass, previous injuries and the natural increase in osteoarthritis with age.

3. Does menopause cause osteoarthritis? Not necessarily. This is an important distinction. Osteoarthritis (OA) is a disease involving the entire joint, including cartilage, bone and surrounding tissues. Menopause occurs around the same period when the natural incidence of osteoarthritis increases with age. There is evidence suggesting that oestrogen deficiency may influence cartilage and joint biology, but the relationship between menopause, oestrogen and osteoarthritis is still being investigated. A recent systematic review found evidence linking oestrogen deficiency with cartilage degeneration, but the human evidence was less definitive than the experimental evidence. So you shouldn't assume: "My joints hurt because I am menopausal, therefore I have arthritis." Persistent joint pain should still be medically assessed.

4. What about rheumatoid arthritis? Rheumatoid arthritis (RA) is different from ordinary menopause-related joint aches. RA is an autoimmune inflammatory disease. If you develop:

  • persistent swelling of multiple joints
  • significant morning stiffness
  • warm/red joints
  • symmetrical hand or wrist pain
  • prolonged stiffness lasting an hour or more
  • unexplained fatigue or other systemic symptoms you should be assessed by a doctor rather than assuming it is menopause. Menopause and autoimmune diseases can overlap in timing, which can sometimes make diagnosis more difficult.

5. What happens to your bones? This is where menopause has a particularly important medical effect. Your bones are living tissue. Throughout life, your body continuously: breaks down old bone → builds new bone. This is called bone remodelling. Two important cell types are: Osteoclasts Break down/resorb old bone. Osteoblasts Build new bone. Before menopause, oestrogen helps keep this process balanced. When oestrogen falls substantially during menopause, bone resorption increases, and the amount of bone removed can exceed the amount replaced. The result is: oestrogen decline → increased bone turnover → accelerated bone loss → reduced bone strength.

6. When is bone loss fastest? This is particularly important. Bone loss doesn't suddenly start on the day your period stops. It can begin during perimenopause. Research indicates that the period of particularly rapid bone loss extends from approximately one year before to two years after the final menstrual period. Therefore: Perimenopause → rapid bone loss begins Menopause → continued significant bone loss Later postmenopause → bone loss generally continues, although the rate changes over time This is one reason bone health should be considered before someone is well into postmenopause.

7. What exactly happens to the bone? Oestrogen deficiency increases bone remodelling activity. This can cause:

  • thinning of the outer cortical bone
  • loss of trabecular bone
  • deterioration of the internal architecture of bone
  • reduced bone mineral density
  • reduced overall bone strength It's therefore not simply that the bone becomes "less dense." Its structure and quality can deteriorate as well.

8. Why does osteoporosis become more common after menopause? Osteoporosis means that bone strength has deteriorated sufficiently that the risk of fracture becomes substantially increased. The classic fracture sites include:

  • hip
  • spine/vertebrae
  • wrist NICE notes that fracture incidence increases around menopause in association with lower oestrogen, reduced bone mineral density and increased bone turnover. The problem with osteoporosis is that you often cannot feel your bones getting weaker. There may be no symptoms until a fracture occurs. That's why osteoporosis is sometimes called a silent disease.

9. Why are fractures so important? A fracture after menopause isn't always just an inconvenience. A fragility fracture can occur after relatively minor trauma, such as a fall from standing height. Particularly important are:

  • hip fractures
  • vertebral fractures
  • wrist fractures Hip and vertebral fractures can have significant effects on:
  • mobility
  • independence
  • chronic pain
  • quality of life
  • long-term health NICE considers fracture prevention a major component of menopause and osteoporosis management.

10. Does menopause affect your muscles too? Yes. This is important because muscle and bone health are closely connected. As you get older, muscle mass and strength naturally decline. Menopause can add to the changes occurring during midlife. Reduced muscle strength can mean: less strength → poorer balance/function → greater fall risk → greater chance of fracture if bones are fragile. NICE therefore specifically recommends maintaining muscle mass and strength through physical activity during menopause.

11. What can you do to protect your bones? Weight-bearing exercise Examples:

  • brisk walking
  • hiking
  • dancing
  • stair climbing
  • jogging, if appropriate
  • tennis/pickleball
  • other activities where your skeleton supports your body weight Resistance training This is particularly important. Examples:
  • weights
  • resistance machines
  • resistance bands
  • squats
  • lunges
  • rows
  • presses Resistance training helps maintain:
  • muscle mass
  • muscle strength
  • physical function and provides mechanical loading that supports bone health. Balance training Especially as you get older:
  • Pilates
  • yoga
  • tai chi
  • balance exercises
  • strength training can help maintain physical function and reduce falls.

12. Calcium and vitamin D matter too Your bones require adequate:

  • calcium
  • vitamin D
  • protein
  • other nutrients But taking large amounts of calcium supplements isn't automatically the answer. The goal is generally to obtain adequate calcium from diet where possible and correct vitamin D deficiency when present. Your doctor may recommend supplementation depending on your diet, vitamin D status, osteoporosis risk and other factors.

13. What about HRT and bone health? This is an important difference between HRT for symptoms and HRT specifically for osteoporosis prevention. Menopausal hormone therapy can reduce bone loss and lower fracture risk while it is being used. NICE includes osteoporosis prevention among the potential benefits of HRT. However, HRT is not automatically appropriate for every woman. Your personal:

  • age
  • menopause timing
  • fracture risk
  • cardiovascular risk
  • breast cancer risk
  • history of blood clots
  • type of menopause
  • other medical conditions all need to be considered. HRT should therefore be discussed individually with a healthcare professional rather than started purely because of concerns about osteoporosis.

14. When should you consider a bone-density test? A DXA/Dexa scan measures bone mineral density. You may be considered for assessment earlier than routine screening if you have risk factors such as:

  • early or premature menopause
  • previous fragility fracture
  • strong family history of hip fracture
  • low body weight
  • long-term corticosteroid use
  • smoking
  • high alcohol intake
  • certain medical conditions
  • certain medications that weaken bone Your doctor can calculate fracture risk and determine whether a DXA scan is appropriate. A 2026 clinical review specifically emphasises identifying women at higher risk during peri- and postmenopause because early detection and fracture prevention are important.

15. Joint pain vs bone pain — an important distinction This can be confusing. Menopause-related joint/muscle symptoms Usually feel like:

  • aching
  • stiffness
  • soreness
  • reduced mobility
  • intermittent pain
  • muscle tension Osteoporosis Usually doesn't cause pain by itself. You can have significant osteoporosis and feel completely normal. Pain may occur when osteoporosis results in a fracture, particularly a vertebral compression fracture. So: Joint pain does not automatically mean your bones are becoming weak. And: Having no bone pain does not mean your bones are healthy.

16. When should you get joint pain checked? Don't automatically attribute new or severe joint symptoms to menopause. See a healthcare professional if you have:

  • a swollen joint
  • a hot/red joint
  • persistent or worsening pain
  • significant morning stiffness
  • loss of movement
  • unexplained weakness
  • multiple painful joints
  • pain that wakes you regularly
  • a sudden severe pain
  • pain following a relatively minor fall
  • new back pain after minimal trauma
  • loss of height or a change in posture Particularly after menopause, new unexplained back pain following minor trauma deserves assessment for a vertebral fracture.

Medical sources NICE — Menopause: Identification and Management (NG23) This is one of the most important clinical guidelines. It specifically recognises joint/muscle pain as a menopause symptom and recommends discussing bone health and maintaining muscle mass and strength. NICE — Menopause: identification and management NICE — Full Menopause Guideline Contains the evidence and recommendations concerning osteoporosis, bone mineral density, fracture risk and HRT. NICE — Full menopause guideline PubMed — Bone Health During the Menopause Transition and Beyond Excellent review explaining the rapid bone-loss period around the final menstrual period, changes in bone structure and fracture risk. PubMed — Bone Health During the Menopause Transition and Beyond PubMed — Emerging Concepts in Osteoporosis Across the Menopausal Transition Reviews the biology of bone loss during perimenopause and postmenopause and the role of oestrogen/FSH. PubMed — Osteoporosis across the menopausal transition PubMed — Musculoskeletal Manifestations of Perimenopause, 2026 A very recent systematic review and meta-analysis involving 93,021 women, examining joint and muscle pain during the menopause transition. PubMed — Musculoskeletal Manifestations of Perimenopause PubMed — Musculoskeletal Pain and Menopause Reviews joint pain, arthritis, arthralgia and the possible role of oestrogen deficiency, while emphasising that a direct causal relationship has not been definitively established. PubMed — Musculoskeletal Pain and Menopause PubMed — Musculoskeletal Pain During the Menopausal Transition Systematic review and meta-analysis examining the prevalence of musculoskeletal pain during perimenopause and postmenopause. PubMed — Musculoskeletal Pain During the Menopausal Transition PubMed — Estrogen Alone and Joint Symptoms: Women's Health Initiative Randomised trial data examining the effect of oestrogen therapy on joint pain and swelling in postmenopausal women. PubMed — Estrogen and Joint Symptoms PubMed — Management of Postmenopausal Osteoporosis, 2026 A recent 2026 review covering postmenopausal bone loss, osteoporosis and fracture-risk management. PubMed — Management of Postmenopausal Osteoporosis PubMed — Menopause and Osteoporosis: Epidemiology, Pathophysiology, Screening and Diagnosis, 2026 Recent clinical review explaining why oestrogen reduction accelerates bone resorption and how osteoporosis risk is assessed. PubMed — Menopause and Osteoporosis The Menopause Society Patient-focused medical information from a major professional menopause organisation. It recognises mild joint aches and pains as a possible menopause symptom. The Menopause Society — Menopause Symptoms