Joint pain, osteoarthritis and perimenopause

10 Feb

Have you experienced some unusual joint pain lately? Maybe it’s your shoulder or your knee? I had never had any issues with my shoulder but about 18months ago, I started to experience less mobility in my left shoulder joint, and some movements had become very painful. I could not recall an injury to my shoulder or an accident involving my shoulder, so I was very confused by this sudden pain and immobility. When I went to see my physiotherapist, she told me that she sees this all the time in perimenopausal women! This had me intrigued and I started looking into the reasons for it. Sure enough, I quickly realised that ‘frozen shoulder’ is indeed very commonly experienced in perimenopause.

However, it’s not just in the shoulder where women experience pain. Joint pain can also affect your knees, elbows, neck or hands & wrists. In fact, joint pain is a common but often overlooked symptom of perimenopause. So why does this happen you may ask? It’s happening because of fluctuating hormones. As there are estrogen receptors in joints, these fluctuating hormones have an impact. Whilst the exact mechanisms are not always entirely clear, we do know that estrogen is important for joint health. It protects against inflammation, helps regulate fluid around the joints and supports collagen production.

The decline of estrogen and joint pain

1. Estrogen Decline – the main reason due to its anti-inflammatory properties

Estrogen has anti-inflammatory effects and helps maintain joint tissue elasticity.
As estrogen levels drop, inflammation can increase in the joints, leading to stiffness and discomfort.

2. Collagen Loss

Estrogen supports collagen production—essential for healthy cartilage and connective tissues.
Less estrogen = less collagen = less cushioning around joints = more aches and stiffness.

3. Increased Inflammation

Menopause is linked with a rise in pro-inflammatory cytokines, which can contribute to joint swelling and pain.

4. Fluid Balance Changes

Estrogen helps regulate fluid levels in tissues.
Declining estrogen can reduce joint lubrication, contributing to stiffness and a “dry joint” feeling.

5. Sleep & Stress Factors

Poor sleep, common in perimenopause, can increase pain sensitivity.
High cortisol levels from chronic stress also promote inflammation and tissue breakdown.

The fluctuations in hormones during perimenopause also put women at a higher risk of developing osteoarthritis (OA). OA is a chronic degenerative disease where protective joint cartilage breaks down, causing pain, stiffness, and reduced function, typically in knees, hips, and hands. There are of course other factors contributing to the development of OA as well, like for example age, prior injury, genetics and obesity, but declining estrogen levels certainly seem to be a contributor as well, for the reasons outlined above.

During perimenopause, changes in weight and muscle can also make joint pain and OA feel worse. Gaining extra weight puts more pressure on your joints, while losing muscle around your hips, knees, and back can make them feel less supported and more unstable. Together, these changes can increase strain on your joints and contribute to more pain and stiffness over time.

The decline of estrogen can of course also lead to osteopaenia and osteopororis – an issue I have talked about in these other blog posts.

So what can you do to avoid joint pain and/or OA from developing, or how can you manage these conditions if you already have those pains?

How to Support Joint Health in Perimenopause

Support Collagen:

Nutrients like vitamin C, collagen peptides, silica, and zinc support tissue repair.

Reduce Inflammation:

Include omega-3 fatty acids, curcumin, ginger, glucosamine, and antioxidant-rich foods (fruit, berries, vegetables – ‘eat the rainbow’) - I can provide meal plans that focus on anti-inflammatory foods and are specifically designed for women who experience these symptoms
soy products such as edamame beans, tofu and tempeh – they all contain isoflavones, which mimic estrogen and may help to reduce joint pain
Avoid highly inflammatory foods such as highly processed foods, high sugar foods and seed oils. Keep alcohol to a minimum and avoid smoking.
There are also some effective herbs that can help lower inflammation, which we can discuss in a consultation.

Move Gently:

Regular movement (walking, swimming, yoga, tai chi, pilates) lubricates joints and reduces stiffness.
Incorporate resistance exercises to develop and maintain strong muscles and bones. It might be worth working with a personal trainer for a while to avoid injury.

Prioritise Sleep & Stress Management:

Better sleep and lower cortisol can reduce inflammation and pain perception. Make sure your bedroom is dark and cool, your mattress and pillow are supportive and avoid looking at your phone or other small screens for at least an hour before bedtime.
A good night’s sleep helps to manage your stress levels, which if ignored, can contribute to back and neck pain, especially during perimenopause

Weight Management:

Maintaining a healthy weight reduces pressure on weight-bearing joints

Physical Therapy:

A physical therapist can provide exercises and techniques to improve joint function, range of motion and reduce pain.

Herbal support for perimenopause

Herbs can support the systems most affected during perimenopause and help reduce symptoms such as hot flushes, night sweats, insomnia, mood swings and brain fog. As mentioned before, they can also be effective in reducing joint pain and reducing inflammation.
Consult with a naturopath to get the herbs that work best for you. Herbs are a powerful natural medicine and should not be taken without a professional consultation.

Hormone Replacement Therapy (HRT):

Whilst this is of course not prescribed by a naturopath, I want to mention it because many report that it can alleviate menopausal symptoms and potentially offer some protective effects on joints. Talk to your GP about HRT if this is something you would like to try.

Consult a GP or orthopaedic specialist if you are concerned

If your joint pain is chronic or significantly impacts your daily life, consult a healthcare provider for proper assessment and management.
If fever or weight loss accompanies your joint pain, or if the pain worsens, please get in touch with your doctor.