Quick answer: Joint aches and stiffness are common during perimenopause and menopause, partly because falling oestrogen affects joints, muscles and inflammation. HRT relieves many menopause symptoms and may ease joint aches for some women, although it is not a treatment for arthritis. Menopause can also coincide with the start of hand osteoarthritis, changes in inflammatory arthritis and bone loss, so persistent joint symptoms are worth discussing with your GP.
Why menopause can make joints ache
Oestrogen does much more than regulate periods. It helps to control inflammation, supports cartilage, bone and muscle, and affects how we feel pain. As oestrogen levels fluctuate and then fall during perimenopause and menopause, many women notice new aches, stiffness and reduced flexibility, often in the hands, knees, shoulders, neck and back. Poor sleep from night sweats, weight changes, low mood and less activity can all add to joint discomfort.
Perimenopause, the years leading up to your final period, often starts in your mid-40s but can begin earlier. Symptoms can continue for several years after periods stop.
Menopause joint pain or arthritis?
Menopause-related aches tend to be widespread, come and go, and are often accompanied by other menopause symptoms, such as hot flushes, night sweats, brain fog, low mood or changes in periods. However, arthritis can also begin around this time, and the two can overlap.
- Hand osteoarthritis commonly starts or worsens around the menopause, with pain, bony swellings and stiffness in the finger joints and at the base of the thumb. See our hand arthritis guide.
- Inflammatory arthritis, such as rheumatoid arthritis, causes joints that are swollen, warm and stiff for more than about half an hour in the morning, often in the hands and feet on both sides. This needs prompt GP assessment.
- Other conditions, such as an underactive thyroid, low vitamin D, polymyalgia rheumatica or fibromyalgia, can cause similar aches.
See your GP if joints are visibly swollen, stiffness lasts a long time in the morning, symptoms are getting steadily worse, or you feel generally unwell. Our guide to how arthritis is diagnosed explains what tests might be done.
Can HRT help joint pain?
Hormone replacement therapy (HRT) replaces the oestrogen your body is making less of, usually with a progestogen as well if you still have a womb. It is the most effective treatment for many menopause symptoms, including hot flushes and night sweats, and it helps protect against osteoporosis.
Many women report that their joint aches improve on HRT, and research suggests oestrogen may reduce joint pain for some women. However, evidence is mixed, HRT is not a treatment for arthritis itself, and joint pain alone is not usually the main reason to start it. The best approach is to discuss your overall symptoms, preferences and health history with your GP or a menopause specialist.
NICE guidance supports offering HRT for menopause symptoms after discussing the benefits and risks, which depend on your age, the type of HRT and your personal health history. Patches, gels and sprays (transdermal oestrogen) do not raise the risk of blood clots in the way tablets can, which matters for some women with arthritis-related conditions.
Menopause and existing arthritis
- Rheumatoid arthritis: some women notice changes in disease activity around the menopause. Tell your rheumatology team about menopause symptoms, as they can be confused with flares, and vice versa.
- Lupus and antiphospholipid syndrome: HRT may still be possible, but the type needs careful choice because of clot risk. Specialist advice is important. See our lupus guide.
- Osteoarthritis: menopause may coincide with worsening symptoms, particularly in the hands and knees. Exercise and weight management remain core treatments.
- Fibromyalgia: poor sleep and hormonal change can worsen widespread pain and fatigue.
HRT is generally compatible with common arthritis medicines, but always tell your GP, pharmacist and rheumatology team about everything you take. Do not change your arthritis medicines yourself.
Protecting your bones
Bone loss speeds up in the years after menopause, and some women with arthritis have extra risk from steroid use or inflammation. HRT helps protect bone density while you take it. Weight-bearing and strength exercise, enough calcium, vitamin D in autumn and winter, not smoking and limiting alcohol all help. Ask your GP about a fracture risk assessment if you have risk factors. See our osteoporosis guide.
Self-help that helps both menopause and joints
- Keep moving: regular activity, including strength training, eases stiffness, supports bones and muscles, and helps mood and sleep. See our resistance training guide.
- Prioritise sleep: a cool bedroom, layered bedding and a regular routine can help with night sweats and pain. See our guide to sleep and pain.
- Eat well: a Mediterranean-style diet supports heart, bone and joint health.
- Manage weight: hormonal change can make weight gain more likely, which adds load to knees and hips.
- Look after your mood: talking therapies, including CBT, can help with menopause symptoms and pain.
Joint pain from breast cancer treatment
Women taking aromatase inhibitors after breast cancer commonly develop joint pain and stiffness. HRT is not usually suitable in this situation. Talk to your oncology team, as there are ways to help, including exercise, and changes to treatment in some cases.
Getting help
Your GP practice is the best place to start. Some practices have a GP or nurse with a special interest in menopause, and NHS menopause clinics exist for more complex situations. In England, an HRT prescription prepayment certificate can reduce the cost of HRT prescriptions. Keeping a symptom diary for a few weeks before your appointment can help you and your clinician see the pattern.
Questions to ask your GP
- Could my joint symptoms be linked to the menopause, arthritis or something else?
- Do I need any blood tests, such as thyroid function or inflammation markers?
- Would HRT be suitable for me, and which type would you suggest given my health history?
- Should I have a bone health or fracture risk assessment?
- Would a referral to physiotherapy or a menopause clinic help?
Frequently asked questions
Can the menopause cause joint pain?
Yes. Falling oestrogen levels can lead to aches and stiffness in joints and muscles, often alongside other menopause symptoms.
Will HRT help my joint pain?
Many women find joint aches improve on HRT, and some research supports this, but evidence is mixed and HRT is not a treatment for arthritis. Discuss your overall symptoms with your GP.
Can I take HRT if I have rheumatoid arthritis?
Usually yes. HRT is generally compatible with arthritis medicines, but tell your GP and rheumatology team so they can advise.
Is HRT safe with lupus?
It may be, but the type of HRT needs careful choice because of clot risk, particularly with antiphospholipid antibodies. Get specialist advice.
How do I know if it is menopause or arthritis?
Swollen joints, prolonged morning stiffness or steadily worsening symptoms suggest arthritis and need a GP assessment. Menopause aches tend to be more widespread and come with other symptoms.
Sources and further reading
- NHS: Menopause
- NHS: Hormone replacement therapy (HRT)
- NICE NG23: Menopause: identification and management
- NHS: HRT prescription prepayment certificate
This guide is for general education and is not a substitute for personal medical advice. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.