Aching, Stiff, and Tired? Understanding Musculoskeletal Symptoms in Perimenopause
Perimenopause is more than just hot flashes : For many women, it’s the slow, surprising onset of body aches, joint stiffness, and fatigue that brings them into the clinic asking, “Why do I feel like I’m falling apart?”. The truth is: musculoskeletal (MSK) symptoms are one of the most overlooked aspects of hormonal changes that begin in midlife—often years before your final period. Let’s dive into what’s happening, why, and what we can do about it.
The BIG question , When Does Perimenopause Start?
Perimenopause typically begins between ages 35–45, though subtle hormonal shifts can start earlier. The average age of menopause (12 months without a period) is 51, but the transition can last 7–10 years.
During this time, estrogen and progesterone fluctuate unpredictably, affecting not only your menstrual cycle, but muscle, joint, and connective tissue health.
So, What’s Happening Under the Surface?
Estrogen supports joint lubrication, collagen integrity, and muscle mass. As levels decline, joints become stiffer, ligaments lose elasticity, and muscles recover slower.
Inflammation increases as estrogen declines.
Sleep becomes disrupted, reducing growth hormone release, which is key for muscle repair and pain modulation.
Mood and pain perception change, due in part to estrogen’s role in serotonin and endorphin activity.
Common MSK Symptoms Present in Perimenopause:
Joint pain and stiffness (especially in the morning or after inactivity)
Tendon tenderness or inflammation
Generalized body aches and muscle fatigue
Neck, back, or hip tension
Worsening of pre-existing arthritis
Reduced exercise recovery
Increased injury risk or slower healing
It is staggering that 7 in 10 women in midlife report MSK pain during perimenopause—even those without prior joint issues.
Do I need blood work to diagnose the joint pain in perimenopause?
Before attributing joint pain or stiffness to perimenopause, it’s important to rule out other joint conditions such as osteoarthritis, inflammatory arthritis, or autoimmune-related arthritis. A proper evaluation often begins with targeted lab work.
So, What Labs Should You Get Done?
While lab tests cannot diagnose perimenopause itself, they can help identify or rule out other underlying causes and guide treatment decisions. I often recommend the following:
Basic Lab Panel:
CBC, CMP – to check for anemia, liver, and kidney function
TSH, Free T3, Free T4 – to screen for thyroid dysfunction
Vitamin D (25-OH) – deficiency can contribute to muscle and joint pain
CRP or ESR – markers of inflammation
Ferritin – low levels can worsen fatigue and achiness
Hormonal Testing:
Estradiol, Progesterone, FSH, LH – to provide insight into hormone patterns during the transition
Testosterone & DHEA-S – low levels can affect muscle strength, recovery, and libido
Lab testing will not confirm perimenopause, but it plays a key role in creating a complete picture of your symptoms and overall health.
What can you do for the pain?
The good news is: there are practical, evidence-based ways to support your muscles and joints during perimenopause. It’s not about pushing through the pain—it’s about giving your body what it actually needs.
Let’s start with supplements that can help support joint health, reduce inflammation, and ease muscle tension.
Smart Supplements for Midlife Joint and Muscle Support:
Vitamin D3 (2000–5000 IU/day if low): Vital for muscle function and bone health, especially if you're deficient (which many of us are).
Magnesium Glycinate (200–400 mg/day): Helps with muscle relaxation, cramping, and even sleep.
Omega-3 Fatty Acids (EPA/DHA – around 2g/day): Powerful anti-inflammatory support from fish oil or algae-based sources.
Turmeric/Curcumin: A natural inflammation fighter—just make sure you use a form your body can absorb well.
Collagen Peptides: Feed your joints, tendons, and connective tissue what they need to stay strong and resilient.
Creatine Monohydrate (3–5g/day): Supports muscle strength, energy, and recovery—even in midlife women.
As always, talk to your doctor before adding supplements. It’s about building a plan that works with your body, not guessing your way through the supplement aisle.
Prescription Medications that May Help:
Topical NSAIDs – for joint pain without GI side effects
Low-dose estrogen therapy (patch, gel, or pill) – can significantly reduce MSK symptoms in appropriate candidates
Micronized progesterone – supports sleep and may reduce inflammation
SNRIs (like duloxetine) – for chronic pain with mood or sleep issues
Testosterone therapy – may be considered in women with low levels and fatigue/muscle loss
Note: Hormone therapy should always be individualized based on your age, personal risk factors, and goals.
Lifestyle Medicine - Where the real magic happens!
Supplements help, but your daily choices—what you eat, how you move, how you sleep—make a powerful impact on your joints and muscles. Think of these as your daily dose of natural medicine.
Let’s talk food first:
Prioritize anti-inflammatory foods: leafy greens, berries, fatty fish, olive oil, nuts, seeds.
Cut back on sugar, alcohol, and processed foods—they can trigger inflammation and make pain worse.
Eat more protein (about 1.2–1.5 g/kg/day): your muscles and bones will thank you.
And drink more water—joints need fluid just like plants need sunshine.
Then there’s movement:
Strength training (2–3x/week) helps protect bones, build muscle, and reduce joint strain.
Try low-impact cardio like walking, cycling, or swimming—gentle but effective.
Don’t skip mobility work: yoga, stretching, foam rolling—it helps keep stiffness away.
Add a weighted vest or resistance bands if you want to step things up without hurting your joints.
Not feeling up to long workouts? That’s okay. Short, consistent sessions (20–30 min) a few times a week work wonders.
And yes, sleep counts too:
Aim for 7–9 hours a night. Your body does most of its repair work while you sleep.
Create a calming wind-down routine, avoid screens before bed, and consider magnesium at night to help your muscles relax.
If hot flashes, night sweats, or sleep apnea are messing with your rest, talk to your doctor—better sleep means less pain.
The bottom line? Perimenopause doesn’t have to mean living with constant aches and pains. With the right support—from nutrition to movement to supplements—you can feel strong, steady, and more like yourself again.
You’re Not Imagining It. You’re Not Alone.
If you're in your 40s and suddenly feel like your body is aching more than ever, it’s not “just aging” — it might be perimenopause.
With the right labs, personalized insight, and a sustainable plan, you can reclaim your energy, focus, and sense of well-being.
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Far too often, women are told “everything looks fine” even when they clearly feel otherwise. We believe your symptoms matter. We listen, we test thoroughly when appropriate, and we treat with you—not just your labs—in mind. Whether you’re navigating perimenopause, menopause, post menopause changes, or feeling out of sync, you deserve to understand what’s really going on. Reach out today to schedule a comprehensive hormonal evaluation. **We offer comprehensive hormonal evaluations to non-members. Contact us to learn more. If you're looking to establish care with a primary care physician, explore our Primary Care Membership Program. This program offers unlimited access to your doctor with no co-pays, unhurried appointments, and discounted lab tests for uninsured members. Start your healthcare journey today by enrolling and learning more HERE.