1. Introduction
Menopause is a natural part of life, but its effects go far beyond just hot flushes and mood swings. As clinicians who see these changes both professionally and personally in our practice, we want to shine a light on a crucial—but often overlooked—aspect: menopause and musculoskeletal health.
Understanding what’s happening in your body is the first step toward achieving optimal health and maintaining your quality of life, both during and after menopause.
2. Estrogen and Its Role in Musculoskeletal Health
Estrogen does a lot more than most people realise—it’s not just about reproductive health. This hormone is key for keeping your joints, muscles, tendons, and bones strong and flexible. But after menopause, when estrogen levels drop sharply, you might notice your body doesn’t feel quite the same.
Did you know women can lose up to 20% of their bone density within just five to seven years after menopause? That’s a big reason why osteoporosis and fractures become so much more common during this stage of life.
It’s not just bones, either. Nearly half of postmenopausal women say they experience new or worsening joint pain. Estrogen deficiency can also lead to tendon problems, especially in areas you use a lot, like your rotator cuff or Achilles tendon.
And let’s not forget muscle. After age 50, muscle mass naturally drops by about 1% each year, but this speeds up after menopause. That means a higher risk of weakness, falls, and injuries.
3.Estrogen deficiency after menopause contributes to:
- Joint pain and stiffness due to reduced anti-inflammatory effects.
- Tendon degeneration, particularly in weight-bearing and high-use areas such as the rotator cuff and Achilles tendon.
- Loss of muscle mass (sarcopenia), reducing strength, and increasing injury risk.
- Decreased bone density, leading to osteoporosis and heightened fracture susceptibility.
4. Macrophage Polarization and Increased Inflammation
One of the lesser-known but critical aspects of postmenopausal musculoskeletal decline is the shift in your immune system, particularly in macrophage activity.
Estrogen helps maintain a healthy balance between pro-inflammatory (M1) and anti-inflammatory (M2) macrophages. After menopause, the body shifts toward an M1-dominant, pro-inflammatory state, leading to chronic inflammation in synovial tissues and tendons.
This inflammatory environment increases the production of cytokines like TNF-α, IL-6, and IL-1β, which contribute to pain, tissue degradation, and delayed healing.
As a result, conditions such as frozen shoulder (adhesive capsulitis), rotator cuff injuries, and plantar fasciitis become more common and persistent in postmenopausal women.
5.Why This Happens
inflammation, supports collagen production, maintains tendon elasticity, and preserves bone density.
When estrogen declines, the immune system becomes more inflammatory and less efficient at healing. This leads to chronic pain, stiffness, and tissue breakdown.
That’s why joint and tendon pain, as well as injuries, are more prevalent and stubborn after menopause. However, understanding these changes empowers you to take proactive steps for health optimisation and long-term wellbeing.
6. The Power of Strength Training During and After Menopause
If there’s one health optimisation strategy every woman in midlife should know, it’s the transformative power of strength training.
Research consistently shows that resistance and weight-bearing exercises are among the most effective ways to counteract the musculoskeletal effects of menopause.
Here’s how strength training supports menopause and musculoskeletal health:
- Bone Health: Weight-bearing and resistance exercises stimulate bone remodelling and increase bone density, reducing the risk of osteoporosis and fractures.
- Muscle Mass and Strength: Regular strength training can slow or even reverse muscle loss, helping you maintain independence and reduce injury risk.
- Metabolism: Building muscle boosts your resting metabolic rate, making it easier to manage weight and counteract metabolic changes after menopause.
- Mood and Mental Health: Strength training has been shown to reduce depression and anxiety, and improve emotional resilience in menopausal women.
- Sleep Quality: Regular physical activity, including resistance training, improves sleep quality and duration.
- Cardiovascular Health: Strength training lowers blood pressure, improves insulin sensitivity, and helps prevent heart disease and type 2 diabetes.
- Balance and Mobility: Stronger muscles enhance joint stability, reducing the risk of falls and injuries as you age.
- Reduced Hot Flashes: Some studies suggest that regular exercise can decrease the frequency and severity of hot flushes.
Other important interventions that can help the body during menopause include:-
Nutritional Support: Adequate protein, omega-3 fatty acids, and antioxidants support tissue repair and reduce oxidative stress.
Massage Therapy and Acupuncture: Particularly beneficial for frozen shoulder and muscular aches, promoting circulation and reducing fibrosis.
7. Putting It All Together
Menopause does not have to mean living with pain, weakness, or stiffness. With the right support—such as tailored exercise, proper nutrition, and, when appropriate, hormone therapy—you can thrive through this transition and beyond. If you’re experiencing shoulder pain, unexplained tendon injuries, or your body just doesn’t recover like it used to, don’t ignore these symptoms. They are common, but not inevitable, and early intervention can make a significant difference.8. Conclusion
Menopause and musculoskeletal health are more connected than many people realise. The good news? With the right knowledge and a few proactive steps, you can take charge of your health, ease pain, and keep your energy and vitality for years to come. If you start addressing things like joint pain, muscle loss, or tendon injuries early, you’ll notice a real difference in how you feel day to day. It’s all about helping you stay active, independent, and confident—no matter where you are on your menopause journey. If you’re ready to take control of your health, we’re here to help at Sure Health Management. Here’s how we can support you:- Personalised assessment and expert guidance tailored to your stage of menopause and musculoskeletal needs
- Customised exercise and strength training programs designed for safety, effectiveness, and long-term results
- Evidence-based rehabilitation to address pain, improve mobility, and prevent future injuries
- Ongoing support and education to help you stay motivated, confident, and empowered on your health journey
Contact us today to start your journey toward better health and lasting wellbeing.
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