By Anna Lowe PhD
It’s very common to get new aches and pains in midlife, both men and women report more musculoskeletal pain (bone, muscle, joint, connective tissue pain) as midlife approaches. There are lots of reasons for this, our tissues are ageing, they don’t respond as well to stresses and strains and recovery can take longer. Our body composition changes; we tend to put on weight in midlife and this affects in particular weight bearing joints such as knees and hips. We also become more sedentary as we approach midlife, whilst this doesn’t apply to everyone, population-level data shows a clear trend towards lower levels of activity, and movement is critical in keeping our musculoskeletal system healthy.
All of these factors contribute to the uptick in joint-related pain in midlife….and that’s before we talk about hormones. Those of us born with ovaries are subject to major hormonal fluctuations as we enter perimenopause and this creates additional challenges for our musculoskeletal system which operates best in a stable and predictable internal environment.
How does menopause affect our joints?
Hormones have a critical role in maintaining balance of the internal environment, joints (and their related structures) are highly sensitive to changes in hormone levels. We tend to focus on joint pain but connective tissue problems (think achilles tendinopathy, frozen shoulder etc) are also more common in midlife and more common in women than men. Again, connective tissue is sensitive to fluctuations in hormones and this can result in changes in the elasticity, levels of inflammation and healing potential. A recent paper coined the phrase the ‘Musculoskeletal Syndrome of Menopause’ this umbrella term covers hormone-related changes in joints, cartilage, connective tissue, muscle and bone. When considered together the collective impact of these conditions is tremendous in terms of the effect on people’s ability to work, move, keep themselves fit and enjoy life. Women are at increased risk, due to menopause-related changes and the paper creates a compelling argument for professionals to be more proactive in helping women to prevent and treat conditions that fit under this umbrella.
It’s important to note that some women report no menopausal symptoms at all. Many women experience menopausal symptoms, but not joint pain and some menopausal women may experience joint pain that is unrelated to their menopausal status. So it can be difficult to tease out whether joint pain in midlife is hormonally mediated or due to other midlife factors, or a mixture of both. If hormone therapy offers significant relief from joint pain then it would indicate that it could be hormonally mediated. Either directly (joints are happier with a more stable internal environment) or indirectly (for example,hormone therapy enables a person to sleep better and lifts their mood making pain more manageable and exercise possible).
What can we do to keep joints healthy?
It’s always important to get things checked out, particularly if you have new pain or severe pain and feel unwell in yourself. Don’t delay in speaking to a healthcare professional, the more info you have, the better equipped you’ll be.
There is increasing recognition that joint pain is often mediated by inflammation, by this we mean systemic inflammation so while we might think of joint pain as limited to the joint itself, it can actually be part of a bigger overall health picture. With this in mind, healthy living fundamentals really matter; good sleep, managing stress, nutrition and exercise all help to keep systemic inflammation in check and this in turn helps our joints.
Maintain a healthy body weight, for the reasons above (body weight affects metabolic health, which affects inflammation) but also because of the more obvious increased forces that are translated through joints, particularly lower limb joints.
Stay active, our musculoskeletal system is designed to move and does not respond well to long periods of sitting. Move often and in lots of different ways. This can be hard if you have painful joints but seek help and get creative, there are always ways to stay active.
Build muscle strength, muscles control movement and posture (they also have an important role in metabolic health), they allow us to move well and this protects our joints. Muscles waste very quickly and this is evident when there is joint pain and a vicious cycle begins (pain → reduced movement → reduced strength → more pain etc etc). Being proactive and building up strength reserves is critical.
Joint and soft tissue mobility helps to keep our musculoskeletal system supple and responsive. It helps to mediate pain and also lubricate joints….as they say….motion is lotion!
Don’t suffer in silence, treatment outcomes are better when help is sought early. Get help from a healthcare professional and if you are a woman in midlife make sure you talk to them about menopausal changes and how these might affect your joints.
References
Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472. https://doi.org/10.1080/13697137.2024.2380363