Perimenopause Joint Pain: Why Your Joints Ache and What Helps

Joint pain is a common part of perimenopause. The NHS lists muscle aches and joint pains as menopause symptoms and says lower oestrogen levels can cause aching, painful joints (estrogen in the US). Regular exercise, a healthy weight and pharmacist advice on pain relief help. Hot, swollen joints need a GP, as does stiffness lasting over 30 minutes after waking.

This guide explains how common midlife joint aches are, what is known (and not known) about the role of hormones, what helps, and the signs that point to a different cause such as arthritis. For every other symptom of the transition, see our perimenopause hub.

How common is joint pain in perimenopause?

Very common. The NHS includes muscle aches and joint pains in its list of menopause and perimenopause symptoms, and notes that joint pain is one of the symptoms that can continue after menopause. The NICE menopause guideline (NG23) also tells doctors that symptoms may include musculoskeletal symptoms, giving joint and muscle pain as the example.

Two large pieces of research give a sense of scale:

• A global review. A 2024 meta-analysis of 321 studies covering 482,067 middle-aged women found that joint and muscular discomfort was the most common symptom, reported by about 65%. That figure covers middle-aged women in general, so not all of that discomfort will be caused by menopause.
• The SWAN study. In 2,218 women from the US Study of Women’s Health Across the Nation, 1 in 6 reported daily aches and pains. After allowing for age, women in early perimenopause, late perimenopause and postmenopause all reported more aches and pains than premenopausal women. Once the researchers also accounted for factors such as weight, smoking and depression, only the difference for postmenopausal women remained statistically significant.

So joint aches are clearly common in these years. How much of that comes from hormones, and how much from age, weight and other health factors, is harder to separate.

Why does perimenopause make your joints ache?

Falling oestrogen is the most likely hormonal factor, but the details are not settled. The NHS says perimenopause and menopause can cause aching and painful joints due to lowered levels of oestrogen. Researchers make a similar point: a 2026 review notes that the high rate of musculoskeletal pain around menopause suggests oestrogen deficiency may play a role, while stressing that more research is needed before firm conclusions can be drawn.

Other midlife changes can add to the picture:

• Age. The NHS says joint pain is common, especially as you get older, and the osteoarthritis pattern it describes is usually seen over the age of 45.
• Weight. Weight gain is common during perimenopause and menopause, the NHS says, often around the stomach and upper body.
• Other causes. The NHS says joint pain has many possible causes, from injury to longer-lasting problems such as arthritis, which is why new or changing joint pain is worth getting checked rather than putting down to hormones.

Which joints are affected, and is morning stiffness normal?

There is no single pattern. The NHS says you might feel pain in one joint, or more than one joint at the same time, such as your knees and hips. Common sites of joint pain include the knees, hips, shoulders, hands and wrists, feet and ankles, elbows and neck.

Some stiffness when you first get up is common, but how long it lasts is a useful clue:

• Morning stiffness from osteoarthritis usually wears off within 30 minutes of getting up, according to the NHS.
• Morning stiffness from rheumatoid arthritis often lasts longer than this.
• The NHS advises seeing a GP if your joints are stiff for more than 30 minutes after waking.

Shoulder pain with stiffness that limits how far you can move your arm may be a different problem. Our article on frozen shoulder and menopause explains what the research says about that link.

What helps perimenopause joint pain?

Staying active, building strength and keeping to a healthy weight are the first steps, with pain relief from a pharmacist or GP when needed. Which mix suits you depends on what is causing the pain, so ask a GP or physiotherapist if you are unsure.

Keep moving and build strength

Exercise is one of the most useful things you can do. NICE asks doctors to explain the importance of maintaining muscle mass and strength through physical activity to people going through menopause. For painful joints, the NHS advises resting the affected joint if you can, but not stopping moving it completely, and exercising regularly.

If pain makes exercise hard, a physiotherapist can help you start safely. In many areas you may be able to refer yourself to NHS community musculoskeletal (MSK) services, such as physiotherapy, without seeing a GP first.

Aim for a healthy weight

The NHS advises trying to lose weight if you are overweight, eating a healthy, balanced diet and not smoking.

Pain relief basics

The NHS suggests these steps for joint pain at home:

• rest the painful joint if you can, without keeping it completely still
• put an ice pack (or a bag of frozen peas) wrapped in a towel on the painful area for up to 20 minutes every 2 to 3 hours
• speak to a pharmacist or GP about which painkiller to take, especially if you take other medicines or have a health condition

Does HRT help joint pain?

Possibly a little, but the evidence is mixed and HRT is not a recognised treatment for joint pain on its own. The NICE guideline lists joint and muscle pain as a menopause symptom but does not make a specific recommendation about treating it with HRT. On a related point, NICE says there is limited evidence suggesting that HRT may improve muscle mass and strength.

The research points in different directions:

Study	What it found
Women’s Health Initiative trial of oestrogen alone (10,739 postmenopausal women who had had a hysterectomy)	After 1 year, joint pain was a little less common with oestrogen than with placebo (76.3% vs 79.2%), but joint swelling was slightly more common (42.1% vs 39.7%). The authors called the effect on pain modest.
2026 systematic review and meta-analysis (57 studies)	No significant effect of ever using HRT versus never using it on general musculoskeletal pain. Studies on osteoarthritis and rheumatoid arthritis varied too much to pool, and their results conflicted.

In practice, HRT may be worth discussing if you also have other symptoms, such as hot flushes (hot flashes in the US), night sweats or poor sleep. There is not enough evidence to recommend it for joint pain alone, and HRT has risks as well as benefits that depend on your health. Talk to your GP (family doctor) about what suits your health and history.

Is it menopause or something else?

You cannot tell for sure on your own, and the NHS advises against self-diagnosing joint pain. The pattern of symptoms can help you describe what is happening to a GP. These are some of the possible causes the NHS joint pain page lists:

Symptoms	Possible cause
Pain that is worse when walking, and stiffness after activity (usually over the age of 45)	Osteoarthritis
Pain and stiffness on both sides of the body, worse after not moving, for example when you wake up	Rheumatoid arthritis
Warm, swollen joint that is more painful when you move it or press on it	Bursitis
Hot, swollen toe joint (usually the big toe) with very bad pain that comes on suddenly, often overnight	Gout
Hot, swollen joint that is difficult to move, with a high temperature or feeling hot or cold and shivery	Joint infection (septic arthritis), which is urgent

Rheumatoid arthritis is worth knowing about because some of its symptoms overlap with perimenopause. The NHS says it often affects the small joints in the hands and feet first, usually on both sides of the body at once. Affected joints can swell and become hot and tender to touch, and some people also have tiredness, a high temperature, sweating, poor appetite or weight loss. Tiredness and sweating can easily be put down to menopause, so mention them to your GP if you also have painful or swollen joints.

Before your appointment, our perimenopause symptoms checklist shows which other symptoms you have, and a few weeks in the menopause symptom diary can record which joints hurt, how long morning stiffness lasts and any swelling.

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When to see a doctor

See a GP if:

• joint pain is stopping you doing normal activities or affecting your sleep
• the pain or swelling is getting worse or keeps coming back
• the pain has not improved after 2 weeks of treating it at home
• your joints are stiff for more than 30 minutes after waking up
• you have other perimenopause symptoms and want to talk about your options

Get help the same day (ask for an urgent GP appointment or contact NHS 111) if:

• you have joint pain and the skin around the joint is swollen and feels hot
• you have joint pain and feel generally unwell, have a high temperature, or feel hot, cold or shivery

The NHS lists a hot, swollen joint that is difficult to move, with a high temperature, as a possible sign of a joint infection (septic arthritis).

Go to A&E or call 999 if:

• you have very bad joint pain after a fall or injury
• you cannot walk or put weight on a joint
• a joint has moved out of place
• you have tingling or no feeling around a joint after an injury

In an emergency call 911 (US), 999 (UK) or 112 (EU).