Menopause and Muscle Aches: How Estrogen Decline Contributes to Pain

Menopause and Muscle Aches: How Estrogen Decline Contributes to Pain

Written By
Maclaine Borne
Published
June 28, 2024

Muscle aches during menopause are common (1), yet the role of estrogen decline in contributing to these pains is often overlooked. Since muscle pain (Myalgia) 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.

 

What are the 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 synthesis (11), 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).

 

In addition to muscle and joint discomfort, the drop in estrogen during menopause can trigger a wide range of physical and emotional symptoms (12). These often begin in perimenopause and may persist well into post-menopause. 

 

Common symptoms include:

  • Hot flashes and night sweats – Sudden feelings of heat and sweating, often disrupting sleep.
  • Fatigue – Ongoing tiredness or low energy, which can be compounded by poor sleep or aches.
  • Mood swings and irritability – Emotional changes linked to hormonal fluctuations. Stress reduction techniques can help to soothe the impact of rising cortisol levels.
  • Decreased libido – Changes in sexual desire or arousal.
  • Brain fog – Difficulty concentrating, forgetfulness, or feeling mentally sluggish.
  • Weight gain or redistribution – Changes in metabolism and fat storage, especially around the abdomen.
  • Thinning hair and dry skin – Estrogen affects collagen and hydration, impacting skin and hair health.

 

Estrogen and the Musculoskeletal System

When it comes to pain, research suggests that hormonal imbalances, specifically 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 density, muscle mass, and tendon and ligament flexibility(15). 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).

 

What is the Connection between Muscle Aches and 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).

 

How do I Manage 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.

 

Other Ways to Manage the Symptoms of Menopause
  • An anti-inflammatory diet (16), including magnesium, vitamin D, and omega-3 fatty acids
  • Physical therapy
  • Resistance training to build muscle mass
  • Stretching routines
  • Stress reduction techniques
  • Sleep hygiene



References: 

  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. https://my.clevelandclinic.org/health/body/22353-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. https://www.niams.nih.gov/health-topics/osteoarthritis 
  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. https://health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic 
  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.
  11. Thornton M. J. (2013). Estrogens and aging skin. Dermato-endocrinology, 5(2), 264–270. https://doi.org/10.4161/derm.23872
  12. Iqbal, J., & Zaidi, M. (2009). Understanding estrogen action during menopause. Endocrinology, 150(8), 3443–3445. https://doi.org/10.1210/en.2009-0449
  13. Ahmady, F., Niknami, M., & Khalesi, Z. B. (2022). Quality of sleep in women with menopause and its related factors. Sleep science (Sao Paulo, Brazil), 15(Spec 1), 209–214. https://doi.org/10.5935/1984-0063.20220021
  14. Waetjen, L. E., Crawford, S. L., Chang, P. Y., Reed, B. D., Hess, R., Avis, N. E., Harlow, S. D., Greendale, G. A., Dugan, S. A., Gold, E. B., & Study of Womenʼs Health Across the Nation (SWAN) (2018). Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause (New York, N.Y.), 25(10), 1094–1104. https://doi.org/10.1097/GME.0000000000001130
  15. Leblanc, D. R., Schneider, M., Angele, P., Vollmer, G., & Docheva, D. (2017). The effect of estrogen on tendon and ligament metabolism and function. The Journal of Steroid Biochemistry and Molecular Biology, 172, 106-116. https://doi.org/10.1016/j.jsbmb.2017.06.008
  16. Skoczek-Rubińska, A., Muzsik-Kazimierska, A., Chmurzynska, A., Jamka, M., Walkowiak, J., & Bajerska, J. (2021). Inflammatory Potential of Diet Is Associated with Biomarkers Levels of Inflammation and Cognitive Function among Postmenopausal Women. Nutrients, 13(7), 2323. https://doi.org/10.3390/nu13072323

 

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