The Musculoskeletal Syndrome of Menopause: What It Is, Why It Matters, and What the Science Says

Iain Harrington
Jul 5
3 min read

When people think about menopause, they usually picture hot flashes, sleep troubles, and mood swings. But there’s a lesser-known side to this life stage that affects millions of women worldwide — and it often flies under the radar in medical appointments: musculoskeletal pain and tissue loss.

What makes this tricky is that these aches and pains are often mistaken for specific injuries — a sore knee here, a frozen shoulder there — and then treated one by one with short-term fixes. But the real story is bigger: these pains are signs of a systemic change happening inside the body as estrogen drops.

✅ Analogy: Think of it like dealing with a leaky roof versus fixing a house with a cracked foundation. Plugging each leak might hold for a while — but if the whole structure is shifting underneath, you need to shore up the foundation first.

A recent review in the journal Climacteric — The Musculoskeletal Syndrome of Menopause by Wright and colleagues (2024) — makes this point clear: these pains aren’t just “getting older” or random injuries. They’re part of a systemic shift — and they deserve a systemic plan to match.

🔍 What is the Musculoskeletal Syndrome of Menopause (MSM)?

The MSM is a new umbrella term for a cluster of issues that many midlife women experience as their estrogen levels drop. According to the review, about 70% of women in midlife will feel these musculoskeletal effects — and one in four will be significantly affected or disabled by them.

The MSM includes:

Joint pain (arthralgia)
Loss of muscle mass (sarcopenia)
Loss of bone density (osteoporosis risk)
Progression of arthritis
Increased risk of tendon and ligament injuries
Frozen shoulder (adhesive capsulitis)

The key point: these symptoms are not just “getting older” — they’re directly tied to the sharp drop in estrogen that defines menopause. And while they often show up alongside hot flashes or brain fog, they’re not always recognized, diagnosed, or treated as part of the same hormonal shift.

📊 Why do these symptoms happen?

Estrogen does far more than people realize. It’s not just about reproductive health — it also:

Helps regulate inflammation that affects joint pain.
Supports muscle repair and growth, partly by activating special stem cells called satellite cells.
Maintains bone strength by protecting bone mineral density.
Plays a role in cartilage health, which helps slow arthritis progression.

When estrogen drops, inflammation ramps up, muscle repair slows down, bone mass drops faster, and cartilage may degenerate more quickly. The result? More pain, more stiffness, more risk of injuries or falls — all connected by a common cause.

🩺 What does the paper recommend?

The authors argue that just like the medical community recognized the Genitourinary Syndrome of Menopause (GSM) — covering vaginal and urinary symptoms that were once poorly defined — we should now do the same for musculoskeletal symptoms. By naming it, clinicians and women can talk about it clearly, test for it, plan for it, and treat it as a whole.

They also highlight early risk assessment and prevention:

Screening for osteoporosis before it causes fractures.
Talking openly about joint pain, new aches, or muscle loss during regular checkups.
Using clear, evidence-based treatments — and this is key: hormone therapy where appropriate, but equally important, proven whole-body steps like good nutrition, vitamin D, and especially strength training.

✅ Why highlight strength training?

Because building and maintaining muscle is one of the best systemic ways to protect joints, tendons, bones, and balance as estrogen drops — addressing the root, not just each leak.

Strength training:

Improves many musculoskeletal symptoms more reliably than hormones alone.
Helps maintain bone mineral density, lowering fracture risk.
Improves balance, reducing falls.
Counters age-related muscle loss (sarcopenia).
Lowers high blood sugar and cholesterol.
Protects cognitive function.

It’s more work than taking a pill — but for menopause-related aches, it delivers far more of what really helps.

⚡ Key takeaway

The biggest risk for women is not knowing that these aches and pains can be part of menopause — and that they can be managed more effectively when treated as part of a systemic shift, not just piecemeal injuries.

Recognizing and naming the Musculoskeletal Syndrome of Menopause helps women and health pros build real plans that hold up the foundation — not just patch the leaks.

If this topic hits home, keep an eye out for future Playbook articles — we’ll break down practical ways to understand, test for, and manage the MSM in everyday life.

🗂️ Reference

📚 Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The Musculoskeletal Syndrome of Menopause. Climacteric 2024; 27(5):466–472.👉 Read the paper