Maybe you’re well aware that menopause can mean irregular periods, hot flashes, and mood swings. But what’s with the new aches and pains? Suddenly you’re playing whack-a-mole with pain in your shoulders, hips, or knees. Less visible but no less concerning: losing muscle mass and bone density. And out of nowhere, your body decided to move fat to unexpected — and unwelcome — places.

Such changes in your muscles, bones, joints, body fat composition, and metabolism during menopause are common due to decreasing levels of the hormone estrogen. In fact, 80% of women in menopause experience symptoms including joint pain, inflammation, changes in fat distribution, an increase in arthritis, and loss of muscle mass and bone density. 

When women seek care for these symptoms that occur during the menopause transition, there often is not a clear structural issue, which can lead to frustration and feelings of not being heard, according to Vonda Wright, MD, Associate Professor of Orthopedic Surgery at the University of Central Florida School of Medicine. Dr. Wright recently authored a new review to describe and propose a name for the constellation of musculoskeletal signs and symptoms associated with the loss of estrogen in the menopause transition: musculoskeletal syndrome of menopause (MSM). 

As Dr. Wright and colleagues write in the review, "it is important for clinicians and the women they care for to be aware of this terminology and the constellation of musculoskeletal processes" given their impact on patients' quality of life. 

Musculoskeletal Syndrome of Menopause: Connecting the Dots

The new designation shines a light on the connections between all of these symptoms and raises awareness of the steps you can take to ease pain, prevent the loss of muscle and bone, reduce inflammation, and boost your metabolic health during menopause. 

"Treating menopause symptoms in isolation misses the bigger picture,” says urogynecologist Tamara Grisales, MD, an expert physician at Hinge Health. “It’s time to shift our perspective. Seeing these symptoms as part of a wider syndrome lets us provide holistic care to help prevent frailty and falls, reduce pain, enhance quality of life, and improve long-term health. It’s a shift that’s long overdue.” 

Read on to learn about musculoskeletal syndrome of menopause; how menopause causes changes in your muscles, bones, joints, and metabolism; and the best ways to get relief, including exercises and lifestyle strategies.

For many of these symptoms, first-line treatment includes following an exercise therapy plan for your symptoms and needs. ​​Interested in getting a personalized exercise therapy plan? Learn more about Hinge Health’s digital physical therapy program and see if you’re eligible.

What Causes Musculoskeletal Syndrome of Menopause?

Shifting hormones — specifically estrogen — play a major role. Estrogen is a sex hormone that affects many body systems, including your musculoskeletal system. Estrogen helps maintain bone structure by slowing down the natural breakdown of bone. It helps improve muscle mass and strength and increases the collagen content of connective tissues in your joints. Estrogen also plays a part in preventing inflammation that can lead to joint pain. Research shows estrogen can decrease stiffness in muscles, tendons, and ligaments, leading to better joint performance and reduced injury rates. It also plays a role in regulating fat storage.

Enter perimenopause — the time leading up to menopause. Perimenopause usually begins in a woman’s mid-to-late 40s and lasts an average of four years. During this transition, hormone levels fluctuate and estrogen drops over time. Menopause officially means that it’s been a year since your last period. 

How Menopause Affects Your Bones

Lower estrogen increases the rate of bone breakdown. It can lead to a 15 to 25% drop in bone density in the first 10 years after menopause. Bone loss can also lead to osteoporosis, a condition where bones become weak and are more likely to break. (You’re at a higher risk for osteoporosis if it runs in your family; you have a small frame; you’re of northern European, Asian, or Latino descent; or if you take certain medications or have certain medical conditions.)

How Menopause Affects Your Joints

With lower levels of estrogen, joint inflammation may occur more easily. Plus, cartilage and other joint tissues lose some of their protection, which can lead to stiffness, friction, and pain. Studies show that more than 70% of perimenopausal women report musculoskeletal pain — often with no clear structural problem. 

Other possible causes of joint pain during this time include osteoarthritis, rheumatoid arthritis, and fractures due to osteoporosis. Talk to your healthcare provider to determine the factors contributing to your joint pain so you can get proper treatment.

How Menopause Affects Your Muscles

When estrogen drops, it changes how muscle is formed and repaired — and speeds up muscle loss. This can increase your risk of muscle injuries and slow healing. Low muscle mass and reduced muscle function, or sarcopenia, are related to falls and fractures. 

How Menopause Affects Your Metabolism

As you age, your metabolism slows, meaning your body burns fewer calories at rest. Decreasing estrogen levels can change how your body stores fat, leading to more fat around your belly and internal organs.

Symptoms of Musculoskeletal Syndrome of Menopause

MSM symptoms vary from person to person and can include the following, according to the new report and clinical experience of Hinge Health physical therapists:

• Joint pain and stiffness 

• Muscle pain

• Decreased muscle strength, endurance, and tone

• Onset or worsening of arthritis

• Increased risk of falls due to impaired muscle strength

• Decreased mobility and range of motion

• Inflammatory conditions such as frozen shoulder, bursitis, and tendinitis

• Slower walking speed

• Impaired balance

• Increased risk of fractures

• Back pain due to vertebral fractures or compression

• Loss of height and stooped posture

• Changes in fat distribution (less fat under the skin and more overall, visceral, abdominal, and upper body fat)

Why Terminology Matters

Until recently, all these MSM symptoms were considered separately and not recognized as part of a wider, connected syndrome. 

"Clearly, this is an issue that many women experience but is not adequately acknowledged or addressed within the medical establishment," Dr. Wright said in a press release about the research. Recognizing the wide range of symptoms that can come with menopause “offers a new understanding, hope, and nomenclature for clinicians and women suffering from these symptoms.”

The new terminology helps providers look at all your menopause symptoms together, rather than treating each one separately. It also shows how important it is to treat musculoskeletal-related menopause symptoms holistically, to reduce or even prevent conditions that lead to frailty, higher mortality, and lower quality of life.

"Every woman going through menopause should know that their symptoms are valid and may be interconnected,” says Bonnie Whiting, PT, DPT, a Hinge Health physical therapist. “Movement is vital for overall health and physical therapist-designed exercise therapy can be a first-line treatment for many musculoskeletal issues during menopause. With movement-based interventions for musculoskeletal syndrome of menopause, we can help our members maintain their mobility and health.”

Physical Therapy and Exercise for Musculoskeletal Syndrome of Menopause

When your joints and muscles ache, you’re more likely to avoid movement. But in most cases, being active can actually help you feel better. “Movement and exercise play a crucial role in managing joint and muscle pain during menopause and maintaining muscle mass, bone density, and metabolic health,” says Jacqueline White, PT, DPT, a physical therapist at Hinge Health. Regular physical activity can:

• Keep bones strong. Exercise stimulates bone-forming cells and encourages bone remodeling, which helps maintain bone density. It encourages calcium deposition and collagen formation, which make bones stronger and less likely to break. Exercise thickens and strengthens the outer layer of bone and the network of spongy tissue inside. It can also improve balance and help prevent falls, a common cause of broken bones. Regular weight-bearing exercise can prevent or reverse about 1% of bone loss per year both pre- and post-menopause, which can help manage osteopenia and osteoporosis.

• Decrease joint pain and stiffness, in part by promoting joint lubrication. Your joints contain synovial fluid, which is rich in nutrients. Exercise helps circulate the fluid, explains Dr. White. Flushing out the old fluid and bringing in the new helps promote joint health. Movement also helps relieve pain by improving your range of motion.

• Maintain and build muscle mass and strength. Exercise can increase lean muscle mass and improve muscle structure. Strengthening muscles around the joints can also provide better support and stability to take pressure off painful joints.

• Decrease fat storage and improve metabolism. Exercise can decrease your overall body fat and visceral fat (the fat around your organs that’s related to chronic diseases). Reducing fat and boosting muscle mass can improve your metabolic health, which may help prevent conditions like diabetes and high blood pressure and help you maintain a healthy weight.

• Promote better sleep as well as decrease fatigue and improve your mood — indirectly alleviating other common symptoms of menopause that may impact pain.

You can exercise on your own to improve your health and ease menopause-related joint and muscle pain, but working with a physical therapist (PT) can be helpful, too. A PT can do a full assessment and help tailor a comprehensive treatment plan to help relieve joint and muscle pain and improve your overall function.

A PT may recommend low-impact exercise and stretches to help prevent stiffness and tightness, as well as exercises to strengthen your core, pelvic floor, low, mid-, and upper back muscles. They can make sure your plan includes weight-bearing exercises to help prevent osteopenia and osteoporosis. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

How to Exercise for Musculoskeletal Syndrome of Menopause

Many types of movement benefit joints, muscles, and bones in menopause. Aerobic impact exercises like walking, running, jumping, racquet sports, and yoga move your body against gravity and generate forces through contact with the ground. Resistance or strength training involves lifting or pushing against an external resistance and includes exercises such as lifting weights, using resistance bands, or doing bodyweight exercises like push-ups. 

Both aerobic impact and resistance training are considered weight-bearing exercise. They boost joint health, muscle strength, and bone density. 

Aim for 30 minutes of aerobic exercise most days and strength training two to three times a week, targeting each major muscle group. (Check with your doctor before starting any new exercise routine.) 

Exercises for Musculoskeletal Syndrome of Menopause

Here are examples of the types of exercises that could be incorporated into a well-rounded program to treat MSM. If you’re interested in working with a Hinge Health physical therapist to develop a personalized program to reduce pain and improve your overall health in perimenopause and menopause, click here to see if you’re eligible for free coverage from your employer or benefit plan.