In this article
Stiff fingers in the morning. Knees that complain on the stairs. A shoulder that aches for no reason you can name. Many women notice these changes in their 40s and 50s and wonder if hormones are behind them, and whether hormone therapy could help. Here is what the research measured.
Joint aches at menopause
MedlinePlus lists joint aches among the less common symptoms of menopause [8]. One review estimates that more than half of women have joint pain around the time of menopause [6]. Another review, from 2024, estimates that more than 70% of women will have musculoskeletal symptoms through the transition, and about 25% will be disabled by them [5]. Those are estimates from reviews, not a measured count, but they show how common this is.
The 2024 review's authors proposed a name for the cluster: the musculoskeletal syndrome of menopause [5]. They group joint pain together with loss of muscle mass, loss of bone density, and progression of osteoarthritis, all of which they tie in part to shifting estrogen [5]. It is a new term, not a formal diagnosis, but it captures why so many women feel it in their bodies at once.
Why it happens is harder to pin down. Midlife is also when osteoarthritis and other rheumatic conditions become more common, so it is hard to tell what is menopause and what is age [6]. Joint pain is thought to result partly from falling estrogen, and a similar pattern of aches can follow a sudden stop of hormone therapy [6].
Estrogen does act on joints. The Menopause Society notes that estrogen binds to receptors in joint tissues and helps maintain their structure and function [1]. But it calls the exact effect of estrogen on osteoarthritis controversial, and finds no clear link between hormone therapy and osteoarthritis [1].
What the WHI found
The Women's Health Initiative (WHI) gave us the best data, because women were randomly assigned to hormones or placebo. Joint symptoms were not the main question, so these are follow-up analyses of the trials [2].
Estrogen alone
This trial enrolled 10,739 postmenopausal women who had had a hysterectomy [2]. They took a daily oral conjugated estrogen pill (0.625 mg) or a placebo, and answered questions about joint pain and swelling [2]. About 77% had joint pain when they joined [2].
| Symptom | Estrogen alone | Placebo |
|---|---|---|
| Joint pain | 76.3% | 79.2% |
| Joint swelling | 42.1% | 39.7% |
Joint pain was less frequent and less severe on estrogen, and the difference lasted through year three [2]. Joint swelling, though, was slightly more common on estrogen [2]. The authors called the reduction in joint pain modest but sustained [2].
Estrogen plus progestin
The combination trial enrolled 16,608 women aged 50 to 79 who still had a uterus [3]. Among women who had joint pain or stiffness when they joined, more of those on hormones said it was relieved after the first year [3]:
- Relieved ~47%
- Not relieved ~53%
- Relieved ~38%
- Not relieved ~62%
Among women with joint pain or stiffness at the start, 47.1% on estrogen plus progestin and 38.4% on placebo reported relief at year one; percentages rounded [3].
The combination also prevented new muscle and joint symptoms from starting in women who did not have them [3]. Notice the placebo group, though: more than a third of them also felt better. Joint pain comes and goes, which is why only placebo-controlled trials can show a real effect.
Another placebo-controlled trial
A different 3-year trial, summarized on the Prometrium label, compared estrogen plus micronized progesterone with placebo in postmenopausal women [10]. Joint pain was reported by 20% of women on the hormone combination and 29% of women on placebo [10]. That points the same direction as the WHI, though joint pain was not what the trial was designed to study.
After stopping
When the combination trial was stopped, researchers surveyed women 8 to 12 months later [4]. Women who had been on hormones were more likely than former placebo users to report pain or stiffness [4]. If hormones are helping your joints, stopping may bring the aches back, so plan any change with your clinician.
What this means for you
The Menopause Society reads the evidence like this: women in the WHI and other studies had less joint pain or stiffness on hormone therapy than on placebo, but estrogen's effect on joint health needs more study [1]. For osteoarthritis specifically, the evidence is too thin for strong conclusions [1].
A few honest caveats:
- The effect was small. In the estrogen-alone trial, joint pain was about 3 percentage points less common [2].
- The WHI used older pills. Both trials tested conjugated estrogens by mouth, and participants averaged 63 in the combination trial [3]. Newer forms, like estradiol patches, were not tested for joint pain there.
- Joint pain shows up as a side effect too. In a review of hormone therapy trials, joint pain was among the side effects behind some withdrawals [9].
- Hormone therapy is not a joint treatment. It is approved for hot flashes and a few other uses, not joint pain [1].
One review suggests hormone therapy can be considered for joint aches in women who also have distressing hot flashes [6]. If you have both, that may be worth raising with your clinician. To weigh the risks, read Is HRT safe? and HRT for hot flashes.
When joint pain needs a closer look
Not every ache is menopause. MedlinePlus lists many causes of joint pain, including osteoarthritis, rheumatoid arthritis, lupus, gout, bursitis, tendinitis, infections, injury, and overuse [7]. Contact a healthcare provider if [7]:
- You have a fever not explained by the flu
- You have lost 10 pounds or more without trying
- Your joint pain lasts more than several days
- You have severe, unexplained joint pain and swelling, especially with other unexplained symptoms
What else may help
For non-arthritic joint pain, MedlinePlus says both rest and exercise are important, and warm baths, massage, and stretching may help [7]. For women with osteoarthritis, one review encourages weight loss and physical activity, and says fatigue, poor sleep, and depression, which often travel with chronic pain at midlife, should be addressed too [6]. Ask your clinician before starting any pain reliever, especially if you take other medicines.
Hormone therapy through WarriorBabe Health
If joint aches come with hot flashes, night sweats, or other menopause symptoms, a WarriorBabe Health clinician can review your history and talk through whether hormone therapy fits. Options include oral estradiol, an estradiol patch, estradiol cream, and a progesterone capsule for women with a uterus. Compare them on our hormone therapy page.
Our hormone products are compounded by a licensed pharmacy and are not FDA-approved. A licensed clinician decides whether any prescription is right for you.
Day to dayWhat to do day to day, from the WarriorBabe Show:How can I tell muscle soreness from joint pain? →Frequently asked questions
Can menopause cause joint pain?
It appears to contribute. Joint aches are listed as a less common menopause symptom [8], and a review estimates more than half of women have joint pain around menopause [6]. Because osteoarthritis also becomes more common at midlife, the exact cause can be hard to separate [6].
Does HRT help joint pain?
Modestly, in the WHI. Joint pain was slightly less common on estrogen alone than on placebo after a year (76.3% vs 79.2%) [2]. With estrogen plus progestin, 47.1% of women with joint symptoms reported relief, versus 38.4% on placebo [3]. Hormone therapy is not approved to treat joint pain [1].
Does HRT prevent osteoarthritis?
The evidence does not show that. The Menopause Society finds no clear link between hormone therapy and osteoarthritis, and says there is not enough evidence for strong conclusions [1].
Can stopping HRT make joints ache?
It can for some women. After the WHI combination trial stopped, women who had been on hormones were more likely than former placebo users to report pain or stiffness 8 to 12 months later [4]. Talk with your clinician before making changes.
When should I see a doctor about joint pain?
MedlinePlus advises contacting a provider if joint pain lasts more than several days, comes with a fever not explained by the flu or unexplained weight loss, or is severe and unexplained with swelling [7].
References
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
- Chlebowski RT, Cirillo DJ, Eaton CB, et al. Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial. Menopause. 2013;20(6):600-608. pubmed.ncbi.nlm.nih.gov/23511705/
- Barnabei VM, Cochrane BB, Aragaki AK, et al. Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women's Health Initiative. Obstet Gynecol. 2005;105(5 Pt 1):1063-1073. pubmed.ncbi.nlm.nih.gov/15863546/
- Ockene JK, Barad DH, Cochrane BB, et al. Symptom experience after discontinuing use of estrogen plus progestin. JAMA. 2005;294(2):183-193. pubmed.ncbi.nlm.nih.gov/16014592/
- Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466-472. pubmed.ncbi.nlm.nih.gov/39077777/
- Magliano M. Menopausal arthralgia: fact or fiction. Maturitas. 2010;67(1):29-33. pubmed.ncbi.nlm.nih.gov/20537472/
- MedlinePlus. Joint pain. Medical Encyclopedia. US National Library of Medicine. medlineplus.gov/ency/article/003261.htm
- MedlinePlus. Menopause. Medical Encyclopedia. US National Library of Medicine. medlineplus.gov/ency/article/000894.htm
- MacLennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004;(4):CD002978. pubmed.ncbi.nlm.nih.gov/15495039/
- Prometrium (progesterone, USP) capsules prescribing information. U.S. Food and Drug Administration; revised 02/2026. www.accessdata.fda.gov/drugsatfda_docs/label/2026/019781s026lbl.pdf
This article is for general information. It is not medical advice and does not replace a visit with a licensed clinician who knows your history. Do not start, stop or change a medication without talking to your clinician. If you think you are having a medical emergency, call 911.
