Perimenopause, menopause, aches and pains

Aches and pains can be unexpected during menopause, but why do they happen and what can you do about them?

• What is pain?
• Why pain can be a surprising symptom of the perimenopause and menopause
• Advice on pain management and how to seek help for your symptoms

If you have recently started suffering from new or worsened aches and pains, you are not alone. Many women report an increase in pain around the perimenopause and menopause, and for some it has a huge impact on their everyday life. Here we look into why that may happen and what can help.

What is pain?

Pain is a critical issue for women. Women report more recurrent pain, more severe pain and longer lasting pain than men [1]. Chronic pain impacts an estimated 34% of adults in England, and is experienced by more women than men [2].

Pain is described ‘as an unpleasant sensory and emotional experience’ by international pain experts [3]. Importantly, these experts stress pain is a deeply personal experience, and how you describe your pain should be respected and listened to by others.

Chronic pain, which is defined as pain lasting longer than six months, affects women more than men. Painful conditions that disproportionately affect women include fibromyalgia, (which causes widespread pain throughout the body), irritable bowel syndrome, rheumatoid arthritis, osteoarthritis, chronic pelvic pain and migraine headache [4].

Can menopause lead to pain?

Many women report an increase in pain around their menopause – but also say they were not prepared or expecting the symptom.

In a survey of 5,800 women carried out by balance founder Dr Louise Newson, pain was reported as the most common unexpected symptom by more than a third (34%) of women [5]. As you may not be expecting it, it can be easy to miss this as a sign of your menopause.

Women experiencing menopausal symptoms are almost twice as likely to have chronic pain, a large US study with 200,000 women found. [6]

Researchers have found that 71% of women in the perimenopause report joint and muscle pain. While overall rates dropped after menopause, women are then at higher risk of severe joint and muscle pain [7].

Why does perimenopause and menopause cause pain?

Levels of your hormones oestrogen, progesterone and testosterone fluctuate and fall. There are receptors for these hormones throughout your body, and they play important roles in pain.

These hormones influence your pain in complex ways that are still being understood. But it seems that oestrogen can both change how you feel pain, by making you more sensitive to it, and may also cause or contribute to issues that cause pain. This means if you already have a chronic pain condition, like fibromyalgia, you may find it gets worse during the perimenopause.

Hormonal changes may also worsen your sleep, cause an increase in your weight and lead to mood changes that may all have a negative impact on your life, especially if you are living with chronic pain.

Oestrogen, progesterone and testosterone can all alter the way the body responds to pain and lower levels in the body can lead to more pain [8].

There is also a link between depression and chronic pain conditions, and the same chemical messengers in the brain influence both mood and pain [9]. As perimenopause and menopause is a time when you may be at higher risk of depression and anxiety, this could also have a negative impact on your pain. 

Another chronic condition that you may notice worsen during your perimenopause is migraine. You may have found that your periods influenced when you had migraines before perimenopause as your changing hormone levels can trigger them. During the perimenopause, migraines can occur more frequently and be worse, as your hormones fluctuate.

Why do my joints and muscles ache?

Oestrogen, progesterone and testosterone work as anti-inflammatory agents in your muscles, and also help to lubricate your joints [10].

So during the perimenopause and menopause, when hormone levels fall, it can cause muscle and joint pains. This is usually most common in the mornings, as this is when hormone levels tend to be lowest.

One woman told Dr Louise’s survey that her pain was so severe it stopped her doing the activities she loved.

 ‘My unexpected symptoms were mainly joint pain, muscle pain and tendon pain all of which hugely affected my life,’ she said.

‘I like to be active and play sport and these symptoms stopped me for months at a time.’

It is also likely that oestrogen has an important role in reducing incidence and severity of osteoarthritis, when joints become painful and swollen [11].

RELATED: Dr Louise Newson video on unexpected menopause symptoms

How can I manage pain?

Being overweight puts you at higher risk of pain, with those who are obese being four times more likely to report pain [12]. So maintaining a healthy weight and being active can help with a range of issues that contribute to pain, including by reducing pressure on joints, strengthening muscles that support your bones and reducing inflammatory factors that can contribute to pain conditions. You can read more about healthy eating,  getting active and exercise on the balance website.

Get to know the 3 Ps

If you live with chronic pain, you may find that using the three Ps:

• Pace
• Plan
• Prioritise

Can help manage your condition. The Royal College of Occupational Therapists (RCOT) recommends this approach if you’re recovering from an illness or have a long-term health condition [13]. It involves:

Pace: pacing yourself will help you have enough energy to complete an activity. You’ll recover faster if you work on a task until you are tired rather than exhausted. Break activities up into smaller tasks and spread them throughout the day.

Plan: look at the activities you normally do on a daily and weekly basis and develop a plan for how you can spread these activities out.

Prioritise: some daily activities are necessary, but others aren’t. Try and create a balance between those you need and want to do. Find out more at RCOT.

Will HRT help me?

Your menopause and your pain is unique to you and therefore needs a personalised approach. If you think that your menopause could be contributing to your pain, make an appointment with your healthcare professional to discuss HRT.

Your doctors will discuss the benefits you could get from HRT in balance with any risk factors you may have. It is likely that taking the right dose and type of HRT, often with testosterone, will improve pain you are experiencing.

Research has found that HRT may influence joint health. The Women’s Health Initiative, a large study mainly looking at older forms of HRT, found that women taking oestrogen-only HRT had lower rates of hip and knee replacements than those who didn’t [14].

How can I best prepare for my healthcare appointment?

Keeping a symptom diary before you go will help guide you and your healthcare professional to finding the best approach for pain.

Recording when, where in your body and how severe your pain is, along with tracking other signs of your menopause and your periods (if you’re having them) can help build a picture of the role of your hormones on your pain. Balance has a free app with a symptom tracker that you can use to build a healthcare report ahead of an appointment.

References

1. International Association for the Study of Pain ‘Global year against pain in women’

2. Pavlović J., Derby C. (2022), ‘Pain in midlife women: a growing problem in need of further research’, Womens Midlife Health, 8 (1): doi: 10.1186/s40695-022-00074-x

3. The British Pain Society ‘What is Pain?’

4. International Association for the Study of Pain ‘Pain in women’

5. Newson L. et al (2023), ‘Distressing, debilitating and embarrassing: surprising symptoms and the need for holistic approach to menopause care’, Abstract at 14th European Congress on Menopause and Andropause

6. Gibson C.J. et al (2019), ‘Menopause symptoms and chronic pain in a national sample of midlife women veterans’, Menopause, 26(7):708-713. doi: 10.1097/GME.0000000000001312

7. Lu C.B. et al (2020), ‘Musculoskeletal pain during the menopausal transition: a systematic review and meta-analysis’, Neural Plast, 25;2020:8842110. doi: 10.1155/2020/8842110.

8. Athnaiel O., Cantillo S., Paredes S., Knezevic N. (2023), ‘The role of sex hormones in pain-related conditions’, Int J Mol Sci, 24 (3): 1866. Doi: 10.3390/ijms24031866

9. Trivedi M.H. (2004), ‘The link between depression and physical symptoms’, Prim Care Companion J Clin Psychiatry, 6(Suppl 1):12-6. PMID: 1600109

10. Hussain S.M. et al (2018), ‘Female hormonal factors and osteoarthritis of the knee, hip and hand: a narrative review’, Climacteric, 21(2), pp. 132–9. doi: 10.1080/13697137.2017.1421926

11. Dennison E.M. (2022), Osteoarthritis: the importance of hormonal status in midlife women’, Maturitas, 165, pp. 8–11. doi:10.1016/j. maturitas.2022.07.002

12. Okifuji A., Hare B.D. (2015), The association between chronic pain and obesity, J Pain Res, 14;8:399-408. doi: 10.2147/JPR.S55598.

13. Royal College of Occupational Therapists ‘How to Manage your Energy Levels’

14. Cirillo D.J. et al (2006), ‘Effect of hormone therapy on risk of hip and knee joint replacement in the Women’s Health Initiative’, Arthritis Rheum, 54(10):3194-204. doi: 10.1002/art.22138.