Part One of the Nobody Warned Us: The Perimenopause Series
One morning, you wake up and apparently you’re 97.
Your knees sound like someone stepping on a bag of chips. Your hips hurt because you actually had the audacity to sleep. Your hands feel stiff. Your back is just dealing angry. And your right shoulder has suddenly decided that reaching into the back seat of your car—or putting on a bra—is no longer included in your range of available services.
Naturally, you begin retracing your steps.
Did I hurt myself at the gym lifting something wrong? … not unlikely 😬
Did I sleep weird?
Was it that one time I carried all the grocery bags inside at once because making two trips is for quitters?
Or—and hear me out—could it be perimenopause?
Because while hot flashes and irregular periods get most of the attention, muscle aches and joint pain are also recognized symptoms of perimenopause and menopause. They just happen to be among the many symptoms nobody bothered to mention before our bodies started literally falling apart in front of our eyes.
Wait…perimenopause can make my joints hurt?
Potentially, yes.
Estrogen doesn’t only affect our periods and reproductive system. It also plays a role in our bones, muscles, tendons, cartilage, connective tissue and inflammatory response.
During perimenopause, estrogen levels don’t simply decline in one neat, predictable line. They fluctuate—sometimes dramatically. Researchers are continuing to study exactly how these hormonal changes affect the musculoskeletal system, but joint pain, stiffness and muscle aches are commonly reported during the menopause transition.
A 2024 paper even proposed the term “musculoskeletal syndrome of menopause” to describe a group of concerns associated with this stage of life, including joint pain, loss of muscle mass, declining bone density, worsening arthritis and increased risk of tendon and joint problems.
In other words: it is not necessarily “just aging,” and you are not imagining it.
And then there’s frozen shoulder 😖
Frozen shoulder—medically known as adhesive capsulitis—is a condition in which the tissue surrounding the shoulder joint becomes inflamed, stiff and tight.
It often develops gradually and can move through stages:
- Increasing pain, sometimes worse at night
- Progressive stiffness and loss of movement
- A prolonged “frozen” stage where everyday tasks become ridiculously difficult
- Gradual improvement or “thawing”
And when I say everyday tasks, I mean things like putting on a coat, fastening a bra, washing your hair or reaching for something on a shelf. All the glamorous activities required to remain a semi-functioning human.
Frozen shoulder is more common in adults over 40, particularly women. Diabetes, thyroid conditions, certain injuries, surgery and periods of reduced shoulder movement can also increase the risk.
There is growing interest in a possible relationship between declining estrogen and frozen shoulder, particularly because the condition becomes more common around the menopause years. Early observational research has found an association between hormone therapy use and a lower occurrence of frozen shoulder in menopausal women—but that research is preliminary. And we know how quickly they move with research on women 🫠
That means we cannot yet say estrogen loss directly causes frozen shoulder, nor that HRT is a proven frozen-shoulder treatment. It does mean the possible connection deserves considerably more attention than it has received.
Shocking, I know. Another women’s health issue waiting for someone to properly study it 🙄
Not every aching joint is caused by hormones
This part is important.
Perimenopause may contribute to pain, but it should not become the new version of “You’re probably just stressed.”
Joint pain can also be related to an injury, osteoarthritis, rheumatoid arthritis, thyroid problems, autoimmune conditions, infection and several other medical issues. New, severe, persistent or worsening pain deserves to be assessed—not dismissed as something you simply have to tolerate because you’re over 40.
Go see your doc if you experience:
- A joint that is hot, red or noticeably swollen
- Sudden or severe pain
- Fever or feeling generally unwell along with joint pain
- Numbness, tingling or notable weakness
- Pain following an injury
- Inability to use or put weight on a joint
- Shoulder pain with chest pain, shortness of breath or other concerning symptoms
- Pain or stiffness that persists, worsens or interferes with daily life
You do not need to wait until your arm becomes a decorative attachment before asking for help.
What may actually help?
There isn’t one universal answer because the right treatment depends on what is causing the pain. But there are several sensible places to begin.
Keep moving—but work with your body
Gentle, regular movement can help maintain mobility and reduce stiffness. Walking, mobility exercises and low-impact activities can all be useful.
This does not mean forcing an angry joint through sharp pain because someone on the internet told you to push harder. Pain is information, not a character-building exercise.
Continue strength training
Resistance training becomes increasingly important through perimenopause because it helps preserve muscle, supports joint function and benefits bone health.
You may need to adjust your exercises, range of motion, weight or recovery time when something hurts. Modifying your workout isn’t failing. It’s how you keep training without turning a cranky shoulder into a full-blown hostage situation.
Prioritize protein and overall nutrition
Adequate protein supports muscle maintenance and recovery. Calcium, vitamin D and a generally balanced diet are also important for bone health.
Supplements can be useful when there is a genuine nutritional gap, but they are not magical hormone confetti. More is not always better, and some supplements can interact with medications or be unsafe at high doses. We’ll dig much deeper into supplements later in this series.
Consider physiotherapy
A physiotherapist can assess what is happening, help protect your range of motion and provide exercises appropriate for your specific condition.
Frozen shoulder treatment often focuses on managing pain and maintaining as much safe movement as possible. Depending on the person and stage of the condition, treatment may also include medication, corticosteroid injections or other medical interventions.
Talk to your healthcare provider about the bigger picture
If joint pain arrived alongside changes in your cycle, sleep, mood, temperature regulation or other possible perimenopause symptoms, mention the entire pattern—not only the joint that hurts the most.
Hormone therapy may be appropriate for some women experiencing bothersome menopause symptoms, but it is not suitable for everyone and should be discussed based on personal symptoms, medical history, risk factors and preferences.
Most importantly, HRT should not be presented as a guaranteed cure for unexplained pain or frozen shoulder. You still deserve an actual assessment.
Track what is happening
When pain is unpredictable, it can be difficult to remember when it started, what makes it worse or whether it follows a pattern.
Try tracking:
- Where the pain occurs
- Pain intensity
- Stiffness and time of day
- Changes in mobility
- Sleep quality
- Exercise and recovery
- Cycle timing
- Other symptoms occurring alongside it
- Anything that improves or worsens the pain
This gives you something more concrete to bring to an appointment than, “Everything hurts and I don’t know why.”
Although, for the record, that is also a perfectly valid description of perimenopause some days.
The bottom line
If your body suddenly feels like it has aged 30 years in six months, you are not lazy, weak or being dramatic.
Joint pain and stiffness can be part of the perimenopause picture. Frozen shoulder also disproportionately affects women in the same age range, and researchers are investigating the role hormonal changes may play.
But you also deserve better than having every symptom automatically blamed on hormones—or on aging, your weight, anxiety or stress—without proper consideration.
Pay attention to what has changed. Track your symptoms. Keep moving in ways that support your body. And if pain is persistent, worsening or limiting your life, keep asking questions until someone takes those questions seriously.
Because “welcome to getting older” is not a diagnosis.
This article is for education and solidarity, not individual medical advice. New, persistent or severe pain should be discussed with a qualified healthcare professional.
Sources and further reading
- NHS: Symptoms of menopause and perimenopause
- NHS: Joint pain and possible causes
- Mayo Clinic: Frozen shoulder—symptoms, causes and risk factors
- Mayo Clinic: Frozen shoulder—diagnosis and treatment
- PubMed: The musculoskeletal syndrome of menopause
- Preliminary research: Hormone therapy and adhesive capsulitis