“I feel old in my joints.”
This is one of the most common—and most commonly dismissed—complaints of perimenopause. You wake up stiff. Your knees ache. Your hands hurt. You wonder if this is just what 45 feels like.
It’s not just aging. Estrogen affects your joints, and this is real.
The Estrogen-Joint Connection
Estrogen receptors exist throughout your musculoskeletal system—places you might not expect a “reproductive hormone” to matter:
- Joints: Estrogen helps maintain cartilage and the synovial fluid that lubricates movement
- Tendons and ligaments: Estrogen affects collagen production and elasticity
- Muscles: Estrogen influences muscle mass, strength, and recovery
- Inflammation: Estrogen has anti-inflammatory effects throughout the body
When estrogen fluctuates wildly and eventually declines:
- Joint lubrication decreases
- Inflammation may increase
- Tissues become less resilient
- Recovery from exertion takes longer
This is the same hormonal story playing out in your joints that’s playing out in your brain, your skin, your heart.
What This Feels Like
Morning stiffness: Joints feel stuck after sleep, loosening as you move throughout the day.
Widespread aching: Not a specific injury—just a general sense of discomfort that moves around or settles in everywhere.
Hand and finger pain: The small joints often hurt most; this can be mistaken for early arthritis.
Shoulder issues: Frozen shoulder is significantly more common during perimenopause—another estrogen-linked condition.
Knee and hip pain: Weight-bearing joints take the hit as cartilage support decreases.
“I used to be able to…”: Activities that were easy now leave you sore for days.
They’ll Try to Tell You It’s Something Else
Women are often told joint pain is:
- “Just getting older”
- Stress
- Weight gain
- Not enough exercise
- Too much exercise
While some of these factors matter, the hormonal component is real and well-documented. Studies show joint pain increases significantly during the menopausal transition—more than would be expected from aging alone.
If a man experienced this, we’d look for a medical cause. For women, it gets explained away. Don’t accept that.
What Actually Helps
Movement (counterintuitively): Gentle, regular movement often helps more than rest. Your joints need to move to stay lubricated; stillness makes stiffness worse.
- Swimming, water aerobics—low-impact on joints while building strength
- Yoga, tai chi—flexibility and gentle strength work
- Walking—simple and effective
- Strength training—supports joint stability and maintains muscle mass
Anti-inflammatory approaches:
- Omega-3 fatty acids (fish oil, flaxseed)
- Turmeric/curcumin (some evidence for anti-inflammatory effects)
- Mediterranean-style eating patterns
- Reducing processed foods and sugar
For morning stiffness:
- Gentle stretching before bed and upon waking
- Warm shower first thing in the morning
- Staying well-hydrated
- Not sitting in one position for prolonged periods
Medical options:
- Hormone therapy can improve joint symptoms for some women
- NSAIDs for flare-ups (with caution about long-term use)
- Physical therapy for specific issues
- Investigation for other conditions if symptoms are severe or atypical
When to Investigate Further
Most joint symptoms during perimenopause are benign—uncomfortable but not dangerous. But certain patterns warrant medical evaluation:
- Significant swelling in joints
- Redness or warmth (signs of inflammation or infection)
- Symptoms that don’t improve with movement
- One-sided pain (could indicate injury)
- Severe or rapidly worsening symptoms
Conditions like rheumatoid arthritis, lupus, and fibromyalgia can emerge or flare during perimenopause. Hormonal transitions can be triggers. It’s worth ruling these out if symptoms are significant.
The Felt Experience
Feeling old in your body is disorienting. You reach for something and wince. You get up from a chair and your knees protest. You may grieve the body that moved easily, that didn’t announce itself with every motion.
This grief is real. And for many women, the pain does improve—either with support and intervention, or as hormones stabilize in postmenopause.
Your body isn’t broken. It’s changing. That doesn’t make the experience less hard.
What I can tell you: you’re not imagining this. You’re not just getting old. And you don’t have to simply accept it without trying things that might help. Tracking your symptoms can help you identify patterns—which days are better, what makes things worse—and bring that information to your provider.