Menopause and Musculoskeletal Health: Bone, Tendon and Joint Changes

Why Midlife Is a Distinct Period

The menopause transition coincides with changes in bone, tendon, muscle and joint tissue, as well as sleep, mood, activity and workload. Estrogen influences several of these systems, which is why musculoskeletal complaints are often discussed alongside menopause. A recent narrative review cautions, however, that attributing injury risk in midlife women to estrogen decline alone is too narrow, because biomechanical, neuromuscular and structural changes also contribute, and much of the supporting research is observational (Ansari et al., 2026).

Joint aches and stiffness are widely reported in midlife, but the cause in any one person is usually multifactorial, and not every ache is hormonal.

Bone

Bone is the clearest example. Bone density declines during the menopause transition. In the Study of Women's Health Across the Nation (SWAN) cohort, greater leisure-time physical activity was associated with slower loss of femoral neck bone density, and even modest increases in common activities such as walking were associated with less loss (Greendale et al., 2023). This was an observational study, so it shows an association rather than proving that activity prevents bone loss.

Bone density testing, calcium and vitamin D intake, and medication decisions belong with a GP or specialist. Loading-based exercise is generally considered a sensible part of the overall picture.

Tendon and Joint Pain

Tendon problems such as gluteal tendinopathy (lateral hip pain), rotator cuff-related shoulder pain and Achilles pain are common in midlife women. A randomised trial in postmenopausal women with greater trochanteric pain syndrome found that all groups improved over time when education about avoiding tendon compression and load management was provided with either tendon-specific or sham exercise. In an analysis stratified by body mass index, menopausal hormone therapy was associated with better outcomes in women with a BMI below 25 (McMillan et al., 2022).

This does not mean hormone therapy is needed for tendon pain. It does suggest that education, load management and progressive exercise are an important foundation, and that any hormone treatment is a medical decision made with a GP.

When to Seek Medical Review

Medical review is advisable for a sudden onset of severe back pain, especially after minimal load, a noticeable loss of height, pain that persists at night or at rest, a hot swollen joint, unexplained weight loss, or a fracture after a low-impact fall. These can reflect bone fragility or other conditions that need investigation rather than musculoskeletal treatment alone. Individual exercise and load guidance depends on assessment of symptoms, history and current activity.