Joint pain and postmenopause

Many women report new or worsening joint aches during post-menopause, even if they have never had issues before. But why does this happen - and what can practitioners do about it? Here we explore the connection between hormones, inflammation, gut health, and how the right support -  from diet, lifestyle and supplements – can make a big difference.

Why does joint aches get worse around menopause?

The underlying driver of many musculoskeletal symptoms during the menopausal transition, including arthralgia, is the physiological decline in circulating oestrogen. Oestrogen exerts multiple protective effects relevant to joint health, including:

• Modulation of inflammatory pathways – Reducing pro-inflammatory cytokine activity.
• Stimulation of collagen synthesis – contributing to cartilage integrity and connective tissue resilience.
• Maintenance of bone and joint architecture – through regulation of bone remodelling and support of periarticular structures.

With reduced oestrogen levels in perimenopause and postmenopause, joints are more susceptible to inflammatory change and loss of cushioning. This often manifests as stiffness, reduced mobility and pain, particularly on waking or after prolonged immobility.

Does it get worse after menopause?

In some women, joint symptoms may intensify in the postmenopausal period, particularly in the context of declining muscle mass (sarcopenia), reduced bone mineral density, or diminished overall mobility. Without timely intervention, arthralgia and stiffness can become chronic, most commonly affecting weight-bearing and high-use joints such as the knees, hips, cervical spine and hands.

Importantly, these symptoms are not an inevitable consequence of menopause. Interventions including lifestyle changes, musculoskeletal strengthening and appropriate therapeutic interventions can significantly reduce pain and preserve function and mobility.

The gut health–inflammation–joint aches connection

Evidence indicates that gastrointestinal health exerts a significant influence on systemic inflammatory status and musculoskeletal symptoms during and after the menopausal transition. 

• Immune modulation: The gut microbiota plays a key role in regulating immune responses and controlling pro-inflammatory signalling pathways.
  
• Hormonal interaction: Oestrogen decline has been shown to alter gut microbial composition (dysbiosis), with particular relevance to the estrobloome — the collection of gut microbes capable of metabolising and modulating oestrogen activity.
  
• Inflammatory consequences: Dysbiosis may promote low-grade, chronic inflammation, which can worsen joint pain, stiffness and connective tissue discomfort.
  

From a therapeutic perspective, supporting gastrointestinal health — through dietary strategies that emphasise prebiotic fibres and, where appropriate, probiotic interventions (e.g. strains such as Lactobacillus reuteri) — may contribute to the modulation of systemic inflammation and improvement of joint-related symptoms in menopausal and postmenopausal women.

Prognosis of Menopausal Arthralgia

In some women, joint discomfort may improve over time as hormonal fluctuations stabilise and targeted lifestyle interventions — such as exercise, strength training and anti-inflammatory dietary measures — are implemented. However, persistent systemic inflammation, sarcopenia, or reduced mobility can contribute to ongoing or progressive arthralgia into later life.

Early, proactive strategies to preserve musculoskeletal integrity and improve inflammatory processes are essential for long-term joint health in menopausal and postmenopausal women.

The impact of body weight on joint health in menopause

Weight gain is a common feature of the menopausal transition and can increase mechanical load on weight-bearing joints, particularly the knees and hips. Even modest reductions in body weight have been shown to meaningfully decrease joint stress, reduce local and systemic inflammation, and improve functional outcomes.

Clinical focus should include:

Evidence-based approaches to managing menopausal and postmenopausal arthralgia

Managing joint pain in perimenopause and postmenopause requires multiple approaches which reduce inflammation, reduce pressure on the joints and provide the nutrients for the protection of cartilage in joints.

1. Dietary interventions

Diet significantly influences systemic inflammation and joint health:

• Anti-inflammatory foods: Polyphenols, mono and polyunsaturated fatty acids, sulphoraphane and other antioxidants.
• Reduce pro-inflammatory components: Limit ultra-processed foods, hydrocarbons, added sugars, and refined oils, which may exacerbate low-grade inflammation.
• Micronutrients for musculoskeletal support: Magnesium and an antioxidant-rich diet, with adequate amino acids for collagen maintenance.
• Hydration: Adequate fluid intake maintains joint lubrication.

2. Supplements

A well-formulated joint health supplement can provide nutrients that:

• Support cartilage repair (e.g. MSM, silica)
• Reduce inflammation (e.g. curcumin, piperine, magnesium)
• Build and preserve bone (e.g. calcium, vitamin D3, K2, boron)
• Promote collagen and tissue structure (e.g. vitamin C, lysine, copper)
• Support hormonal balance and nutrient metabolism (e.g. B6, B12, methylfolate, zinc)

Including a probiotic like Lactobacillus reuteri also supports gut integrity and systemic inflammation - an important, often overlooked aspect of joint health.

3. Daily movement

Regular activity helps lubricate the joints, strengthen supporting muscles, and keep stiffness at bay. Low-impact exercises like walking, yoga, pilates, swimming and resistance bands are all excellent options. 

The role of diet in supporting joint health

Diet plays a major role in how joints feel. Diet tips:

• Plenty of vegetables and whole plant foods. 
• Magnesium-rich foods (like seeds, greens, and legumes). 
• Foods high in antioxidants (berries, herbs, colourful vegetables). 
• Protein-rich meals with lysine, which supports collagen formation. 

And don’t forget to stay hydrated - joints need water to stay cushioned and flexible.

Supplements that may help

If joint aches are affecting your client's quality of life, adding a targeted supplement can be a game-changer. Look for one that includes:

This blend supports the whole joint system - bone, cartilage, ligaments, and the gut–immune–inflammation axis.

Stay active, stay mobile

Joint health in postmenopause isn’t just about managing pain - it’s about staying strong, mobile, and independent for the long term. By combining a thoughtful supplement routine with gut-friendly foods, movement and anti-inflammatory support, client's can take control of how their joints feel - now and into the future.

You may enjoy reading our practitioner paper on Bone Health.