Understanding the Musculoskeletal Changes of Menopause— and How HRT Can Help
By Elizabeth Silva, FNP-BC
Published on 10/15/2025
A New Way to Think About Menopause
When we think of menopause, the first symptoms that usually come to mind are hot flashes and night sweats. But there’s another side to this life stage that often flies under the radar — one that affects the muscles, joints, and bones.
Many women notice new or worsening joint pain, stiffness, or muscle aches around menopause. Others are surprised to learn that this stage of life is also when bone loss speeds up, raising the risk of osteoporosis and fractures.
These changes are part of what’s now recognized as the “musculoskeletal syndrome of menopause.”
Why Does This Happen?
The main reason lies in one powerful hormone: estrogen.
Estrogen does far more than regulate menstrual cycles — it also plays a vital role in maintaining bone strength and joint health. When estrogen levels decline during menopause, bone breakdown (called resorption) begins to outpace bone formation. Over time, this can reduce bone mineral density, weakening the skeleton and increasing the risk of fractures, especially in the spine and hips.
In addition to bone changes, many women describe feeling more achy or stiff, even without arthritis. Some research suggests that muscle mass and recovery may also be influenced by estrogen levels, which helps explain the soreness and fatigue many women report during this transition.
The Role of Hormone Replacement Therapy (HRT)
The most effective way to protect bone health during menopause is hormone replacement therapy (HRT) — also known as menopausal hormone therapy (MHT).
HRT works by restoring estrogen levels to relieve symptoms and protect the musculoskeletal system. Here’s how it helps:
🦴 Reduces bone loss and helps maintain bone mineral density
🦵 Lowers fracture risk, including hip and spine fractures
💪 Offers modest improvement in joint and muscle discomfort
While HRT isn’t a cure-all for every ache and pain, it remains the cornerstone therapy for preserving bone health in postmenopausal women.
Is HRT Right for You?
Studies show that the benefits of HRT are most favorable when initiated for women under age 60 or those within 10 years of their last menstrual period. This is when the protective effects on bone and overall health are strongest — and the risks are lowest.
HRT is not “one-size-fits-all.” The type, dose, and route (for example, skin patch vs. pill) are personalized to each woman’s needs and health profile.
Women with a uterus will need a combination of estrogen and progesterone to protect the uterine lining.
Transdermal (through-the-skin) estrogen may carry fewer risks of blood clots and is often preferred for certain women.
What If You Can’t Take Hormones?
Some women aren’t candidates for HRT due to medical history or personal preference. In those cases, other medications — such as bisphosphonates, selective estrogen receptor modulators (SERMs), or newer bone-building therapies — can help protect bone density and reduce fracture risk.
However, these options don’t address the broader musculoskeletal symptoms of menopause and are not as comprehensive as hormone therapy for maintaining overall bone health.
The Bottom Line
Menopause marks an important transition in a woman’s health — and the changes extend well beyond hot flashes. The musculoskeletal system is deeply affected by the loss of estrogen, leading to increased bone loss and sometimes new or worsening muscle and joint pain.
For many women, HRT is the cornerstone of protection, helping preserve bone strength and reduce the risk of fractures. The key is individualized care — balancing benefits and risks and tailoring treatment to your unique needs and goals.
If you’re approaching menopause or noticing new aches and pains, talk with your clinician. Together, you can design a plan to protect your bones, strengthen your muscles, and support your overall well-being through this next chapter.
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