Perimenopause and Joint Pain: Why Your Knees, Hands, and Hips Hurt

Quick Answer

If you are in perimenopause and experiencing joint pain in your knees, hands, or hips, you are not imagining it. More than 70% of women will experience musculoskeletal symptoms during perimenopause and menopause, and 25% will be disabled by them . The primary driver is declining estrogen, which plays a critical role in maintaining joint health, cartilage, and connective tissue . Estrogen has natural anti-inflammatory properties, and when levels drop during perimenopause, inflammation can increase, accelerating cartilage breakdown and contributing to pain in joints throughout the body . This cluster of symptoms, now called the musculoskeletal syndrome of menopause, represents a significant but often overlooked aspect of the menopausal transition.

Introduction

You wake up in the morning and your knees ache. Your hands feel stiff. Your hips hurt after sitting too long. You wonder if this is just part of getting older.

While aging does play a role, there is another factor that often gets overlooked: your changing hormones. The estrogen decline of perimenopause doesn't just cause hot flashes and sleep disruption it also affects the health of your joints in ways that can cause significant pain and stiffness.

This article explores why perimenopause causes joint pain in areas like the knees, hands, and hips and what you can do about it.

The Newly Recognized Syndrome: Musculoskeletal Syndrome of Menopause

In October 2024, researchers coined the term musculoskeletal syndrome of menopause to describe the collective joint, muscle, and bone symptoms associated with estrogen loss . The term helps capture what clinicians have been seeing for decades: that the hormonal changes of perimenopause have profound effects on the entire musculoskeletal system.

According to the research introducing this term, more than 47 million women worldwide enter the menopause transition annually. More than 70% will experience musculoskeletal symptoms, and 25% will be disabled by them through the transition from perimenopause to postmenopause .

Why Estrogen Decline Causes Joint Pain

Estrogen Receptors in Joints

Estrogen receptors are found throughout the body, including in joints, ligaments, tendons, and cartilage . When estrogen levels decline during perimenopause, these tissues lose a key support system. This can lead to reduced joint lubrication, increased friction, and pain .

Inflammation Increases

Estrogen normally suppresses the release of pro-inflammatory cytokines, including TNF-alpha and IL-6 . When estrogen drops, this suppression is removed, and inflammation increases throughout the body. This inflammation can affect joint tissues, leading to pain and stiffness .

Cartilage Breakdown

Estrogen helps maintain cartilage, the protective tissue that cushions joints. When estrogen levels decline, cartilage breakdown can accelerate . This is particularly important because osteoarthritis the most common form of arthritis occurs when cartilage wears away and causes friction as bones rub together .

Pain Sensitivity Changes

Researchers have found that estrogen can affect pain perception through the modulation of neurotransmitters . This means that declining estrogen may not only increase joint damage but also make you more sensitive to pain.

Where Perimenopause Joint Pain Commonly Occurs

Knees

Knee pain is one of the most common perimenopause joint pain complaints. The knees are large joints that support a significant portion of your body weight and are put under considerable pressure throughout life. Research has found that perimenopausal women (ages 40-59) show the most pronounced increase in knee cartilage damage, with the medial compartment of the knee the area most exposed to load-bearing forces showing significant age-related degeneration .

A 2025 study in the International Journal of Molecular Sciences confirmed that changes in perimenopausal estrogen levels are closely related to pain in knee osteoarthritis . Estrogen affects knee osteoarthritis pain through three primary mechanisms: regulation of inflammatory responses, inhibition of cellular senescence and apoptosis, and modulation of neurotransmitters .

Hands and Wrists

Many women in perimenopause report hand pain, stiffness, and reduced grip strength. This is often one of the first signs of perimenopause joint pain. Morning stiffness in the hands that lasts less than 30 minutes is common in menopausal arthralgia .

Hips and Lower Back

Hip pain and lower back pain are also common during perimenopause. Lower estrogen levels may cause inflammation in the joints of the spine, and cartilage breakdown in the weight-bearing hip joints can contribute to pain and stiffness . Osteoarthritis in the hips and lower spine becomes more common around age 50, during the menopause transition .

Shoulders

Frozen shoulder (adhesive capsulitis) is another musculoskeletal condition associated with perimenopause. It occurs when the shoulder joint capsule becomes inflamed and stiff, severely limiting range of motion .

What the Research Shows

A 2026 systematic review and meta-analysis found that the prevalence of muscle or joint symptoms was 40% in premenopausal women, rising to 57% in perimenopausal women and 59% in postmenopausal women. Perimenopausal women had a 35% increased risk of muscle or joint pain compared to premenopausal women .

The research also found that menopausal arthralgia (joint pain) typically presents without classic inflammatory features such as prolonged morning stiffness (greater than one hour), visible joint swelling, redness, or warmth . If you have these inflammatory features, it may indicate a different condition requiring evaluation.

When to See a Provider

You should consider a medical evaluation if your joint pain affects your ability to move, sleep, or function normally. If your joints swell, become red or warm, or if you experience severe or worsening pain, it is worth discussing with a provider. If pain or stiffness is stopping your day-to-day activities, affecting your sleep, or your joints are stiff for more than 30 minutes after waking in the morning, evaluation is warranted .

What You Can Do

Strength Training

Strength training is one of the most powerful tools for protecting muscle and joint health during perimenopause . Two to three sessions per week of resistance training can help maintain the muscle that supports joints, preserve bone density, and improve joint stability .

Low-Impact Movement

Regular movement keeps joints flexible and supports overall musculoskeletal health. Low-impact exercise such as walking, swimming, cycling, and yoga helps keep joints mobile without placing excessive stress on them .

Anti-Inflammatory Nutrition

Anti-inflammatory foods such as colorful fruits and vegetables can help tamp down bodywide inflammation that fuels musculoskeletal pain. Limiting added sugars, which can increase inflammation, is also beneficial .

Hormone Therapy

For many women, menopausal hormone therapy can help alleviate musculoskeletal symptoms . Estrogen therapy can attenuate fat gain, decrease lean muscle loss, and reduce inflammation . However, hormone therapy use is individualized and should be assessed for risks and benefits by a qualified provider.