You wake up and your back feels stiff. Your knees aren't quite as forgiving as they used to be. Your shoulder hurts even though you can't remember injuring it. Exercise takes longer to recover from, and sometimes you find yourself wondering:
When did my body start feeling like this?
For many women, aches and pains seem to appear almost overnight in their 40s. They're often dismissed as getting older, exercising too much—or not exercising enough.
But emerging research is highlighting another piece of the puzzle that many women have never been told about: the menopause transition.
Joint and muscle pain are increasingly being recognised as common symptoms of perimenopause and menopause, and researchers are investigating the role changing oestrogen levels may play in our muscles, joints, tendons and bones.
The research is pretty striking
A 2026 systematic review and meta-analysis brought together 37 studies from 22 countries involving an incredible 93,021 women.
Researchers found that around 40% of premenopausal women experienced muscle or joint pain.
Among perimenopausal women, that jumped to 57%.
For postmenopausal women, it was 59%.
Overall, perimenopausal women had a 35% higher relative risk of muscle or joint pain compared with premenopausal women.
Importantly, these were observational studies, so they cannot prove that menopause itself caused every ache and pain. Ageing, osteoarthritis, activity levels, body composition and other health conditions can all contribute.
But the association is strong enough that researchers are calling for musculoskeletal symptoms to receive much more attention during the menopause transition.
What does oestrogen have to do with your joints?
We tend to think of oestrogen as a reproductive hormone.
In reality, its influence extends far beyond periods and fertility.
Oestrogen receptors are found throughout musculoskeletal tissues, and oestrogen is involved in processes affecting bone, skeletal muscle, cartilage, tendons and inflammation.
As women move through perimenopause, oestrogen doesn't simply decline smoothly. Levels can fluctuate considerably before ultimately becoming lower after menopause.
Researchers believe these hormonal changes may contribute to some of the physical changes women notice during this period.
A 2024 review even proposed a new term: "musculoskeletal syndrome of menopause."
The authors used it to describe a collection of symptoms and conditions associated with declining oestrogen, including joint pain, loss of muscle mass, reduced bone density, tendon and ligament problems, frozen shoulder and progression of osteoarthritis.
It's a relatively new term rather than an established medical diagnosis, but it reflects something women have been reporting for years:
Their bodies can genuinely feel different during midlife.
It's not always "just ageing"
Of course, ageing itself matters.
Osteoarthritis becomes more common as we get older. Previous injuries can begin causing problems. Muscle mass gradually declines with age, particularly if we're not doing resistance exercise.
That's why it's important not to automatically attribute every new pain in your 40s to hormones.
Joint pain can have many causes, including osteoarthritis, inflammatory conditions, injuries and other medical conditions.
But menopause may be one factor that has historically been overlooked.
The Australasian Menopause Society now specifically includes joint pain and tiredness among the symptoms women may experience during menopause.
That recognition matters.
Because women shouldn't simply be told:
"You're getting older."
Then there's muscle
Muscle is becoming one of the biggest conversations in women's healthy ageing—and for good reason.
We naturally begin losing muscle mass as we age. Hormonal changes around menopause may contribute further to changes in muscle mass, strength and function.
This matters for much more than how "toned" we look.
Muscle supports:
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strength and mobility
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balance
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bone health
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metabolic health
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independence as we age
This is why resistance training is increasingly being encouraged for women approaching and moving through menopause.
Walking is fantastic for health, but strength training provides a different stimulus.
Lifting weights, using resistance bands or performing bodyweight exercises helps tell the body:
We still need this muscle.
Your bones are changing too
Another reason this period matters is bone health.
Oestrogen plays an important role in maintaining bone density. As oestrogen levels fall around menopause, bone loss accelerates, increasing the long-term risk of osteoporosis and fractures.
Unlike a sore knee, however, bone loss doesn't necessarily hurt.
You generally can't feel your bone density declining.
That's why prevention and awareness during midlife are so important.
Adequate nutrition, resistance and weight-bearing exercise, avoiding smoking and discussing individual risk factors with your healthcare provider can all form part of protecting bone health as you age.
What about frozen shoulder?
Here's one symptom many women don't associate with menopause at all.
Frozen shoulder—also known as adhesive capsulitis—causes pain and significant stiffness in the shoulder joint.
Research is investigating its relationship with hormonal changes around menopause, and it has been included among the conditions proposed within the emerging "musculoskeletal syndrome of menopause."
That doesn't mean every sore shoulder in your 40s is hormonal.
But if you've suddenly developed significant shoulder pain or restricted movement without an obvious injury, it's worth getting it properly assessed rather than simply accepting it.
Can menopausal hormone therapy help joint pain?
This is where the evidence becomes less straightforward.
Because oestrogen is involved in musculoskeletal health, researchers have investigated whether menopausal hormone therapy (MHT, sometimes called HRT) can improve musculoskeletal pain.
A 2026 systematic review and meta-analysis examined the available evidence and concluded that although musculoskeletal pain is very common during and after menopause, there currently isn't enough consistent evidence to recommend MHT specifically as a treatment for chronic musculoskeletal pain.
MHT can be an effective treatment for several menopausal symptoms and has important effects on bone health, but whether it's appropriate depends on the individual.
It's a conversation to have with a qualified healthcare professional rather than something to start purely because your joints hurt.
So what can you actually do?
The good news is that reaching your 40s doesn't mean accepting that everything will hurt from now on.
One of the most powerful things women can do is keep moving.
Regular resistance training can help preserve muscle and strength, while weight-bearing exercise supports bone health. Mobility work can help maintain movement, and adequate recovery becomes increasingly important.
Nutrition matters too. Eating enough protein helps support muscle maintenance and repair, while calcium, vitamin D and overall dietary quality are important considerations for bone health.
Sleep and recovery shouldn't be overlooked either. Poor sleep can increase pain sensitivity and make recovery from exercise feel harder.
Most importantly, persistent pain deserves proper investigation.
New or worsening pain, swelling, weakness, significant morning stiffness or pain that interferes with everyday life shouldn't automatically be written off as menopause.
Your body isn't suddenly betraying you
Perhaps that's the most important takeaway.
A lot changes in a woman's body during her 40s.
And for generations, women were given surprisingly little information about it.
Hot flushes and periods disappearing? We knew about those.
Joint pain, muscle changes, brain fog, sleep disruption, anxiety and changes in recovery?
Far less so.
Thankfully, the conversation is changing.
We're beginning to understand that women's health through midlife is about much more than reproductive symptoms. It's about protecting our muscles, bones, brain, heart and overall wellbeing for the decades ahead.
At Not Coffee, that's part of the wider conversation we're passionate about: paying attention to what your body is telling you and making daily choices that support you through every stage of life.
Because your 40s aren't the beginning of your body falling apart.
They might simply be the point where it's asking you to start looking after it differently.
