Joint and muscle pain

Aches, pain and stiffness in the joints, and aching in the muscles around them, that start or get worse around perimenopause. NICE NG23 calls these musculoskeletal symptoms. Roshara's symptom score counts them as one item, aching joints and muscles.

It can be one joint or several at once. The NHS lists knees, hips, shoulders, hands and wrists, feet and ankles, elbows and the neck.

Stiff hands while you knead the morning dough. Getting up off the floor after sitting with family takes two attempts and a hand on the wall. A dull ache in the hips at night, so you turn and turn. Muscles that feel sore as if you had exercised, when you have not.

It tends to be put down to everything except the menopause: the housework, the weight, the years. Sometimes those play a part. Sometimes the hormones are part of it too, and nobody mentioned it. The Asia-Pacific Menopause Federation even says that for Asian women, body aches and joint pain are more common than hot flushes.

The NHS joint pain page says perimenopause and menopause can cause aching, painful joints because estrogen levels fall. The Pakistan Menopause Society puts joint and muscle pains among the early symptoms of perimenopause, alongside headache, breast tenderness and bloating.

It is rarely the only explanation. The NHS lists other causes worth ruling out, including injury, osteoarthritis (more common over 45), rheumatoid arthritis and gout. The PMS recommendations also warn doctors against implying that every midlife problem comes from estrogen alone, because age, lifestyle and other conditions contribute. That works in your favour: it means a proper check, not a shrug.

• NICE NG23: "Explain to people experiencing menopause the importance of maintaining muscle mass and strength through physical activity." (1.2.5)
• The PMS recommendations ask doctors to encourage resistance exercise, weight-bearing activity, enough protein and better sleep (Table 2). Strength training and yoga go into the detail.
• The same recommendations name widespread vitamin D deficiency as one of the main challenges in Pakistan, link it to indoor lives and purdah, and, as their advice for women in Pakistan, ask for vitamin D levels to be checked regularly where that is possible (4.1, Table 5). Vitamin D and calcium links the NHS guidance on how much.
• The NHS joint pain page lists resting a sore joint without stopping moving it altogether, an ice pack wrapped in a towel, asking a pharmacist or GP which painkiller to take, a healthy weight, a balanced diet, regular exercise and not smoking.

Neither NICE NG23 nor the PMS recommendations name a medicine for joint pain in the menopause on its own. The NHS says treatment depends on the cause, and can include painkillers, physiotherapy, steroid injections, or a referral for an X-ray, a scan or a specialist.

If you are talking to your doctor about HRT for other symptoms, mention your joints too. The Menopause Society says that in the Women's Health Initiative and other studies, women on HRT had less joint pain or stiffness than women on a dummy treatment, and rates that evidence as good. NICE NG23 does not name HRT for joint pain, so ask your doctor what they would expect for you.

The NHS says to see a GP if joint pain stops you doing your normal activities or disturbs your sleep, if the pain or swelling is getting worse or keeps coming back, if it has not improved after two weeks of looking after it at home, or if your joints stay stiff for more than half an hour after you wake up.

Ask for an urgent appointment if a joint is swollen and the skin around it feels hot, or if you have joint pain and feel generally unwell, feverish, or hot and cold and shivery.

Get emergency help for very bad joint pain after a fall or injury, if you cannot put weight on a joint, if a joint looks out of place, or if the area around it tingles or has no feeling after an injury.

Five prayers a day means getting down to the floor and up again many times over. When knees and hips hurt, women ask whether they may pray seated, and how much they should push through. Those are questions for a qualified scholar, and plenty of women ask them. You will not be the first.

At home, the aches are usually heard as complaints about the work. Calling them by their name, and knowing NICE lists them, makes it easier to ask for help and for a check-up.