Menopause and Muscle Aches: How Estrogen Decline Contributes to Pain

Menopause and Muscle Aches: How Estrogen Decline Contributes to Pain

Muscle aches during menopause are common (1), yet the role of estrogen decline in contributing to these pains is often overlooked. Since muscle pain resulting from hormonal changes may be unavoidable, it's important for women to understand the role of estrogen and how to best support their muscle health as they age.


Functions of Estrogen

Estrogen primarily functions as a sex hormone. For individuals assigned female at birth, estrogen, along with progesterone, is crucial for reproductive health, promoting the development of secondary sex characteristics and regulating the menstrual cycle (2).

Beyond its reproductive roles, estrogen is integral to various bodily functions, including cholesterol and blood sugar regulation, circulation, collagen production, and brain function (2). Given these diverse roles, changes in estrogen levels can have significant and widespread implications. 


Estrogen Levels During Menopause
Hormonal changes during perimenopause predominantly involve estrogen fluctuations. As an individual approaches and transitions through menopause, estrogen levels ultimately decrease.Post-menopause, estrogen levels stabilize at a lower baseline than during reproductive years. This decline in estrogen not only halts menstrual periods but also contributes to menopause-related body aches (2).


Estrogen and the Musculoskeletal System

When it comes to pain, research suggests that lower estrogen levels may increase pain sensitivity: studies have linked reduced estrogen to higher pain intensities of lower back pain (3). 

Estrogen is also critical for maintaining bone and muscle mass. Since estrogen declines in menopause, this may explain the increased risk of menopause-related body aches and osteoarthritis often noted (2). Osteoarthritis, which mostly affects joints and may lead to swelling and pain, may also be associated with reduced mobility, which may further decrease physical activity and further muscle weakness (4).

Evidence suggests that estrogen plays a role in helping maintain muscle mass, as well as maintaining the quality of our remaining skeletal muscles (5). Not only does estrogen play a role in muscle mass and quality, it directly affects tendons, ligaments, and collagen. In tendons and ligaments estrogen decreases stiffness which has a direct relationship to injury rates (6).


Focus on Muscle Aches in Menopause

Muscle aches are common among individuals transitioning through menopause. One study, which focused on muscle and joint aches during menopause, found that 63% of participants aged 40-59 experienced muscle and joint aches, and 15.6% of participants stated that muscle and joint aches were severe to very severe (7).


Managing Muscle Aches in Menopause
While estrogen decline may be unavoidable, it may be possible to minimize muscle aches and pains, avoid injury, care for your body, and rest as needed. 
The following tips may help:
    • Apply ice or heat: Heat can increase blood flow to the affected area(s), relaxing tight muscles and relieving achy joints. Conversely, ice helps with inflammation and numbs pain. Ice is the preferred method for acute injuries (less than 6 weeks). Apply in cycles of 20 minutes on and 20 minutes off as needed (8).
    • Massage the area: Massage can relax muscles and reduce the severity of muscle pain (9).
    • Gentle stretching: Incorporating stretching into your routine, particularly before bed, and for only 10 minutes, may improve joint and muscle aches, as well as depressive symptoms for women in menopause (10). 

Above all, remember to be patient and gentle with yourself. Muscle aches can be a normal part of menopause and, while frustrating, there are some things you can do to help manage them. As always if your pain is severe or persistent, make sure you speak to your doctor.

  1. Lu CB, Liu PF, Zhou YS, Meng FC, Qiao TY, Yang XJ, Li XY, Xue Q, Xu H, Liu Y, Han Y, Zhang Y. Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis. Neural Plast. 2020 Nov 25;2020:8842110. doi: 10.1155/2020/8842110. PMID: 33299396; PMCID: PMC7710408.
  2. Cleveland Clinic. (2022, February 8). Estrogen: Hormone, function, Levels & Imbalances. Estrogen. 
  3. Nikolov, V. and Petkova, M. (2010). Pain sensitivity among women with low estrogen levels. Procedia - Social and Behavioral Sciences 5(2010):289-293. DOI: 10.1016/j.sbspro.2010.07.090. 
  4. U.S. Department of Health and Human Services. (2023, December 15). Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 
  5. Collins BC, Laakkonen EK, Lowe DA. Aging of the musculoskeletal system: How the loss of estrogen impacts muscle strength. Bone. 2019 Jun;123:137-144. doi: 10.1016/j.bone.2019.03.033. Epub 2019 Mar 28. PMID: 30930293; PMCID: PMC6491229.
  6. Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019 Jan 15;9:1834. doi: 10.3389/fphys.2018.01834. PMID: 30697162; PMCID: PMC6341375.
  7. Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, Danckers L, Espinoza MT, Flores D, Gomez G, Hernandez-Bueno JA, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Tserotas K, Vallejo MS. Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women. Maturitas. 2013 May;75(1):94-100. doi: 10.1016/j.maturitas.2013.02.012. Epub 2013 Mar 23. PMID: 23528735.
  8. Cleveland Clinic. (2024, April 30). Here’s how to choose between using ice or heat for pain. 
  9. Frey Law LA, Evans S, Knudtson J, Nus S, Scholl K, Sluka KA. Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial. J Pain. 2008 Aug;9(8):714-21. doi: 10.1016/j.jpain.2008.03.009. Epub 2008 May 2. PMID: 18455480.
  10. Kai Y, Nagamatsu T, Kitabatake Y, Sensui H. Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial. Menopause. 2016 Aug;23(8):827-32. doi: 10.1097/GME.0000000000000651. PMID: 27300113; PMCID: PMC4961267.