Menopause & Joint Pain: Why Your Tendons Hurt and How to Fix It Naturally
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Why do hip pain, plantar fasciitis, Achilles tightness, tennis elbow or frozen shoulder often appear during perimenopause and menopause—even when there was no obvious injury?
In this episode of the Foundational Health Podcast, Dr. Kevin Schultz explores the connection between menopause, estrogen changes, joint pain and tendon health. You’ll learn how changing hormones may affect collagen, inflammation, muscle maintenance and tissue recovery—and why hormones are only one part of the story.
The episode examines tendon function, estrogen and collagen, common midlife pain conditions, nutrition, sleep, exercise and the developing evidence surrounding hormone therapy.
The key message? Menopause may change the environment in which your muscles and tendons adapt, but it DOES NOT mean your body is broken or that pain is an unavoidable part of aging.
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How Common Is Joint Pain During Menopause?
Muscle and joint pain are common throughout adulthood, but research indicates that these symptoms become more prevalent during the menopausal transition.
A 2026 systematic review examined 37 observational studies involving 93,021 women. Approximately 40% of premenopausal women reported muscle or joint pain, compared with 57% of perimenopausal women and 59% of postmenopausal women.
Those numbers suggest a meaningful increase, but they require context. The included studies varied considerably, frequently grouped different types of pain together and could not prove that menopause directly caused each woman’s symptoms. The findings show an association—not a simple explanation for every painful hip, shoulder, knee or foot. Two extreme conclusions should be avoided:
Hormones have nothing to do with musculoskeletal health.
Every pain experienced after age 40 is caused by menopause.
Hormones matter, but they are part of a larger picture.
What Is a Tendon?
A tendon is a strong band of connective tissue that connects a muscle to a bone. A ligament, by comparison, connects one bone to another.
Muscles and tendons respond to physical activity at different rates. A person may feel muscularly strong enough to increase her running distance, begin a demanding workout or lift heavier weights, while the involved tendons have not yet developed the capacity to tolerate that increase.
Tendons generally struggle with two opposite situations:
Too Much Load Too Quickly
A sudden increase in running, jumping, lifting, hiking, gardening or recreational activity can exceed a tendon’s current capacity.
The activity itself is not necessarily harmful. The problem is often that the increase happened faster than the tissue could adapt.
Too Little Load for Too Long
Extended inactivity can also reduce a tendon’s strength and tolerance. After a long period of minimal movement, ordinary activities such as climbing stairs, taking a long walk or getting out of a low chair may suddenly feel demanding.
This is why complete rest may temporarily reduce pain without correcting the underlying problem. Tendons usually need an appropriately scaled return to movement—not endless inactivity—to rebuild their ability to tolerate force.
How Menopause May Affect Tendon Health
Menopause is confirmed after 12 consecutive months without a menstrual period. Perimenopause is the transitional period leading up to that point, when hormone levels and menstrual cycles may become increasingly irregular. Estrogen is most commonly associated with reproductive health and bone density, but estrogen receptors are also present throughout the musculoskeletal system. Estrogen is involved in processes related to collagen, inflammation, muscle maintenance and the way connective tissue responds to physical loading.
During perimenopause, estrogen does not always decline in a smooth, predictable line. It may fluctuate significantly before remaining at lower levels after menopause. These changes may affect the environment in which muscles and tendons recover.
In 2024, orthopedic surgeon Dr. Vonda Wright and her colleagues proposed the term “musculoskeletal syndrome of menopause.” The term describes a collection of musculoskeletal changes that may emerge or accelerate around the menopausal transition, including:
Muscle and joint pain
Loss of muscle mass
Reduced bone density
Increased inflammation
Progression of osteoarthritis
Tendon and ligament problems
Frozen shoulder
Plantar fasciitis
Reduced physical function
The term can help clinicians consider the entire musculoskeletal system rather than viewing every painful body part as an unrelated problem. However, it is an emerging clinical framework—not proof that every midlife woman with pain has a hormonal disorder.
Lateral Hip Pain and Gluteal Tendinopathy
Pain on the outside of the hip may involve the tendons connecting the gluteal muscles to the upper portion of the thigh bone. This is often called gluteal tendinopathy or greater trochanteric pain syndrome.
Symptoms may be aggravated by:
Sleeping directly on the painful side
Crossing the legs
Standing with most of the body’s weight shifted onto one hip
Climbing stairs
Walking uphill
Running
Getting out of a low chair
Increasing walking distance too rapidly
Hormonal changes may influence tendon health, but pelvic structure, hip strength, movement habits and compression of the tendon can also contribute.
Rotator Cuff and Biceps Tendon Pain
Shoulder pain may involve the rotator cuff, biceps tendon or other structures around the shoulder joint.
Posture can be an important contributing factor. Spending long periods leaning toward a computer or looking down at a phone can allow the shoulders to remain rounded forward. Over time, this may affect how the shoulder moves and loads the surrounding tissues.
Achilles Tendon Pain
Achilles tendon symptoms often feel most noticeable during the first few steps after getting out of bed or standing up after sitting.
As the condition progresses, pain may also appear during walking, running or stair climbing.
Plantar Fasciitis
The plantar fascia is not technically a tendon, but it is a collagen-rich connective tissue along the bottom of the foot. Pain is frequently felt near the heel and may be especially noticeable during the first steps of the morning.
Tennis Elbow
Lateral epicondylitis, commonly called tennis elbow, causes pain around the outside of the elbow. It can develop from repetitive gripping, lifting, computer work, home projects or other repeated arm movements.
Patellar Tendon Pain
The patellar tendon connects the kneecap to the lower leg. Pain is generally felt below the kneecap and may become worse during squatting, jumping or stair climbing.
Frozen Shoulder
Frozen shoulder primarily affects the capsule surrounding the shoulder joint rather than a tendon alone. However, it commonly appears during the same stage of life as other menopause-related musculoskeletal symptoms.
The shoulder may gradually become painful and lose range of motion, making it difficult to reach overhead, fasten clothing or sleep comfortably. The podcast discusses these common pain patterns and the activities that may aggravate them in greater detail.
Why an Activity Can Suddenly Start Hurting
A woman may have walked three miles, gardened, practiced yoga or lifted weights for years without pain. When that same activity begins hurting during perimenopause, it is understandable to assume menopause must be the entire cause.
Hormones may contribute, but other changes may be occurring simultaneously:
Muscle mass may be declining.
Sleep may be worsening.
Recovery may take longer.
Activity may have become less consistent.
The warm-up that was once optional may now be necessary.
The activity may have increased faster than expected.
Posture or movement mechanics may have gradually changed.
The answer is usually not to stop moving indefinitely. Instead, the amount, intensity and preparation involved in the activity may need to change.
Your body may require a different strategy than it did 10 or 20 years ago. Different does not mean broken.
How to Rebuild Tendon Strength During Menopause
1. Begin With an Accurate Diagnosis
“Menopause pain” is not a specific diagnosis.
Pain on the outside of the hip could involve a gluteal tendon, the hip joint, the lower back or another structure. Shoulder pain could involve the rotator cuff, joint capsule, biceps tendon or neck.
Persistent or worsening pain deserves a proper evaluation so that rehabilitation can target the correct tissue and condition.
2. Restore Capacity Gradually
Tendons adapt to progressive loading. The objective is to apply enough force to encourage adaptation without repeatedly exceeding the tissue’s current capacity.
A recovery program may begin with isometric exercises or controlled movements before gradually progressing to heavier resistance, faster movement or more demanding activities.
The appropriate exercise depends on the location and severity of the problem. A physical therapist, rehabilitation professional or appropriately qualified trainer can help create a progressive plan.
3. Use Resistance Training
Resistance exercise provides a stimulus for muscles and tendons to become stronger.
This does not mean every woman should immediately begin lifting extremely heavy weights. It means the body needs an appropriate physical challenge that can gradually increase as strength and tolerance improve.
Women should be encouraged to build strength during menopause rather than becoming afraid of movement.
4. Warm Up Before Demanding Activity
A gradual warm-up becomes increasingly important as the body changes.
Before running, jumping or strength training, prepare the relevant joints and muscles through controlled movement. A good warm-up may include light aerobic activity, dynamic range-of-motion work and easier versions of the movements included in the workout.
Stretching alone is not a complete tendon rehabilitation plan, but an intentional warm-up can prepare the body for greater force.
5. Eat Enough Protein
Dietary protein supplies amino acids used in muscle and connective-tissue remodeling. Exercise creates the stimulus, while nutrition supplies the raw materials needed for adaptation.
Rather than eating minimal protein throughout the day and attempting to compensate with one large dinner, distribute meaningful servings across meals. Individual protein needs vary according to body size, activity level, health status and goals, but a good rule of thumb is aiming for .75g - 1g of protein per pound of body weight.
Protein intake alone will not rebuild a tendon. It works together with resistance exercise, adequate energy intake and recovery.
6. Prioritize Whole-Food Nutrition
Tissue repair requires more than protein. Vitamin C is needed for normal collagen formation, while nutrients such as magnesium, zinc, copper, iron, vitamin D and B vitamins support numerous processes related to muscle and connective-tissue health.
A whole-food diet can supply a broad range of these nutrients through foods such as:
Meat, fish and eggs
Colorful vegetables
Berries and citrus fruits
Leafy greens
Nuts and seeds
Beans and other minimally processed foods
Supplements may be useful when a true deficiency or individual need has been identified, but they should not replace the nutritional foundation.
7. Protect Muscle During Weight Loss
Many women attempt to lose weight during midlife, sometimes through severe calorie restriction or medications that greatly reduce appetite.
Reducing excess body fat may improve certain musculoskeletal conditions, but losing muscle in the process can reduce strength and physical resilience. The goal should be improved body composition while preserving—or ideally building—lean muscle.
Adequate nutrition, sufficient protein and resistance training become especially important during intentional weight loss.
8. Make Sleep Part of the Treatment Plan
Poor sleep can increase pain sensitivity, reduce exercise performance and make recovery more difficult.
Hot flashes, night sweats, stress and hormonal fluctuations can all interfere with sleep during perimenopause. Helpful habits may include:
Maintaining a consistent sleep and wake time
Keeping the bedroom cool and dark
Reducing bright screens before bed
Limiting caffeine later in the day
Avoiding alcohol close to bedtime
Getting outdoor light in the morning
Using prayer, breathing or relaxation practices to reduce nighttime stress
An exercise program is less likely to produce the desired results when the body consistently lacks restorative sleep.
What About Collagen Supplements?
Collagen supplements are marketed heavily for joints, skin and tendon health, but they should not distract from the fundamentals.
The first priorities should remain:
Adequate total protein
Nutrient-dense food
Progressive tendon loading
Resistance exercise
Sleep and recovery
A collagen supplement may be a practical addition for someone who struggles to consume sufficient protein-rich food, but it should not be viewed as a substitute for the habits that actually stimulate adaptation.
Does Hormone Replacement Therapy Help Tendon Pain?
The relationship between menopausal hormone therapy and tendon health remains unsettled.
A randomized clinical trial involving 132 postmenopausal women with greater trochanteric pain syndrome compared menopausal hormone therapy with placebo alongside tendon-specific or sham exercise and education. All groups improved over time. Among women with a body mass index below 25, the hormone-therapy groups experienced additional improvements in pain and function.
A larger observational study published in May 2026 compared two matched groups of 63,836 women. HRT users had modestly higher rates of several diagnosed tendon conditions, including rotator cuff tears, biceps tendinitis and tennis or golfer’s elbow. Achilles tendinopathy rates were nearly identical.
Because this was an observational database study, it demonstrates an association but cannot establish that hormone therapy caused the injuries. The authors also emphasized that the absolute differences were modest. Studies do not prove that HRT always protects tendons or that it is inherently harmful to them. They show that the relationship is complex.
Hormone therapy may be appropriate for certain menopause symptoms and health considerations, but it should not currently be treated as a stand-alone tendon-repair therapy. Decisions should be individualized with a qualified healthcare professional who can evaluate symptoms, medical history, potential benefits and personal risk factors.
Menopause May Change the Strategy—Not the Outcome
Menopause is a major biological transition. It can affect inflammation, muscle maintenance, sleep, pain sensitivity and connective-tissue recovery.
But hormonal changesdo not determine the entire outcome.
The goal is not to eliminate every form of physical stress. A body that experiences no challenge does not have a reason to become stronger. The goal is to apply the right amount of stress, at the right time, followed by adequate nutrition and recovery.
For many women, improving menopause joint pain and tendon pain involves a combination of:
An accurate diagnosis
Progressive resistance training
Gradual load management
Adequate protein and whole-food nutrition
Improved sleep
Healthy blood-sugar regulation
Correction of genuine nutrient deficiencies
An individualized discussion about hormone therapy when appropriate
Your plan may need to evolve, but your body remains adaptable.
Frequently Asked Questions About Menopause Joint and Tendon Pain
Can menopause cause joint and tendon pain?
Hormonal changes during perimenopause and menopause may influence collagen, inflammation, muscle maintenance and tissue recovery. Research also shows that muscle and joint pain is reported more frequently during perimenopause and postmenopause. However, menopause is not necessarily the sole cause of an individual injury or pain condition. does my hip hurt during menopause?
Pain on the outside of the hip may involve gluteal tendinopathy or greater trochanteric pain syndrome. Hormonal changes may be one contributor, but hip strength, pelvic structure, walking or running volume and compression of the tendon can also play a role.
Is plantar fasciitis connected to menopause?
Plantar fasciitis is commonly reported by women around the menopausal transition. The plantar fascia is a collagen-rich connective tissue that may be influenced by many of the same factors affecting tendons, including activity changes, strength, recovery and hormonal environment.
Is frozen shoulder a menopause symptom?
Frozen shoulder becomes more common during the midlife years and is frequently discussed as part of menopause-related musculoskeletal health. It affects the shoulder capsule rather than being exclusively a tendon condition. Not every case is caused by hormones, and an accurate diagnosis is important.
Should I completely rest a painful tendon?
Short-term activity modification may reduce irritation, but extended complete rest can reduce tendon capacity. Most tendon conditions respond better to an appropriately designed, progressive return to loading than to indefinite inactivity.
What exercise is best for menopause tendon pain?
The best program depends on the affected tendon and the severity of the condition. In general, progressive resistance exercises that begin at a tolerable level and gradually increase are used to rebuild strength and load tolerance.
Can strength training make tendon pain worse?
Doing too much too quickly can aggravate a tendon. Appropriately scaled strength training, however, is often part of rehabilitation. The starting intensity, exercise selection and rate of progression matter.
Does protein help tendons heal?
Protein provides amino acids required for muscle and connective-tissue remodeling. It is most effective when combined with progressive physical loading, sufficient total nutrition and sleep.
Are collagen supplements necessary for tendon recovery?
No. Collagen supplements are optional and should not replace adequate dietary protein, whole-food nutrition, resistance exercise and recovery.
Does HRT prevent tendon injuries?
Current evidence does not show that HRT reliably prevents or repairs tendon injuries. A smaller randomized trial suggested a possible benefit for a subgroup of women with lateral hip pain, while a large observational study found modestly higher rates of several tendon diagnoses among HRT users. More research is needed.
Can tendons still become stronger after menopause?
Yes. Menopause may change how carefully training, nutrition and recovery need to be managed, but tendons and muscles remain responsive to progressive exercise and rehabilitation. The episode’s central message is that women should be encouraged to become stronger rather than frightened into avoiding movement.
When should I seek professional help for joint or tendon pain?
Seek an evaluation when pain is severe, persistent, worsening, limiting ordinary activities or not responding to reasonable activity modification. A qualified professional can determine whether the problem involves a tendon, joint, muscle, nerve or another structure.
Resources
Educational disclaimer: This article is intended for general education and is not medical advice. Research surrounding microplastics and human health is developing, and recommendations may change as stronger evidence becomes available.
