Physio · 7 minute read

Ask most women what perimenopause looks like and you’ll hear hot flushes, broken sleep and the occasional urge to scream at the dishwasher. Aching joints rarely make the list. They should, because they’re one of the most common symptoms there is.

A 2020 review pooled 14 studies of 5,836 women and found that 71% of women in perimenopause were dealing with muscle or joint pain. That’s more than women who hadn’t started the transition yet, and about the same as women who were already through it. So if your hips have started complaining on the stairs, or your fingers need a few minutes to wake up in the morning, plenty of other women are dealing with the same thing.

Researchers have even given it a name now, the musculoskeletal syndrome of menopause. World Menopause Day 2026, on 18 October, has a closely related theme: chronic pain at midlife. The International Menopause Society estimates around half of midlife women live with chronic pain, and says it’s still underestimated in research and in care.

Why perimenopause makes everything creakier

Oestrogen does a lot more than run your cycle. Researchers think it helps keep your tendons, muscles and joints in good shape, and it plays a part in how your nervous system processes pain. In perimenopause it doesn’t fade out gracefully. It swings up and down, sometimes month to month, and a US study that followed women for 9 years linked those swings with more aches.

Then life piles on. Muscle gets harder to hang on to from your 40s, night sweats are stealing your sleep, and you’re probably the one remembering everyone else’s dentist appointments. Your joints end up with less support and your pain system gets a bit touchier. You can do something about most of it.

The aches we see most often

The outside of the hip. If one hip aches when you lie on it, climb the stairs or stand at the school gate, it’s often gluteal tendinopathy, an irritated tendon where your bottom muscles attach. Women get it more than twice as often as men: in one US study of people aged 50 to 79, 15% of women had it on one side, against 6.6% of men.

Frozen shoulder. It starts with pain, then the shoulder stiffens until doing up your bra or reaching the top cupboard becomes a whole project. It’s more common in women over 40, and physio can be very useful through the stiff and thawing stages.

Hands, knees and lower back. Often less a single injury and more a general stiffness that’s worst first thing and eases once you get going.

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Why a bad night makes it worse

After a bad night, everything hurts more, and the research agrees. Studies on sleep and pain have found that poor sleep predicts new and worsening pain more strongly than pain predicts poor sleep. That matters a lot at a life stage when night sweats are waking you in the small hours. Stress and the mood changes that can come with perimenopause add to the mix as well.

None of this means the pain is in your head. The pain is real, and sleep, stress and mood give you three more ways to turn it down. If you’re curious about how pain works, Pain is not damage is a good place to start.

How to feel better

1. 1Move a little, oftenStiff joints love regular movement. A walk around the block before the school run, a swim, a gentle ride, whatever you’ll keep doing. Small amounts most days beat one big effort on a Saturday.
2. 2Build your strengthMuscle takes load off your joints and tendons, and from your 40s you have to work a bit harder to keep it. For that outside-of-the-hip pain, an Australian trial of 204 people found more of them felt better overall after a physio-led program of education and exercise than after a steroid injection or waiting it out. Our Midlife Strength class is designed and run by physios for exactly this stage of life, and starts wherever you are. We’ve written more on why strength matters in perimenopause.
3. 3Treat sleep as part of the planGoing to bed and getting up at the same times helps, and cognitive behavioural therapy for insomnia is worth asking about. If night sweats are the culprit, mention it to your GP.
4. 4Have the MHT chatMenopause hormone therapy may help aches and pains for some women. It isn’t right for everyone, so it’s one to talk through with your GP.
5. 5Get it checkedIf something’s been nagging for a few weeks, come and see one of our physios. We’ll work out what’s going on and give you a plan that fits your life. Curious where your strength is at? A Strength Assessment gives you a starting point.

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The takeaway

Achy joints are one of the most common and most overlooked parts of perimenopause. They’re a sign your body is changing, and there’s a lot you can do about them, from moving more often to building strength and protecting your sleep. If an ache is waking you at night or hasn’t settled after a few weeks, come and see us and we’ll help you work out what’s going on.