Menopause & musculoskeletal pain: What We Know, What We Don’t, and Why Lifestyle Still Matters

Last week marked the very first Menopause Café, and what a powerful event it was. No need for discussion prompts. Everyone jumped straight in, sharing their experiences, their symptoms, and their questions. One topic that came up was musculoskeletal pain: aches, stiffness, soreness, either associated with a diagnosed condition, or not. 

Up to 70% of menopausal women report musculoskeletal pain during or after this time. This includes everything from general joint aches to more specific conditions like osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, and even gout. 

There’s a recurring question that naturally comes up: if a drop in oestrogen is linked to this kind of pain, could hormone replacement therapy (HRT) help? 

What the Research Says: Still a Work in Progress 

A review published in March this year dug into all available evidence: looking at women who had ever used HRT versus those who hadn’t. The researchers hoped to get clear answers, but, as is often the case in menopause research, the findings were mixed. 

Some studies showed HRT users experiencing more pain, some less pain, & others found no difference.  

That’s not exactly clear-cut, is it? 

Researchers had expected that HRT, by improving sleep, mood, and fatigue, would also improve pain scores. But the results didn’t consistently support that idea. 

What this highlights is an important gap: we still don’t fully understand how oestrogen interacts with inflammation, the immune system, or cartilage metabolism. We know oestrogen exerts anti-inflammatory and immunosuppressive effects, and that the incidence of arthralgia and arthritis climbs sharply for women around menopause. But exactly how all those pieces connect remains uncertain. 

The Bigger Picture: HRT Is Not the Whole Story 

Even if oestrogen deficiency plays a role, it’s not always the only driver. Pain during menopause is also intertwined with fatigue, mood changes, sleep disturbance, and body mass. So while hormones matter, they’re part of a broader picture. 

It’s also worth remembering that research always carries confounders: those factors that muddy the waters. For example: 

• Women on HRT might visit their GP more frequently, meaning they’re more likely to receive a diagnosis of pain-related conditions. 
• Women already living with musculoskeletal issues may be more (or less) likely to seek treatment or adopt lifestyle changes that support pain management. 
• Women with pre-existing diagnoses may be more (or less) likely to report changes in their symptoms compared to someone newly experiencing musculoskeletal pain.

Until those, and other, variables are fully accounted for, this review would suggest that researchers can’t yet draw hard conclusions about HRT’s exact role in musculoskeletal pain. 

Where We Do Have Clarity: The Power of Lifestyle 

While the research community works on the “HRT question,” what is thankfully clear right now is that lifestyle factors have an undeniable impact, and they’re fully within our control. 

Movement matters.
Keeping active helps maintain muscle strength, joint mobility, and general function. And it reduces stiffness and pain over time. This doesn’t mean marathon training. It’s about finding what feels good and sustainable: walking, swimming, yoga, Pilates, dancing, or just keeping active in everyday life. 

Nutrition counts.
An anti-inflammatory diet can make a tangible difference. Think about foods rich in: 

• Healthy fats - olive oil, nuts, seeds, and oily fish (for omega-3s). 
• Antioxidants - a vibrant variety of colourful fruits and vegetables to reduce oxidative stress. 
• Lean protein - to help maintain muscle mass and joint stability. 

At the same time, limit inflammatory culprits such as smoking, excess alcohol, and refined sugars. These can all amplify inflammation and pain. 

Support is essential.
No one should have to navigate menopausal symptoms, or the lifestyle adjustments that come with them, alone. Ongoing, compassionate partnerships with healthcare providers can make all the difference in helping tailor the right combination of treatments, movement, and nutrition for each person. 

What This Means for You 

Musculoskeletal pain is a recognized and significant symptom of menopause. It can feel discouraging when research doesn’t offer a clear-cut solution, but uncertainty doesn’t mean inaction. In fact, it’s a reminder that small, steady lifestyle shifts can be powerful tools for change, whether or not you choose HRT. 

And that’s really what we hope the Menopause Café is about: open conversations, shared experiences, and evidence-based insights that help us all navigate this phase with strength and clarity. 

Let’s Keep the Conversation Going 

If musculoskeletal pain is part of your experience right now, start by connecting with your healthcare provider. They can guide you in exploring what medical support is appropriate for you and help you design a pain management plan that’s suited to your lifestyle and health history. 

If you’d like support in making therapeutic lifestyle change to help better manage chronic pain, please reach out to me. 

And if you’d like a supportive space to continue these conversations, about symptoms, solutions, and everything in between, please join us at the next Menopause Café: 

Tuesday, June 23, 6pm
Vibe Café, Ridgeway Street, Douglas 

And let’s keep building this community of understanding, learning, and support, together. 

You can reserve your spot at the next Menopause Café today by following the link and take the next step toward thriving through menopause.