The changes you experience during menopause can be disorienting and painful, but we can help guide you towards relief. We asked Board-Certified Clinical Specialist in Women’s Health and Pelvic Health Program Manager Physical Therapist Lauren Garges, PT, DPT to break down what happens during menopause and how physical therapy and exercise can help.
The musculoskeletal syndrome of menopause (MSM) refers to a group of muscle, joint, tendon, and bone symptoms that commonly occur during perimenopause, menopause, and postmenopause. These changes are closely linked to a decline in estrogen, a hormone that plays a critical role in maintaining the health of muscles, joints, tendons, and bones.
Many women notice new or worsening aches, stiffness, weakness, slower recovery, or increased injuries during midlife. These symptoms are common, real, and treatable—and they are not simply “getting older.”
What is estrogen, and why does it matter for muscles, joints, and bones?
Estrogen is a hormone that plays a crucial role in regulating female reproductive health. Estrogen receptors are found throughout the body, including in muscle tissue, bone, cartilage, ligaments, and tendons. This means estrogen directly influences how these tissues function and recover.
Estrogen helps:
- Regulate inflammation, keeping joints and soft tissues calm
- Preserve muscle mass and strength
- Support muscle repair and recovery after exercise or injury
- Maintain bone density by balancing bone breakdown and rebuilding
- Protect cartilage and connective tissue, supporting joint health and mobility
What happens when estrogen declines?
During perimenopause and menopause, estrogen levels fluctuate and eventually drop significantly. As a result:
- Inflammation can increase, contributing to joint pain and stiffness
- Muscles may lose size and strength (sarcopenia)
- Muscle recovery slows, leading to longer soreness and fatigue
- Bone density decreases more rapidly, increasing fracture risk
- Tendons and cartilage become less resilient, raising injury risk
These changes explain why many women experience musculoskeletal symptoms even if their activity level hasn’t changed.
What are the common symptoms of MSM?
You may experience one or more of the following:
- Joint pain or stiffness (commonly in the hands, knees, hips, shoulders, or spine)
- Muscle weakness or noticeable loss of strength
- Muscle fatigue or prolonged soreness after activity
- Tendon or ligament pain and increased injury risk
- “Frozen shoulder” or reduced shoulder mobility
- Loss of bone density (osteopenia or osteoporosis)
- Increased risk of falls or fractures
What can help someone experiencing MSM?
The good news: targeted movement and medical support make a significant difference. MSM responds well to active, consistent treatment.
Strength and resistance training (essential)
Strength training is one of the most powerful tools for protecting muscle and bone health during and after menopause.
How it helps:
- Preserves and builds muscle mass
- Stimulates bone formation
- Improves joint stability and balance
- Reduces fall and fracture risk
How often and how much:
- 2–3 days per week
- 30–45 minutes per session
- Allow at least one rest day between sessions for recovery
What to include:
- Lower body focus (hips, thighs, calves) for balance and fall prevention
- Upper body and core exercises for posture and joint support
- Resistance using:
- Weights
- Resistance bands
- Bodyweight exercises
A physical therapist can design a safe, progressive program that accounts for joint pain, prior injuries, or osteoporosis risk.
Regular movement (daily medicine)
While strength training builds capacity, daily movement keeps joints and tissues healthy.
How it helps:
- Reduces stiffness and joint pain
- Improves circulation and tissue nutrition
- Supports mental health and energy levels
- Enhances recovery from strength training
Recommended movement targets:
- 150 minutes per week of moderate intensity (e.g. fast walking)
- This can be broken up (e.g. 10–15-minute sessions)
Examples:
- Walking
- Cycling
- Swimming
Movement should feel comfortably challenging, not punishing.
Medical management
For some individuals, menopausal hormone therapy (MHT) may:
- Reduce systemic inflammation
- Help preserve bone density
- Support muscle health when appropriately prescribed
Additional considerations:
- Requesting a DEXA scan can assess bone density and fracture risk
- These items can be discussed with your primary care physician or GYN
How can physical therapy help?
Physical therapy plays a key role in managing MSM by:
- Improving strength, balance, and mobility
- Reducing pain and stiffness
- Teaching safe, effective exercise strategies
- Supporting long-term joint and bone health
- Helping you stay active, confident, and independent
NO REFERRAL NEEDED
If you’re experiencing MSM symptoms, physical therapy can provide relief. Patients have the right to be evaluated and treated by a Direct Access Physical Therapist for 30 days without a prescription from a doctor, so you can get the relief you need right away. Schedule an appointment now!