Menopause joint pain: aches, stiffness and what to do about them

Many people are surprised that aching joints can be part of the menopause. The NHS lists muscle aches and joint pains in its symptoms of menopause and perimenopause, alongside weakening bones, palpitations, headaches and migraines, hair thinning, skin changes and mouth problems. It adds that symptoms can happen during perimenopause and menopause and also after menopause has ended.

NICE's guideline also names musculoskeletal symptoms, for example joint and muscle pain, among the symptoms that may be associated with menopause. The sources used here do not explain the mechanism or give figures on how many people are affected, so it is best treated as one of a number of possible, individual symptoms.

The sources used here list the symptom in general terms and do not describe a typical pattern, so a GP can help work out what is happening in your joints. The points below are things worth noticing and reporting.

• Which joints are affected, and whether it is one joint or several.

• Whether the pain is worse with use, as in osteoarthritis, or comes with prolonged morning stiffness, as in rheumatoid arthritis.

• Whether any joint is red, hot or swollen, which points towards other causes.

• Other menopause symptoms alongside, such as hot flushes, sleep problems or period changes.

Midlife is also when other joint conditions appear. The NHS describes osteoarthritis as a condition that causes joints to become painful and stiff and as the most common type of arthritis in the UK. A GP may suspect it if you are aged 45 or older, have joint pain that gets worse the more you use your joints, and stiffness that is not there in the mornings or lasts less than 30 minutes. It is more common in women than men.

Rheumatoid arthritis is different. The NHS says it is an autoimmune disease in which the immune system attacks the cells lining the joints, causing pain, swelling and stiffness, usually in the hands, feet and wrists, and that prolonged joint stiffness in the morning can be a sign of it. It stresses that diagnosing it quickly is important because early treatment can prevent it getting worse.

Other conditions can also cause aches, which is why a GP assessment is worthwhile if symptoms are persistent or disabling.

The NHS advice for menopause includes exercising regularly, with a focus on weight-bearing exercises to build strength, trying relaxing activities, getting plenty of rest and not smoking. NICE says people experiencing menopause should be told of the importance of maintaining muscle mass and strength through physical activity.

For osteoarthritis, the NHS suggests regular exercise, losing weight if you are overweight, suitable footwear and special devices to reduce strain on joints, with painkillers and a structured exercise plan with a physiotherapist for more severe symptoms. It recommends at least 150 minutes of moderate aerobic activity every week plus strength exercises on 2 or more days to keep generally healthy.

The NHS says oestrogen is the main type of HRT and can help manage symptoms, and that if you have symptoms you should talk to a doctor, nurse or pharmacist about HRT and other options. The sources used here do not give figures on how often HRT relieves joint pain, so any benefit for joint aches should be discussed with a clinician who knows your history, and any change in symptoms after starting treatment should be reviewed.

Over-the-counter pain relief and topical treatments are commonly used. Painkillers and anti-inflammatory medicines should be used as the packaging advises, and a pharmacist can help check they are suitable alongside other medicines.

The NHS advises contacting your GP if you think you have symptoms of menopause or perimenopause and want to know your options. It also advises seeing a GP if you think you may have symptoms of rheumatoid arthritis, so they can identify the underlying cause.

Joints that are hot, red and swollen, joint pain with fever, joint pain with a rash or unexplained weight loss, pain that wakes you at night, or severe sudden pain in one joint should be seen promptly. A hot swollen joint with fever can be an infection and needs same-day medical assessment.

Joint pain is not the same as bone loss, but the menopause is also a time when bone health needs attention. The NHS lists weakening bones, which can lead to osteoporosis, among the symptoms and suggests regular strength exercise, a healthy diet with plenty of calcium, getting some sunlight and taking vitamin D supplements, stopping smoking and cutting down on alcohol. It notes that taking HRT can also reduce the risk of osteoporosis.

NICE says professionals should give advice on bone health to people experiencing menopause and discuss it with them at review appointments.

GPs can assess joint pain and decide whether tests or referral are needed. The NHS notes that further tests such as X-rays or blood tests are not usually necessary for osteoarthritis but may be used to rule out other causes.

Some people use private physiotherapy, rheumatology or menopause specialists to be seen sooner. The key difference is access, not the underlying principles of care.