Perimenopause, Menopause & Joint Pain | Athletic Therapy Victoria BC

By Julia Cole, CAT(C) – Proactive Therapy | Athletic Therapy, Strength & Conditioning in Victoria, BC

You may have noticed that aches and pains seem to appear out of nowhere in your 40s or 50s?

Maybe your Achilles is sore after your usual run. Your shoulders feel stiff when reaching overhead. Your knees ache on stairs. Or you're finding it takes much longer to recover from workouts than it used to.

If this sounds familiar, you're not imagining it—and you're certainly not alone.

While hot flashes and sleep disturbances are well-recognized symptoms of perimenopause and menopause, many women are never told that hormonal changes can also have a significant impact on muscles, tendons, bones, and joints. (DOI)

The good news? There is a lot you can do to maintain your strength, reduce injury risk, and continue doing the activities you love.

What Happens During Perimenopause?

Perimenopause is the transition leading up to menopause and often begins in your 40s, although it can start earlier.

During this time, estrogen levels fluctuate and gradually decline. Estrogen affects far more than reproductive health—it also plays an important role in maintaining:

• Muscle mass

• Bone density

• Tendon health

• Joint health

• Recovery from exercise

• Collagen production

As estrogen declines, these tissues become less resilient and may recover more slowly from the same training loads that once felt easy. (DOI)

How Can Perimenopause Affect the Musculoskeletal System?

1. Muscle Loss (Sarcopenia)

Beginning in midlife, women naturally begin to lose muscle mass and strength.

Without resistance training, this decline accelerates after menopause.

This can lead to:

• Reduced strength

• Lower power

• Slower walking speed

• Reduced balance

• Increased injury risk

• Difficulty performing everyday tasks

The encouraging news is that strength training is one of the most effective ways to slow or even reverse much of this loss. (DOI)

2. Tendon Pain

Many women notice tendon pain during perimenopause, including:

• Achilles tendinopathy

• Tennis elbow

• Rotator cuff pain

• Plantar fasciopathy

• Gluteal tendinopathy

Why?

Estrogen influences collagen turnover and tendon structure. As hormone levels change, tendons may become less tolerant of sudden increases in load and recover more slowly after exercise. (ImSociety)

This doesn't mean you should stop exercising.

It means your tendons may need a more gradual progression in training.

3. Joint Pain and Stiffness

Many women describe feeling as though they "aged overnight."

Hands feel stiff.

Knees ache.

Shoulders become sore.

Hips feel tight.

Joint pain is one of the most common—but often overlooked—symptoms of menopause. Fortunately, regular exercise is consistently associated with improvements in pain, function, and overall quality of life. (DOI)

4. Bone Health

One of the most significant musculoskeletal changes during menopause is accelerated bone loss.

Women can lose a substantial amount of bone density during the first several years after menopause, increasing the risk of osteoporosis and fractures. (DOI)

The good news?

Bone responds to loading.

Resistance training and impact exercise (when appropriate) remain some of the best non-pharmacological tools for maintaining bone health. (PubMed Central (PMC))

What Should You Do?

The answer isn't to stop exercising.

In fact, it's usually the opposite.

1. Prioritize Strength Training

If I could recommend just one thing, it would be this.

Aim for 2–3 full-body strength sessions per week, focusing on progressive overload.

Prioritize exercises like:

• Squats

• Split squats

• Deadlifts

• Rows

• Push-ups or presses

• Step-ups

• Loaded carries

The goal isn't simply to "tone."

It's to build and maintain muscle, bone, and tendon capacity.

2. Continue Impact Exercise (If Appropriate)

Walking is excellent for general health.

But for bone health, your skeleton also benefits from higher-impact activities when medically appropriate, such as:

• Hopping

• Jumping

• Running

• Tennis

• Hiking on varied terrain

These activities stimulate bone remodeling more effectively than walking alone. If you already have osteoporosis or other medical concerns, speak with your healthcare provider or rehabilitation professional before starting impact training. (CMAJ)

3. Eat Enough Protein

Muscles need protein to adapt.

Most active women benefit from approximately 1.2–1.6 g of protein per kilogram of body weight per day, particularly when strength training regularly.

Aim to include protein at each meal to support muscle maintenance and recovery.

4. Support Bone Health

Talk with your healthcare provider about whether you are meeting your calcium and vitamin D needs and whether a bone density (DXA) scan is appropriate based on your age and risk factors.

Bone health isn't just about supplements—it's about combining nutrition with regular resistance and weight-bearing exercise. (PubMed Central (PMC))

5. Respect Recovery

Recovery often becomes more important than it was in your 20s.

That doesn't mean you should exercise less.

It means paying more attention to:

• Sleep

• Nutrition

• Stress management

• Gradual training progression

• Recovery days

If you're always training while exhausted, your tissues have less opportunity to adapt.

What About Hormone Therapy?

For some women, menopausal hormone therapy (MHT) may be appropriate.

Current guidelines indicate that MHT can help preserve bone density and reduce fracture risk in appropriate candidates, and some evidence suggests it may improve musculoskeletal symptoms. However, it's not suitable for everyone, and decisions about MHT should always be made with your physician or menopause specialist after considering your individual medical history and goals. (DOI)

Should You Stop Running?

Absolutely not—if running is something you enjoy and your body tolerates it.

You may need to modify:

• Training volume

• Recovery

• Strength work

• Nutrition

But many women continue to run, hike, lift weights, and compete well into their 50s, 60s, and beyond.

The goal isn't to avoid loading your body.

The goal is to build enough capacity to keep doing what you love.

How Athletic Therapy Can Help

If you've noticed new aches and pains during perimenopause or menopause, don't assume it's "just getting older."

A thorough assessment can identify factors contributing to your symptoms, such as:

• Muscle weakness

• Tendon overload

• Joint stiffness

• Training errors

• Recovery issues

• Movement patterns

From there, we can develop a personalized plan that helps you continue exercising confidently while reducing your risk of injury.

The Bottom Line

Perimenopause and menopause bring real physiological changes, but they don't have to mean giving up the activities you love.

The strongest evidence continues to support:

✔ Progressive strength training✔ Weight-bearing and impact exercise (when appropriate)✔ Adequate protein intake✔ Bone-friendly nutrition✔ Gradual training progression✔ Prioritizing recovery

Rather than seeing menopause as the end of your active years, think of it as a time to become even more intentional about how you train.

Your body is changing—but with the right approach, it can remain remarkably strong.

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