Women's Health
Perimenopause & Musculoskeletal Health
If you've been active for years and something has shifted, joints that didn't bother you before, a shoulder that's tightening, recovery that takes longer than it used to, perimenopause is worth factoring into the picture. Here's what conservative care can realistically offer.
Book Your First VisitOestrogen plays a significant role in connective tissue health throughout the body. As levels decline, joints, tendons, and muscles behave differently. The distinction between "hormonal" and "mechanical" often isn't clean, declining oestrogen can amplify or unmask mechanical problems that were already developing. I see a lot of women in their 40s and 50s presenting with exactly this cluster, morning stiffness in the hips and hands, new back pain, a shoulder that's been tightening for months. The connection isn't always obvious until the mechanics are assessed. Assessment identifies which structures are involved and what can be done about them, regardless of the hormonal context.
What's actually happening in the musculoskeletal system
As levels change during the perimenopause transition, the effects show up in joints, tendons, ligaments, and muscle tissue, often in ways that weren't there the year before. The transition can begin years before the final menstrual period.
In practice, it's less useful to ask whether a symptom is "hormonal" or "mechanical" and more useful to assess which structures are actually involved. An examination identifies whether a joint is restricted, whether a tendon is loaded beyond its tolerance, or whether a nerve is being compressed, and that guides what can be done about it, regardless of the underlying hormonal context.
Common patterns
- Morning stiffness: widespread joint stiffness on waking is one of the most commonly reported musculoskeletal symptoms during the perimenopause transition (Lu et al., 2020). It typically improves with movement, which distinguishes it from inflammatory arthritis (though both can occur, and a proper assessment matters). Most commonly affects the low back, hips, and hands.
- New or worsening back pain: research suggests oestrogen may play a protective role in intervertebral disc health and spinal ligament integrity.2,3 As levels drop, some women find their spine is less tolerant of loads it handled without complaint for years. Low back pain that appears or worsens in the mid-40s to early 50s without a clear mechanical cause is worth investigating in this context.
- Tendinopathy: patellar tendinopathy and rotator cuff problems can first appear or worsen during perimenopause. The mechanism involves changes in tendon composition (Frizziero et al., 2014) and how tendons respond to load. Loading progressions need to be adjusted for these changes, but tendons can still respond to appropriate loading, and exercise-based rehabilitation remains the primary management approach.
- Bone stress reactions: active women maintaining training loads while bone density is declining are at elevated risk for bone stress reactions in the foot, shin, and pelvis. If you develop localised bone pain that worsens with load and eases with rest, particularly around a change in training volume, that warrants assessment by a GP rather than a chiropractor. Chiropractic assessment can identify whether a presentation fits this pattern and refer accordingly.
- Carpal tunnel syndrome: nerve entrapment, not a tendinopathy, but hormonal fluid retention changes can contribute to its onset or worsening during this period. Worth assessing separately from tendon problems because the management differs.
- Frozen shoulder (adhesive capsulitis): has a notably higher incidence in women aged 40 to 60, particularly around perimenopause. The association is well-documented even if the mechanism isn't fully understood. Early assessment matters. The natural history without intervention is often prolonged, and the theory of complete resolution without treatment is not well-supported (Wong et al., 2017). Getting it assessed allows staging of the condition and informs whether active treatment or a watchful-waiting approach is appropriate for where you are in the natural history.
- Joint laxity and instability: oestrogen helps maintain collagen synthesis. Lower oestrogen means reduced tendon stiffness and in some women increased joint laxity in weight-bearing and smaller joints. Can paradoxically coexist with stiffness elsewhere.
What I can and cannot offer
Chiropractic care can assess and treat specific musculoskeletal presentations (back pain, hip stiffness, shoulder restriction, knee pain, wrist and hand symptoms, tendinopathy). The evidence for manual therapy and exercise in musculoskeletal pain is well-established. There is emerging evidence supporting its use specifically in menopausal women (Espírito Santo et al., 2024), though the field is still building. Recovery may take a little longer for some women than in earlier decades, and loading progressions for exercise need to account for changes in tendon stiffness and bone density, but these are adjustments, not barriers.
What chiropractic cannot do is treat perimenopause itself. For hormonal management (HRT decisions, systemic symptoms, menstrual changes), a GP, gynaecologist, or menopause specialist is the right provider. If bone density is a concern (worth discussing with your GP if you're perimenopausal), that conversation belongs there. If there are risk factors for osteoporosis, bone density assessment should happen before making high-load exercise recommendations. I'm happy to work alongside other providers and will be clear about what falls within my scope and what doesn't.
On frozen shoulder in perimenopause
Adhesive capsulitis in the perimenopausal period tends to present with significant stiffness, and the natural history can be prolonged. Early assessment, before significant contracture has developed, matters. The natural history of untreated frozen shoulder is often prolonged (Wong et al., 2017), and getting it assessed early allows staging of the condition, informs whether a corticosteroid injection or other time-sensitive intervention is appropriate, and avoids letting a manageable presentation become harder to treat. Whether active treatment, injection referral, or structured watchful waiting is right depends on where you are in the natural history. I'll tell you honestly which applies.
New or worsening joint pain during perimenopause has a real physiological basis and is worth assessing. The musculoskeletal component is manageable even when the hormonal picture is more complex. If you'd like to talk through your situation before booking, get in touch.
When to seek care promptly
See a doctor if you have:
- Significant joint swelling, redness, or warmth (needs to rule out inflammatory arthritis)
- Bone pain, particularly in the spine or hips (bone density assessment may be warranted)
- Acute onset of severe spinal pain after a minor load or low-energy event (coughing, sitting down heavily, a small fall), this warrants urgent assessment, particularly if you have risk factors for reduced bone density
- New spinal pain accompanied by unexplained weight loss, persistent night pain that doesn't ease with position changes, or systemic symptoms that don't fit a musculoskeletal pattern: see a doctor
- Shoulder stiffness that is progressively worsening, seek early assessment (from a chiropractor, physiotherapist, or GP) rather than waiting to see if it settles
- New neurological symptoms: weakness, numbness, or bladder and bowel changes
- Symptoms primarily affecting mood, sleep, or systemic wellbeing, these are for your GP or menopause specialist, not a chiropractor
Musculoskeletal problems that have a clear joint or soft tissue pattern are appropriate for conservative assessment. When in doubt, I'll be direct about what I can help with and what needs a different provider.
If this sounds like your situation, get in touch to talk through it before you commit to anything.
Common questions
Chiropractic addresses the musculoskeletal component (joint pain, muscle tension, altered movement, and spine-related pain), which often increases during perimenopause due to oestrogen-related changes in connective tissue, bone density, and inflammation. I don't treat hormonal symptoms directly, and I won't overstate what manual therapy can do. But if your perimenopause experience includes new or worsening joint pain, stiffness, or back pain, that's a legitimate presentation I can assess and manage.
Often it's both, and the distinction matters for management. Hormonal influences can lower pain thresholds and increase musculoskeletal sensitivity across the body (Athnaiel et al., 2023), diffuse joint aching that shifts location is more likely to have a hormonal component. Mechanical pain tends to be localised, reproducible with specific movements, and consistent in location. A thorough assessment can usually identify which component is primary. If I think the hormonal side is dominating, I'll say so and encourage you to discuss it with your GP or a menopause specialist.
Yes, it can be. Declining oestrogen may affect ligament laxity and intervertebral disc hydration2,3, and reduced bone density can change how the spine manages load, which may increase demand on the surrounding musculature. New-onset back pain in perimenopause is a real presentation. For most people with new back pain, symptoms improve over time regardless of treatment. It doesn't mean the pain isn't addressable. Manual therapy and targeted strengthening can address the mechanical component, and there is a growing body of work on these approaches in menopausal women specifically (Espírito Santo et al., 2024). How much of the response reflects the treatment and how much reflects natural recovery is genuinely hard to separate, but the mechanical component is something I can assess and work with directly. I'll also flag any features that warrant bone density assessment or further investigation.
Both, usually. A gynaecologist or menopause specialist manages the hormonal picture (HRT decisions, systemic symptoms, and long-term hormonal health). I manage the musculoskeletal consequences. These aren't competing approaches. HRT has clear implications for bone health (Gambacciani & Levancini, 2014), and the picture for joints is still being clarified by research (Overton et al., 2025). Whether or not you've started HRT, or are considering it, the musculoskeletal component of your experience is still worth assessing independently. HRT addresses the hormonal side. What's happening in your joints, tendons, and spine can be assessed and managed in parallel, not as an alternative. I'm happy to work alongside whoever else is managing your perimenopause care.
The assessment and treatment approach is similar, but I'll take the hormonal context into account. Where pain sensitivity is heightened, I'll adjust technique based on how your tissues are responding during assessment. Greater ligament laxity may shift the focus toward stabilisation and strengthening rather than high-velocity manipulation. And I'll be more attentive to bone health considerations, particularly if you have risk factors for osteoporosis. The goal is the same, restore function and reduce pain, but the approach accounts for where you are physiologically.
Related reading
References
- Lu C-B, Liu P-F, Zhou Y-S, Meng F-J, Tian X-F, Zhang Y-Q, et al. Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis. Neural Plasticity. 2020;2020:8842110. PMC7710408
- Shelby T, Januszewski J, Bhatt S, Coben M, Raad M, Banagan K, Ludwig S, Cavanaugh DL. The Role of Sex Hormones in Degenerative Disc Disease. Global Spine Journal. 2023;13(7):2096–2099. PMC10556885
- Stevenson TEJ, Brincat MP, Pollacco J, Stevenson JC. Effect of hormone replacement therapy on intervertebral disc height. Climacteric. 2023;26(2):110–113. PubMed 36626929
- Frizziero A, Vittadini F, Gasparre G, Masiero S. Impact of oestrogen deficiency and aging on tendon: concise review. Muscles, Ligaments and Tendons Journal. 2014;4(3):324–328. PMC4241423
- Espírito Santo J, Moita J, Nunes A. The Efficacy of Manual Therapy on Musculoskeletal Pain in Menopause: A Systematic Review. Healthcare. 2024;12:1838. PMC11431219
- Overton R, Bakker CIM, Roseen EJ, Bhatt DL, Bhatt A. The effect of hormone replacement therapy on musculoskeletal pain in menopausal women: A systematic review and meta-analysis. Post Reproductive Health. 2025. PubMed 41344380
- Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Strang BL. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103(1):40–47. PubMed 27641499
- Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Menopause Review. 2014;13(4):213–220. PMC4520366
- Athnaiel O, Cantillo S, Paredes S, Knezevic NN. The Role of Sex Hormones in Pain-Related Conditions. International Journal of Molecular Sciences. 2023;24(3):1866. PMC9915903
Disclaimer
This page is for general information only and does not constitute medical advice. Every person's situation is different. Nothing here should be used as a substitute for assessment and advice from a qualified health professional who can evaluate your specific circumstances.
If you are experiencing severe or rapidly worsening symptoms, loss of bladder or bowel control, progressive weakness, or any symptom that concerns you, seek medical care promptly rather than reading websites.
This page was written with AI assistance and reviewed by Erik Anderson for accuracy. If you find an error, please contact us and we will endeavour to correct it.
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