Menopause and Joint Pain: Why Your Hips and Knees Hurt

A very common story in my office: a woman in her late forties or fifties whose hips and knees started aching over the course of a year or two. There was no injury. Nothing happened. It just gradually became noticeable, and now getting out of a chair or going down stairs is something she thinks about.

She has frequently been told it is just age. Sometimes she has been told it in a way that made clear the conversation was over.

It is usually not just age, and the timing is not a coincidence. This is one of the more under-discussed subjects in musculoskeletal medicine, and it deserves a straight explanation.

The short answer

Joint pain around menopause is common, has a real biological basis, and overlaps with the exact age at which arthritis starts to show up. Both can be true at once, and they are treated differently.

How common this is

More common than most women are led to believe. Joint pain is among the most frequently reported symptoms of the menopause transition — not a rare complaint, and not a sign that something unusual is happening.

The numbers follow estrogen loss closely enough to be striking. Surveys have found joint pain reported by roughly half of premenopausal women, around 62 percent of women after natural menopause, and about 73 percent after surgical or medical menopause — the group with the most abrupt drop in estrogen. Broader work on the transition has found musculoskeletal symptoms in more than 70 percent of women, with a meaningful minority describing them as genuinely limiting.

If you have been feeling like this and were told it was nothing, that gradient is worth seeing.

What estrogen does for a joint

The reason this happens is not mysterious once you know where estrogen acts.

Estrogen receptors are present throughout musculoskeletal tissue — cartilage, the synovium that lines a joint, tendon, muscle and bone. Estradiol, the dominant form before menopause, has effects on inflammatory signaling, on cartilage maintenance, on the pace of bone remodeling, and on muscle. After menopause it is largely replaced by estrone, a weaker form that does not support those tissues in the same way.

So this is not one system changing. It is several tissues a joint depends on changing together, over a fairly short period. That is why the symptoms tend to be diffuse rather than localized, and why they so often arrive alongside changes in strength and body composition.

The musculoskeletal syndrome of menopause

In 2024 a group of clinicians proposed grouping these changes under a single heading — the musculoskeletal syndrome of menopause — covering joint pain, loss of muscle mass, loss of bone density and progression of osteoarthritis as related consequences of estrogen decline rather than four unrelated complaints.

I think the framing is useful, with one caveat worth stating: this is a recently proposed term rather than a long-established diagnosis, and you will not find it in every clinician's vocabulary yet. What it does well is capture something patients describe accurately and are rarely given language for — that several things started going wrong at once, and it did not feel like coincidence.

What it typically feels like

The pattern most women describe has recognizable features:

• Several joints rather than one — hips, knees, shoulders, hands, neck and back in some combination.
• Reasonably symmetric — both knees, both hips, rather than one side.
• Morning stiffness that eases after moving around, and stiffness after sitting for a while.
• Gradual onset over months, with no injury to point to.
• Aching rather than sharp — a background discomfort more than a specific mechanical pain.

What is probably not menopause

This is the part I can be most useful about, because it is where a hormonal explanation can quietly delay a diagnosis.

Certain features point toward a structural problem in a specific joint rather than a systemic change, and they deserve evaluation regardless of what else is happening:

• One joint that is clearly worse than the others, particularly if it has become the reason you change what you do.
• Pain that wakes you at night, or that is present at rest rather than with activity.
• Mechanical symptoms — locking, catching, or a joint that gives way.
• Visible change in the shape or alignment of a leg.
• Groin pain or loss of rotation in a hip — difficulty putting on socks and shoes is a classic one.

Those are not hormonal patterns. I go through the specific ones in knee pain at night, hip pain at night and knee giving way.

The overlap with early arthritis

Here is the genuine difficulty, and the reason this needs a surgeon's perspective rather than only a hormonal one.

The late forties and fifties are exactly when osteoarthritis commonly becomes symptomatic. Women also develop knee osteoarthritis at higher rates than men, and the divergence widens after midlife. So the age at which menopause-related joint pain appears is the same age at which early arthritis appears — and the two are frequently present in the same person.

That means the question is rarely is this menopause or arthritis. It is more often how much of each, and specifically whether any single joint has structural change worth knowing about.

Bone and muscle change at the same time

This is the part that matters most for the next twenty years, and it gets the least attention because it does not hurt.

Bone loss accelerates around menopause, most rapidly in the years immediately surrounding it. That is a separate issue from joint pain and does not produce symptoms until something fractures. If you have not had a bone density scan and you are postmenopausal, it is worth asking about — I go through when and why in bone density and joint replacement.

Muscle mass declines too, and this one feeds directly back into joint symptoms. Muscle is what protects and stabilizes a joint. Losing quadriceps strength makes a knee hurt more, which reduces activity, which costs more muscle. That loop is the single most modifiable thing on this page.

What actually helps

The measures with real evidence behind them are unglamorous, which is probably why they are rarely what gets recommended.

Resistance training is the most valuable thing here. It acts on muscle mass, bone density and joint symptoms simultaneously — the three things changing at once. Two or three sessions a week doing meaningful load is worth more than any supplement discussed anywhere on this site.

Protein matters more after menopause than before, because holding onto muscle gets harder and the raw material has to be there. Vitamin D is worth having in a normal range, for bone rather than for pain.

I go through both, and the supplements women most often ask about, in supplements I discuss with orthopedic patients.

Weight matters as well, for straightforward mechanical reasons — a knee carries several times body weight with each step. Body composition commonly shifts through this period even without much change on the scale, which is another reason the muscle side deserves attention.

Where hormone therapy fits

Patients ask, so I will answer it directly and then stay in my lane.

Some data suggests women on estrogen therapy report less joint pain, and given where estrogen receptors sit that is biologically plausible. The evidence is mixed, and it is not established as a treatment for joint pain specifically.

More importantly, the decision about hormone therapy involves a great deal beyond joints — cardiovascular considerations, breast health, personal and family history, timing relative to menopause, and what other symptoms you are having. That is a real conversation with the physician managing your menopause care. I do not prescribe or manage hormone therapy, and I would not want a joint complaint to be the thing that drives a decision that size.

When to get the joint looked at

Diffuse aching across several joints belongs with your primary care physician or whoever is managing your menopause care. That is the right first stop and I would not send you elsewhere.

Where an orthopedic evaluation is worth it is narrower and more specific: when one hip or one knee has become the problem rather than everything hurting equally, when there are mechanical symptoms, when pain is waking you, or when you simply want to know whether what you are feeling is arthritis and how far along it is.

That takes one visit. An examination and a weight-bearing X-ray show how much cartilage is left, whether alignment has changed, and whether the problem is even in the joint you think it is. If the answer is early arthritis, there is a great deal to do about it — laid out in non-surgical treatment for hip and knee arthritis. If the answer is that your joints are structurally fine, that is genuinely useful to know, and it points the work back toward strength, bone and the hormonal side.

Either way you stop guessing. That is usually worth the visit on its own.

If the hip is the joint in question, the specific causes women present with are covered in hip pain in women.