For many women, the midlife years can feel overwhelming. You might notice that you don’t bounce back from exercise or injury like you used to, that little aches and pains linger longer, or that your energy feels lower than it once did. Added to this, many of us have watched our parents or relatives age and struggle with joint pain, falls, osteoporosis, or loss of independence—and wondered whether there’s anything we can do differently.
The answer is yes. Increasing research is showing that perimenopause and menopause bring unique changes to the musculoskeletal system—our bones, muscles, joints, tendons, and ligaments. These changes are so significant that researchers have coined a term for them: The Musculoskeletal Syndrome of Menopause.
And here’s the good news: physiotherapy and strength training can help.
What Is the Musculoskeletal Syndrome of Menopause?
Coined by researchers at the University of Central Florida, the Musculoskeletal Syndrome of Menopause describes a cluster of symptoms directly linked to hormonal changes. As estrogen levels decline, many women experience:
- Muscle and joint pain
- Loss of lean muscle mass
- Reduced bone density
- Increased tendon and ligament injuries
- Progression of arthritis
- Slower healing times
Up to 70% of women in midlife report musculoskeletal symptoms, and for a quarter of them, the symptoms can be severe—even when scans look “normal.”
The underlying cause? Estrogen plays a much larger role in musculoskeletal health than most people realise. It helps build new muscle cells, regulates bone turnover, repairs cartilage and connective tissue, and keeps inflammation in check. When estrogen drops, the result is loss of strength, more pain, and a higher risk of injury.
Why Physiotherapy Matters during Midlife
Physiotherapists work with women experiencing these hormonal changes every day. Common conditions managed include:
- Hip and shoulder bursitis
- Frozen shoulder
- Plantar fasciitis
- Tennis elbow and carpal tunnel syndrome
- Osteoarthritis, osteopenia, and osteoporosis
- Persistent lower back pain
But beyond managing symptoms, physiotherapists can help women take proactive steps. With the right exercise prescription—particularly strength training—we can target the exact systems affected by menopause and restore resilience in muscles, tendons, and bones.
Strength Training: The Most Effective Intervention
Not all exercise is created equal. Walking, yoga, and Pilates are valuable for overall health, but they do not provide the high loads needed to preserve bone density and build real strength.
A landmark Australian study, the LIFTMOR Trial, demonstrated that postmenopausal women with osteoporosis could safely perform heavy supervised strength training. Over just eight months, participants significantly improved bone density, functional strength, and even regained height by reducing spinal hunching.
Lifestyle and Hormonal Support
Strength training is not the only tool. A holistic approach to managing the musculoskeletal syndrome of menopause includes:
- Discussing Hormone Replacement Therapy (HRT) with your GP
- Prioritising sleep for recovery and hormonal balance
- Managing stress, which impacts both inflammation and healing
- Eating a nutrient-dense diet rich in protein, calcium, and micronutrients
It’s also important to reframe weight changes at midlife. Some body fat gain is normal and even protective, since fat tissue helps produce small amounts of estrogen after menopause. Extreme diets or over-exercising can do more harm than good.
A New Stage, Not the End of the Road
Too often, women are told their aches and pains are “just ageing” or that they should “slow down.” The reality is far more empowering. With the right guidance, it’s possible to maintain strength, independence, and vitality well into later life.
Physiotherapy provides safe, evidence-based strategies for navigating this stage of life. Strength training—introduced gradually, with correct technique—offers one of the best long-term protections for your musculoskeletal health.
Final Thoughts
Menopause is not the beginning of decline. It’s a stage of transition, and like every stage of life, it comes with challenges and opportunities. By embracing strength training and working with a physiotherapist, women can prevent the musculoskeletal syndrome of menopause from limiting their lives.
Your body is resilient. It can adapt. And with the right approach, midlife can be the start of a stronger, more active future.
Our next blog “Exercise Prescription for Bone and Muscle Health in Midlife Women” will focus on the most effective type of exercise to do pre, post, and during the perimenopause years.