Musculoskeletal Syndrome of Menopause

What Is Musculoskeletal Syndrome of Menopause?

Menopause is widely recognized for its effects on hormonal balance, but its impact on the musculoskeletal system is often overlooked. Many women experience joint pain, muscle stiffness, and reduced strength that seem to appear around menopause, even without prior injury or overuse. This collection of symptoms is often referred to as musculoskeletal syndrome of menopause (MSM) and can significantly impact daily function and quality of life.

MSM is characterized by:

• Joint pain and stiffness, especially in the knees, hands, and shoulders

• Muscle weakness and reduced endurance

• Tendon pain and increased risk of tendinopathy

• Increased susceptibility to musculoskeletal injuries

• Changes in posture and movement efficiency
  

Research suggests that nearly 50-70% of postmenopausal women report musculoskeletal pain, with symptoms often mimicking conditions like osteoarthritis, tendinitis, or fibromyalgia (Rianon et al., 2021).

Why Does Menopause Cause Musculoskeletal Symptoms?

The primary driver behind these changes is estrogen deficiency, which affects bone, muscle, and connective tissue in several keyways.

1. Loss of Estrogen’s Protective Effects on Joints

Estrogen plays a major role in maintaining joint health by regulating inflammation and cartilage metabolism. After menopause, cartilage degeneration accelerates, contributing to joint stiffness and increased osteoarthritis risk (Roman-Blas et al., 2010). This is why many postmenopausal women experience new or worsening joint pain, particularly in weight-bearing joints like the hips and knees.

2. Reduced Muscle Mass and Strength

Aging naturally leads to sarcopenia (loss of muscle mass), but menopause speeds up muscle loss due to estrogen's direct role in maintaining muscle protein synthesis. Studies show that women lose up to 8% of muscle mass per decade after menopause if they do not engage in strength training (Lolascon et al., 2021). This can lead to weakness, reduced endurance, and increased injury risk.

3. Increased Tendon Stiffness and Tendinopathy Risk

Estrogen helps regulate collagen turnover in tendons. With declining estrogen levels, tendons become stiffer, less elastic, and more prone to injury (Couppe et al., 2016). This contributes to common postmenopausal tendon issues like Achilles tendinitis, rotator cuff pain, and lateral epicondylitis (tennis elbow).

4. Changes in Bone Density and Postural Control

Estrogen is critical for bone remodeling and calcium absorption. After menopause, women experience accelerated bone loss, increasing the risk of osteoporosis and fractures. This also affects posture, potentially leading to spinal compression fractures and postural imbalances (Sözen et al., 2017).

How Physical Therapy Can Help Manage Musculoskeletal Syndrome of Menopause

While these changes can be frustrating, the good news is that physical therapy (PT) can help by addressing joint pain, muscle weakness, postural changes, and movement dysfunction.

1. Strength Training for Muscle and Bone Health

Resistance training is essential for preventing muscle loss and maintaining bone density. Research shows that progressive strength training 2-3 times per week can increase muscle mass, improve joint stability, and reduce pain in postmenopausal women (Kelley et al., 2013).

A physical therapist can design a safe, joint-friendly strength program to help you stay strong and active.

2. Joint and Soft Tissue Mobilization for Pain Relief

Manual therapy techniques like joint mobilizations and myofascial release can improve mobility, reduce stiffness, and enhance circulation, helping relieve joint and tendon pain. Studies support the use of hands-on therapy in managing osteoarthritis and tendinopathy in postmenopausal women (Deyle et al., 2020).

3. Postural Training and Core Stability Work

Postural changes due to bone loss, muscle weakness, and joint stiffness can lead to increased strain on the spine and shoulders. PT can include postural retraining and core strengthening to reduce spinal stress and improve movement efficiency.

4. Tendon Loading and Stretching Programs

For tendon-related pain, physical therapy includes eccentric loading exercises, which have been shown to help strengthen tendons and reduce pain in conditions like Achilles tendinopathy and rotator cuff issues (Malliaras et al., 2013).

5. Balance and Fall Prevention Training

Since menopause increases fall risk due to muscle weakness and bone loss, balance exercises help improve proprioception and lower-body stability. Research shows that targeted balance training can reduce fall risk by 40% (Sherrington et al., 2008).

6. Lifestyle and Ergonomic Advice

Physical therapists also educate patients on daily movement habits, joint protection strategies, and ergonomic adjustments to reduce strain on the musculoskeletal system.

The Bottom Line: You Don’t Have to Accept Pain as a Normal Part of Menopause

Musculoskeletal syndrome of menopause is real, but it is treatable. If you're experiencing joint pain, muscle weakness, or movement limitations, physical therapy can help restore strength, mobility, and confidence in movement.

At Nashville Physical Therapy & Performance, we offer personalized one-on-one evaluations, hands-on treatment, and customized exercise programs to help you stay strong, active, and pain-free through menopause and beyond.

💡 If you’re struggling with musculoskeletal changes due to menopause, contact us today to get started on a plan designed just for you!

References

• Couppe, C., et al. (2016). "Gender differences in tendon properties and function." Journal of Applied Physiology, 121(5), 1237-1248. https://doi.org/10.1152/japplphysiol.00138.2016

• Deyle, G. D., et al. (2020). "Effectiveness of manual physical therapy and exercise in osteoarthritis management." JOSPT, 50(8), 458-469. https://doi.org/10.2519/jospt.2020.9021

• Lolascon, G., et al. (2021). "Sarcopenia and menopause: A clinical perspective." International Journal of Environmental Research and Public Health, 18(7), 3402. https://doi.org/10.3390/ijerph18073402

• Roman-Blas, J. A., et al. (2010). "The role of estrogen in cartilage and osteoarthritis." Osteoarthritis and Cartilage, 18(6), 600-607. https://doi.org/10.1016/j.joca.2010.03.011