Spotlight on... Menopause and Muscle

Muscles, Bones & Tendons: Why Menopause Isn’t Just About Hot Flashes

Today I want to dive into a topic that we are beginning to hear more about: how the drop in oestrogen during menopause can affect your musculoskeletal system in surprisingly powerful ways. Because it’s not just your mood or sleep that can shift — your muscles, tendons, and bones are listening too.

Did you know? Muscles, tendons and bones love oestrogen … and they hate abrupt change

We often think of menopause in terms of hot flashes, night sweats, mood swings — and yes, those are real and often distressing. But another change many women experience is joint pain — often in multiple sites. Many don’t connect it to menopause, yet it’s a very real and under-appreciated symptom.

Here’s a rough sketch of what’s happening behind the scenes:

• Loss of oestrogen’s anti-inflammatory “shield.” Oestrogen has anti-inflammatory effects and supports healthy tissue remodelling. When levels fall, tissues become more vulnerable to inflammation and wear.

• Harder to build and maintain muscle. Without oestrogen, your muscles become less responsive to the usual stimuli (e.g. protein, exercise). This is sometimes called anabolic resistance. PubMed

• Slower, weaker contractions. Changes in how actin and myosin (the molecular motors inside muscle fibres) interact may reduce speed and power.

• Bone loss accelerates. After menopause, women can lose bone density quite quickly — in part because oestrogen loss removes one of the key regulators of bone resorption and formation.

• Sarcopenia and osteoporosis are real risks. These are not just “old-age issues” — they are modifiable if you act early. And yet, tendons (which often like stability) don’t always respond well to sudden changes in loading. So starting a new exercise strategy needs care — ideally before or as oestrogen starts its decline.

  
  

Why this matters: hip, knee, back & tendon troubles in midlife

Let’s bring this into sharper focus by looking at what research and clinical observations are telling us:

• Women are already at higher risk than men for hip and knee problems.

• One in four women in their 50s develop gluteal tendinopathy — often misdiagnosed as “hip arthritis.” PubMed

• Many midlife women also develop back pain as muscle tone, posture, load tolerance, and spinal support change.

• With declining muscle strength and bone density, even “normal” loads become more stressful on joints, tendons, and vertebrae.

  
  

So, what’s the “magic solution”? Spoiler: there isn’t one single magic bullet. But there are evidence-backed strategies that, combined, can support you practically.

What actually helps — and what the science says

Here’s a toolkit of strategies (and caveats) grounded in current evidence, to help you approach menopause proactively rather than passively.

1. Strength training (progressively, intelligently)

Resistance exercise is your best friend here. Studies consistently show that structured strength training:

• Can counter muscle loss and preserve strength in middle-aged and postmenopausal women. PMC

• Improves body composition, metabolic risk factors, and inflammation markers in postmenopausal women. ScienceDirect+1

• Works even when bone density is shifting — especially if you combine weight-bearing and resistance work. MedPath

• When combined with hormone (oestrogen) therapy (in early menopause), may help augment muscle gains. For example, a study showed transdermal oestrogen improved the muscle response to 12 weeks of progressive resistance training. Frontiers

Caveat / tip: Because your tissues are more “sensitive” to loading in menopause, you have to ease in. Build gradually, monitor soreness, allow recovery, and avoid dramatic one-off spikes in volume. For tendons, especially, too much too soon can backfire.

2. Prioritise protein (and meal timing) — plant-based works too

As oestrogen declines, your muscles become less efficient at building protein (the anabolic resistance I mentioned). So you need to push the stimulus a bit harder.

• Studies show that older women who consume more protein (versus those who consume less) tend to maintain more lean mass and strength. PMC

• Some authors recommend targeting 1.0–1.2 g protein per kg bodyweight per day (or slightly above) post-menopause (vs older RDA ~0.8 g/kg). Laura Clark - The Menopause Dietitian

• There is limited but suggestive evidence that plant-based proteins (e.g. soy, legumes) can support muscle strength and maintenance in postmenopausal women. MDPI+1

• Crucially: protein + exercise is more effective than protein alone. Harvard Health+1

Tip: Spread your protein intake across meals (e.g. 20–30g per meal), and aim for a mix of sources (legumes, soy, pulses, nuts, dairy/alternative) as fits your diet.

3. Tendon care: education + targeted exercise

Tendons don’t like surprises. They prefer consistent, predictable loading. During menopause, they get hit with hormonal shifts and muscle imbalances — a combo that can lead to tendinopathies.

Take gluteal tendinopathy (often mislabelled “hip arthritis” or “trochanteric bursitis”) as a case study:

• It is especially prevalent in postmenopausal women, and lateral hip pain is commonly linked to this tendon dysfunction. Dr Alison Grimaldi

• A randomized trial comparing hormone therapy, exercise, or both for gluteal conditions found benefits in combining tailored exercise with hormone support. PMC

• Recent systematic reviews show that education + exercise is more effective than minimal intervention, both in the short and long term. Nature

• The LEAP trial (and related research) emphasises movement re-education, tendon loading progressions, strength training, and load management as key interventions. ScienceDirect

• In short: In many hip / gluteal pain cases in midlife women, conservative management (education + exercise) should be first-line, ahead of injections or surgery. BioMed Central

For other tendinopathies (shoulder, foot/ankle, etc.), the same principles of progressive load, movement control, and patience apply.

4. Don’t ignore bone health & hormonal options

Even the best muscle and tendon strategies will struggle if your bones are weakening.

• Osteoporosis and rapid bone loss are well-known risks post-menopause, especially in the early years.

• Hormone Replacement Therapy (HRT) is one tool that — used appropriately — can slow bone loss and preserve muscle function (though it’s not a magic fix and must be weighed with risks). Impact

• Some emerging research is exploring whether MHT or selective hormonal therapy may assist tendon adaptation or repair in postmenopausal populations (though evidence is still limited and mixed). Impact

I always recommend consulting with a qualified physician or endocrinologist if you’re considering HRT — and combining it with movement, load management, and nutrition for maximal benefit.

How this could become part of your life (without overwhelm)

So, if you read the above and feel excited (or a bit daunted) — here’s a roadmap to help:

1. Baseline screening. Consider getting a bone density scan, some private clinics have started offering this service to assess bone density and other biometrics (DEXA), your GP may be able to signpost you for blood tests if they feel necessary (vitamin D, basic hormones), movement assessment with an experienced PT or physical therapist (strength, balance, joint mobility).

2. Start small. Add 1–2 resistance exercises (bodyweight, bands, light weights), 2–3x per week, focusing on major muscle groups (legs, back, glutes). Monitor soreness and adjust.

3. Track protein. Aim for ~1.0–1.2 g/kg/day (or according to your health advisor), distributed across meals.

4. Include tendon-friendly loading. For hips, shoulders, ankles: progressively load with isometrics, eccentric work, controlled dynamic moves. Education + gradual progression is key.

5. Monitor & adapt. If you get niggles, scale back, change angles, reduce volume, rest more.

6. Don’t go it alone. Working with a therapist (manual + exercise), strength coach, or physiotherapist can help tailor progressions safely.

7. See the bigger picture. Sleep, stress, nutrition, hydration, movement variety, and social/emotional well-being all feed into how well your musculoskeletal tissues respond.

   
   

Why this matters: beyond pain relief

What’s attractive about this approach is that you’re not just chasing pain relief — you’re investing in resilience: tissues that are more stable, responsive, adaptable. Over time, that means fewer flare-ups, better function, greater confidence with movement — and a body that says, “I’m still here, and I’ve got your back.”

Change can be tough — but you don’t have to navigate it alone. Soft tissue therapy alongside a tailored, progressive exercise plan can help ease the tension and keep you moving with confidence. Get in touch to book your appointment and take the next step in caring for your body. https://www.flexremedial.com/book

References

1. Greising SM, Baltgalvis KA, Lowe DA, Warren GL. Hormone therapy and skeletal muscle strength: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2009;64(10):1071–1081. PubMed

2. BMC Women's Health. Effects of resistance training on body composition, strength and quality of life in postmenopausal women: a systematic review and meta-analysis. BMC Women’s Health (2023). BMC Women's Health

3. Scientific Reports / ScienceDirect. Resistance training and bone health in postmenopausal women: a review. J Sport Health Sci. 2023. ScienceDirect

4. MedPath Clinical Trials Registry. Bone, Estrogen, and Strength Training Study (BEST Trial). MedPath Clinical Trial Registry. Trial.medpath.com

5. Hansen M, Kjaer M. Influence of estrogen on the response to resistance training in postmenopausal women. Frontiers in Physiology. 2020. Frontiers in Physiology

6. Loenneke JP, et al. Association between protein intake and lean mass in older adults: a systematic review. Nutrients. 2015;7(9):7269–7299. PubMed Central (PMC)

7. The Menopause Dietitian. How much protein do I need through menopause? TheMenopauseDietitian.co.uk (2023). The Menopause Dietitian

8. MDPI Journal of Menopause. Plant-Based Proteins and Muscle Health in Postmenopausal Women: An Integrative Review. MDPI Nutrients. 2023. MDPI

9. Harvard Health Publishing. Muscle loss and protein needs in older adults. Harvard Medical School. 2024. Harvard Health

10. Mellor R, et al. The prevalence of gluteal tendinopathy in women aged 50–79 years. Arthritis Care & Research. 2015. PubMed

11. Cook JL, et al. Exercise and Hormone Therapy for Tendon Health in Postmenopausal Women: A Randomized Trial. Br J Sports Med. 2016. PubMed Central (PMC)

12. Nature Scientific Reports. Education and exercise for gluteal tendinopathy: updated systematic review and meta-analysis. Nature Scientific Reports. 2024. Nature.com

13. LEAP Trial Collaboration. Education plus exercise versus corticosteroid injection for gluteal tendinopathy. J Sci Med Sport. 2025. ScienceDirect

14. Fearon AM, et al. Efficacy of education plus exercise compared to minimal intervention for gluteal tendinopathy: randomized clinical trial. BMC Women’s Health. 2016. BMC Women’s Health

15. Reid IR. Menopause, Hormone Therapy, and Bone Health: Evidence and Recommendations. Endocrine Reviews. 2017. PubMed Central (PMC)

16. Deakin University IMPACT Institute. Menopausal Hormone Therapy for Managing Tendon Conditions in the Postmenopausal Population. Deakin IMPACT Blog. 2025. Deakin IMPACT

17. The Better Menopause. The Menopause–Hip Pain Connection: Oestrogen, Exercise, and Gluteal Tendinopathy. The Better Menopause Blog. 2024. The Better Menopause