Getting up off the prayer mat takes longer than it used to. Your fingers are stiff when you knead the dough in the morning. The stairs at your sister's house feel steeper every visit. Your shoulder aches and you cannot remember hurting it.

For decades, women have described this shift in their bodies during perimenopause and menopause: more stiffness, more aches, joint and muscle pain that turns up with no injury and no explanation. And for decades it has been waved away as vague, or as age, or as too much housework.

What a new review found

A systematic review and meta-analysis published in 2026 by Kruse and colleagues brings some long-overdue clarity. It pulled together data from more than 93,000 women across 22 countries, making it one of the largest looks yet at muscle and joint symptoms across the menopause transition.

The findings:

  • 40% of women before the menopause transition report muscle or joint pain
  • 57% of women in perimenopause do
  • 59% of women after menopause do

That is a 35 to 40% higher risk of muscle and joint pain after the transition.

This is not random.

What the guidance already says

The guidelines Roshara follows name it too. NICE NG23 asks doctors to explain that symptoms of menopause can include joint and muscle pain. The NHS joint pain page says perimenopause and menopause can cause aching, painful joints because estrogen levels fall. The Pakistan Menopause Society's 2026 recommendations list joint and muscle pains among the early symptoms of perimenopause, and ask doctors to ask about them, along with loss of strength and doing less than you used to.

Why estrogen matters to muscles and joints

Estrogen receptors, the parts of a cell that respond to estrogen, are found all through the body's moving parts: in muscle fibres, tendons and ligaments, and in the fascia that wraps the muscles, the cartilage that cushions the joints, and the bones themselves.

Estrogen plays a part in making collagen, keeping tissue springy, calming inflammation, carrying signals between nerves and muscles, and helping the body recover after strain. When estrogen swings and falls, all of these change.

That can show up as:

  • finding exercise harder to tolerate than before
  • taking longer to recover after a busy day or a workout
  • sore, irritated tendons, around the heel, the elbow or the shoulder
  • a dull ache spread through the muscles
  • stiffness first thing in the morning that eases as you move
  • a sense that your body no longer responds the way it used to

Too often called "just age"

Even with numbers like these, midlife pain is often poorly described in medicine. Specific conditions are rarely named, and the part hormones play is still underestimated or ignored.

Calling this just ageing is inaccurate. Calling it vague is dismissive. This is biology, and it deserves proper recognition, precise words and care that counts hormones as part of the picture.

What you can do

Write it down. Which joints, which muscles, what time of day, how long the morning stiffness lasts, and what makes it better or worse. A few weeks of notes turns "I ache everywhere" into something a doctor can work with.

Keep moving, and build strength. The British Menopause Society says regular resistance exercise, the kind that works your muscles against a weight, builds muscle. The NHS suggests muscle-strengthening activity on at least two days a week. Start gently and build up. Our page on strength training has more.

Ask about treatment. Neither NICE NG23 nor the Pakistan Menopause Society names a medicine for menopause joint pain 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 already talking to your doctor about HRT for other symptoms, it is fair to mention your joints too and ask what they expect.

When to see a doctor

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.

You are not imagining it

If your body feels different in this season, if moving feels harder, if you were told nothing is wrong when everything feels off, you are not imagining it, and you are not alone. The way medicine understands women's muscles and joints across life is starting to change, and it is long overdue.

At your next appointment, ask: "Could my joint and muscle pain be part of the menopause, and what else should we rule out?" Our page on joint and muscle pain goes further.