Why do my joints ache in perimenopause?

Very commonNot usually arthritisMove, do not rest

Stiff on waking, slow out of a chair, hands and knees and hips. The most commonly reported symptom of the transition in Australian data, and mostly not the joint wearing out.

Tonight, in three steps

Note which joints, and whether it is worst on waking or after sitting
Look at the joints in daylight: any that are swollen, hot or red is a GP, not a page
A ten-minute walk after dinner, because stiff joints want movement and not rest

Jump to what I would do first

Most common

symptom reported across 8 years by 438 Australian women followed through the transition was aches and stiff joints

Szoeke et al., Climacteric, 2008

1 in 6

women in the SWAN study reported aches and pains daily, with more reported from early perimenopause onward

Dugan et al., Clin J Pain, 2006

Over 70%

of women are estimated to experience musculoskeletal symptoms through the transition, in a review proposing the term musculoskeletal syndrome of menopause

Wright et al., Climacteric, 2024

The short answer

Aching joints are the most commonly reported symptom of the transition in Australian data, they are usually not arthritis, and they answer to movement rather than rest.

Yes, perimenopause causes joint pain, and it is one of its most common symptoms: the longest Australian study found aches and stiff joints reported more than anything else. Oestrogen supports cartilage, tendon, muscle and bone, so as it falls joints stiffen, particularly on waking. It is usually not arthritis on an X-ray, and it responds to movement, strength and sleep.

This is not a minor symptom that women imagine. The Melbourne Women's Midlife Health Project followed 438 Australian-born women, aged 45 to 55 and still menstruating at the start, for 8 years with annual interviews and blood tests. Aches and stiff joints were the most commonly reported symptom of all, reporting rose over time, and experiencing the transition was one of the things significantly associated with it, alongside body weight, low mood and not being in work. In the American SWAN cohort of 2,218 women, one in six reported aches and pains daily, and women in early perimenopause, late perimenopause and postmenopause all reported significantly more than premenopausal women once age was accounted for.

The mechanism is oestrogen's reach. It is not only a reproductive hormone. A 2024 review proposes the term musculoskeletal syndrome of menopause for the collection of things that happen as it falls: joint pain, loss of muscle mass, loss of bone density and the progression of osteoarthritis, and estimates that more than 70% of women experience musculoskeletal symptoms through the transition and a quarter are disabled by them. An Australian clinical service describes the pattern: the hands, knees, hips, shoulders and lower back, stronger in the morning and fading later in the day, and some women reporting increased pain sensitivity.

Here is the part that reassures, and it is Australian. When the Melbourne women returned after twelve years and 224 of them had their hands and knees X-rayed, the relationship between what they reported and what the X-rays showed only approached significance. Knee findings tracked with symptoms; hand findings did not. The authors' conclusion is the sentence for this page: aches and stiff joints, common in postmenopausal women, are not necessarily indicative of radiological osteoarthritis. The stiffness is real and it is mostly not the joint wearing out.

Then the boundary that matters. Hormonal aching is stiff, symmetrical-ish, worst on waking and after sitting, and it eases with movement. Inflammatory arthritis is different: joints that are swollen, warm or red, morning stiffness that lasts well over half an hour, the small joints of the hands and feet on both sides. The transition is a window where that risk rises: in women with suspicious joint pain, being postmenopausal roughly tripled the risk of one form of inflammatory arthritis, and early menopause raised it further. That is not a page's to manage. It is a GP this week, and it is treatable.

The usual causes

oestrogen's support for cartilage and tendon fallingless muscle holding the jointa broken night lowering the thresholdsitting, which stiffens what moving loosensweight on the knees and hipsinflammatory arthritis, which is a different thing

What you need to know

TLDR, if you are in a rush.

Joint pain is a symptom of perimenopause, and one of the most common. The longest Australian study found aches and stiff joints reported more than any other symptom across 8 years.

The pattern is hands, knees, hips, shoulders and lower back, worst on waking and after sitting, easing with movement. It is usually not arthritis: Australian X-ray data found symptom reports were not necessarily indicative of radiological osteoarthritis.

The mechanism is oestrogen's reach into cartilage, tendon, muscle and bone. A review calls the collection the musculoskeletal syndrome of menopause and puts it at over 70% of women.

It answers to movement, strength work, sleep and weight, in that order of how fast they act. Rest makes it worse. Nothing sold for joints does what a walk and two strength sessions a week do.

A joint that is swollen, warm or red, morning stiffness over half an hour, or small joints on both sides of the hands or feet: that is a GP this week, because inflammatory arthritis is treatable and the transition is a window where the risk rises.

Before tonight

Four things to settle before you try anything.

Which joints, and when

Hormonal aching favours the hands, knees, hips, shoulders and lower back, is worst first thing and after sitting, and loosens within the first half hour of moving. Write down which joints and when for a week. If it is one joint, hot and swollen, or if the morning stiffness runs past an hour, that is a different list.

The look

In daylight, compare the two hands and the two knees. Swelling, warmth or redness on one side, or puffiness across the knuckles on both, are not the hormonal picture and belong with a GP. The hormonal version usually looks normal and feels stiff.

Movement, not rest

The instinct with a sore joint is to protect it, and with this kind of stiffness that is exactly wrong. Sitting stiffens what moving loosens. The ten-minute walk after dinner is the cheapest test on this page, and most women feel the difference the same evening.

The night underneath

A broken night lowers the threshold for pain the next day and pain breaks the night. In SWAN, symptoms clustered rather than arriving alone, and aching joints and poor sleep travel together in this decade. If you are waking at 3am, that page moves this one.

Searching moments

When women go looking for this.

I am stiff as a board when I wake up

The most common version, and the pattern an Australian service describes exactly: stronger in the morning, fading later. It is oestrogen's support for cartilage and tendon falling, not the joint wearing out. Move before you judge it; it loosens inside half an hour.

My hands and fingers ache and my rings are tight

Hands and fingers are among the five sites named most often. Aching on its own is the hormonal picture. Puffiness across the knuckles on both hands, warmth, or stiffness that lasts past an hour in the morning is the inflammatory picture and wants a GP this week.

It hurts to get up from a chair

Knees and hips, after sitting. Sitting is the amplifier. Standing every half hour and the walk after dinner do more than anything in a bottle, and strength work for the legs is what holds the joint over time.

I was told it is just my age

Look, and write down the pattern

Which joints, when it is worst, whether it eases with movement, and whether any joint is swollen, warm or red. Compare both hands and both knees in daylight. Stiff on waking, easing within half an hour, symmetrical, nothing to see: that is the hormonal picture and the rest of the page applies. Anything swollen or hot, or morning stiffness past an hour, is a GP this week.

Ten minutes, and it decides the route

Walk every day, and stand every half hour

Sitting is the amplifier and movement is the answer. A ten-minute walk after dinner tonight, twenty by the end of the week, every day. Stand and move for a minute every half hour at a desk. Most women feel the evening walk the same night. This is the cheapest thing on the page and the one that acts fastest.

The same evening, and clearly within a fortnight

Two short strength sessions a week

Muscle holds the joint, and the transition takes muscle. Squats to a chair, step-ups, a resistance band for the shoulders, calf raises, twenty minutes twice a week. Strength work in this decade also has evidence for mood, and pain and mood travel together. Start lighter than pride suggests.

Eight weeks before you judge it

Protect the night

A broken night lowers the pain threshold the next day and pain breaks the night. If you are waking at 3am, run that page: magnesium glycinate, a protein dinner, a cooler room. A better night is worth more to a stiff morning than anything applied to the joint.

Three to four weeks

The GP conversation, if the picture is not hormonal

Swelling, warmth or redness, both hands or both feet, morning stiffness past an hour, or aching that has not moved after a month of the moves above. Inflammatory arthritis rises in this window and is treatable, and treated early it does far better. Ask for inflammatory markers and a rheumatology referral if the GP agrees the picture fits.

This week if any of those apply

This month

The habits that change the baseline.

The moves above loosen it. These stop it stiffening again.

Move before you sit down for the evening

The walk after dinner, every day, is the single habit with the fastest return on this page.

Strength twice a week, permanently

Muscle is what holds a joint, and the transition is taking it. This is not a course; it is the new baseline.

Shoes that fit the walking

Knees and hips pay for cheap shoes. This is the one purchase on the page worth making.

Protein at every meal

Muscle is built from it and the transition makes building harder. Steady intake is what makes the strength work stick.

Weight, if it is a factor, gently

The Australian study found body weight associated with aching joints. Every kilo is several on the knees. Walking and strength do this on their own without a diet.

The morning routine, not the morning rest

Ten minutes of gentle movement before the day starts, every day, so the first half hour of stiffness happens on your terms.

Research notes

Source-backed signals for this page.

Each line is a specific figure or finding, with where it came from. Nothing on this page is guessed.

In the Melbourne Women's Midlife Health Project, 438 Australian-born women aged 45 to 55 were followed for 8 years; aches and stiff joints were the most commonly reported symptom, reporting rose over time, and experiencing the menopausal transition was significantly associated with it alongside body mass index, negative mood and not being employed.

Szoeke et al., Climacteric, 2008

After twelve years, 224 of the same women had hand and knee X-rays; the relationship between symptom reports and radiological osteoarthritis only approached significance, knee osteoarthritis tracked with symptoms and hand osteoarthritis did not, and the authors conclude aches and stiff joints are not necessarily indicative of radiological osteoarthritis.

Szoeke et al., Climacteric, 2008

In 2,218 SWAN participants, one in six reported daily aches and pains, and early perimenopausal, late perimenopausal and postmenopausal women all reported significantly more than premenopausal women in age-adjusted analysis.

Dugan et al., Clin J Pain, 2006

A 2024 review proposes the term musculoskeletal syndrome of menopause for joint pain, loss of muscle mass, loss of bone density and progression of osteoarthritis as ovarian hormones fall, estimating more than 70% of women experience musculoskeletal symptoms through the transition and 25% are disabled by them.

Wright et al., Climacteric, 2024

An Australian clinical service says aches and pains around menopause commonly affect the hands, knees, hips, shoulders and lower back, may be stronger in the morning and fade later in the day, that some women report increased pain sensitivity, and that ageing, inactivity, past injury and arthritis can also cause or affect them.

Jean Hailes, Menopause

Over 16 years, SWAN found physical, psychological and menopausal symptoms cluster across the transition rather than arriving singly.

Harlow et al., Womens Midlife Health, 2017

Among women with joint pain suspicious for rheumatoid arthritis, being postmenopausal was associated with roughly three times the risk of developing one form of inflammatory arthritis, and early menopause and fewer reproductive years raised it further.

Heutz et al., Rheumatology, 2025

The studies

The research behind the advice.

Not testimonials. The studies that give the moves above their standing, with what was tested and what was found.

01 · Climacteric 11(1), longitudinal cohort with X-ray follow-up, 2008

The Australian study, and what the X-rays did not show

What was tested: What is associated with reported joint symptoms across the transition, and whether those reports match arthritis on an X-ray.
How: 438 Australian-born women aged 45 to 55 and menstruating at baseline, interviewed annually for 8 years with fasting bloods, 88% retained; then 224 returning after twelve years for blinded hand and knee X-rays.
What was found: Aches and stiff joints were the most commonly reported symptom and increased over time, associated with the transition, body mass index, negative mood and not being employed. X-ray osteoarthritis only approached significance against symptoms; knee findings tracked, hand findings did not.
What it means for you: Common, real, tied to the transition, and mostly not the joint wearing out. That last part is what most women in this decade have never been told, and it is the reason movement rather than rest is the answer.

View source

02 · Clinical Journal of Pain 22(4), cross-sectional cohort, 2006

How common, and from when

What was tested: Whether menopausal status is associated with musculoskeletal pain after accounting for age, weight, smoking, depression and other factors.
How: 2,218 SWAN participants at their third annual visit, with aches and pains derived from five survey questions.
What was found: One in six reported daily symptoms. Early perimenopausal, late perimenopausal and postmenopausal women all reported significantly more than premenopausal women after age adjustment, and postmenopausal women still did after full adjustment.
What it means for you: It starts in early perimenopause, before the cycle has visibly changed, which is why so many women are told it is age when it is the transition arriving early.

View source

03 · Climacteric 27(5), review, 2024

Naming the whole thing

What was tested: Whether the musculoskeletal changes of the transition are better understood as one syndrome than as unrelated complaints.
How: A review of joint pain, muscle loss, bone loss and osteoarthritis progression as ovarian hormones fall, proposing a collective term.
What was found: More than 70% of women estimated to experience musculoskeletal symptoms through the transition, 25% disabled by them, with the collection largely influenced by hormonal change and often unrecognised by clinicians and patients alike.
What it means for you: The aching, the lost strength and the bone density are one story, which is why strength work is on this page and not only on the bone one. Treat the muscle and the joint gets its support back.

View source

Comparison

The transition, osteoarthritis, or inflammatory arthritis?

Three causes of aching joints in this decade. The first is the common one, the second is what women fear, and the third is the one that should not wait.

	The transition	Osteoarthritis	Inflammatory arthritis
Which joints	Hands, knees, hips, shoulders, lower back. Often several at once, roughly both sides.	Usually one or two weight-bearing joints, a knee or a hip, or the base of the thumb.	The small joints of the hands and feet, both sides, often symmetrical.
The morning	Stiff on waking, loosening within about half an hour of moving.	Stiff briefly, worse after use, better with rest.	Stiff for well over half an hour, sometimes hours.
What you can see	Usually nothing. Feels stiff, looks normal.	Bony enlargement over time; not hot.	Swelling, warmth, redness. Puffy knuckles.
What it answers to	Movement, strength work, sleep, weight. Rest makes it worse.	Movement and strength too, with a GP for the specific joint.	Treatment from a GP or rheumatologist, and the earlier the better.
What to do next	Run the moves on this page for a fortnight, then judge.	A GP if one joint dominates and is worsening with use.	A GP this week. Ask for inflammatory markers and a referral.

Fit check

Who this page is for, and when to see a GP instead.

This will help if

your joints are stiff on waking and after sitting, and loosen with movement
it is the hands, knees, hips, shoulders or lower back, and nothing looks swollen
you are somewhere in the transition and it arrived alongside other things
you have been told it is your age and want to know what actually moves it

See a GP instead when

any joint is swollen, warm or red, or the knuckles of both hands are puffy
morning stiffness lasts well over half an hour, or the small joints of both hands or feet are involved: ask about inflammatory markers and a rheumatology referral
one joint is dominating and getting worse with use, or has locked, given way or clicked painfully
the aching comes with a rash, fevers, weight loss, or eyes or mouth that have gone dry
it comes with feeling cold, heavy tiredness and weight gain: ask for thyroid function alongside
a month of daily walking and two strength sessions a week has changed nothing at all

By situation

The same rules, applied to your case.

Stiff hands in the morningRings tight, fists slow to close.

Hands are one of the five sites an Australian service names most often, and morning stiffness that loosens within half an hour is the hormonal picture. In the Australian X-ray study, hand osteoarthritis did not track with symptoms, which is the reassurance.

Then

Puffy knuckles on both hands, warmth, or stiffness past an hour is the inflammatory picture, and that is a GP this week.

Knees and hips after sittingGetting up from a chair like someone older.

Sitting is the amplifier and these are the weight-bearing joints. The walk after dinner and standing every half hour act the same day; strength work for the legs holds the joint over time. Weight, gently, matters here more than anywhere.

Then

If one knee dominates and worsens with use, a GP for that joint. If both ache and loosen with movement, this page.

Aching all over, with fatigueEverything hurts and nothing is swollen.

In SWAN's sixteen-year follow-up, symptoms clustered rather than arriving alone, and aching and tiredness are a common pair. A broken night lowers the pain threshold and pain breaks the night.

Then

Run the fatigue page's blood tests and the 3am page's night alongside this one. The night moves both.

Worse before a periodA week of stiffness, then easier.

Oestrogen is at its lowest in the days before bleeding, and its support for cartilage and tendon goes with it, so an aching that clusters premenstrually is the hormonal shape. Two months of noting it against the cycle is worth having.

Then

A pattern on paper changes what a prescriber suggests.

On menopausal hormone therapy (MHT, or HRT), and still achingBetter, not gone.

Where the aching is hormonal, hormone therapy may ease it, and it does not replace the muscle that holds a joint or the movement that loosens it. Run the moves alongside.

Then

Raise the joints at a review as their own item, particularly if any joint is swollen.

The seven-day plan

One change a day, in the order they matter.

A week of moving and looking. Then a fortnight before judging the walking, and eight weeks before judging the strength.

Day one

Look at both hands and both knees in daylight. Write down which joints, when it is worst, and whether anything is swollen, warm or red. If anything is, ring the GP tomorrow.

Day two

Ten-minute walk after dinner tonight. Set a reminder to stand and move for a minute every half hour tomorrow.

Day three

Ten minutes of gentle movement before the day starts: shoulders, hips, ankles, a slow walk to the kettle and back. Walk again after dinner.

Day four

First strength session: squats to a chair, step-ups on the bottom stair, a band for the shoulders, calf raises. Twenty minutes, lighter than pride suggests.

Day five

Protein at every meal from today. Walk after dinner, twenty minutes now if you can.

Day six

If you are waking at 3am, start that page's first moves tonight. Second strength session.

Day seven

Read the week. Stiffness easing with movement and nothing swollen: keep going and judge the walking at a fortnight. Anything on the GP list: book it. Set a reminder for the strength verdict at eight weeks.

Questions

What women ask before they try this.

Yes, and it is one of the most common symptoms, and for some women severe: a 2024 review estimates a quarter are disabled by musculoskeletal symptoms through the transition. The longest Australian study, 438 women followed for 8 years, found aches and stiff joints reported more than any other symptom, tied to the transition. In SWAN, one in six women reported daily aches and pains, with more from early perimenopause on. Oestrogen supports cartilage, tendon and muscle, and as it falls, joints stiffen.

Achy joints and muscles together is the usual shape, because oestrogen reaches further than the reproductive system. It supports cartilage and tendon, helps hold muscle and bone, and a 2024 review names the collection that happens as it falls the musculoskeletal syndrome of menopause: joint pain, muscle loss, bone loss. Add a broken night lowering the pain threshold and more sitting, and stiff mornings follow.

Very. A 2024 review estimates more than 70% of women experience musculoskeletal symptoms through the transition. In the Australian study it was the most commonly reported symptom of all, and in SWAN one in six women had daily aches and pains. An Australian clinical service names the hands, knees, hips, shoulders and lower back as the usual sites.

Usually not, and this is the reassuring part. In the Australian study, 224 women had hand and knee X-rays after twelve years, and symptom reports were not necessarily indicative of radiological osteoarthritis: knee findings tracked with symptoms, hand findings did not. The stiffness is real and it is mostly not the joint wearing out. A swollen, hot or red joint is the exception and wants a GP.

An Australian clinical service describes exactly that pattern: stronger in the morning, fading later in the day. Overnight, joints go unmoved for hours and the tissues oestrogen used to keep supple stiffen; the first half hour of movement loosens them. Morning stiffness that lasts well over half an hour is a different picture, the inflammatory one, and that is a GP question.

There is no pill for the hormonal version, and there is a treatment that works. Movement first: a daily walk and standing every half hour, which most women feel the same evening. Strength work twice a week, because muscle holds the joint and the transition takes muscle. Sleep, because a broken night lowers the pain threshold. Weight, gently, for the knees and hips. Relief comes from those rather than from anything sold for joints, and rest makes it worse.

Nothing sold for joints addresses the reason for this aching, which is oestrogen's support falling and muscle going, and none of it has evidence of the quality that daily movement and strength work do for this picture. Spend the money on walking shoes. If the picture is more than aching, a GP can say what has evidence for your specific joint.

Because oestrogen is at its lowest in the days before bleeding and its support for cartilage and tendon goes with it, so stiffness that clusters premenstrually is the hormonal shape. Note it against the cycle for two months. A pattern on paper is the strongest evidence you can bring to a GP and it changes what a prescriber suggests.

Where the aching is hormonal, it may ease, and that is a prescriber conversation with the pattern in hand. It does not replace the muscle that holds a joint or the movement that loosens it, so the walk and the strength work run alongside any prescription. Raise the joints at a review as their own item rather than assuming the flushes prescription covers them.

This week if any joint is swollen, warm or red, if the knuckles of both hands are puffy, or if morning stiffness runs well over half an hour. Inflammatory arthritis rises in this window, it is treatable, and treated early it does far better; ask for inflammatory markers and a referral. Also if one joint dominates and worsens with use, or if a month of daily walking and strength work has changed nothing.

Keep reading

Related symptoms, and the article that goes with this one.

The tirednessWhy am I so tired in perimenopause?Tired on waking as if the night did not count, or a wall at three, or flat all day. Most of it is the night arriving in the day, and the rest is two things a blood test finds.The 3am wakeWhy do I wake at 3am in perimenopause?You fall asleep fine, then wake at 3am, wide awake, heart going. It is one of the earliest and most reliable signs of the transition, and it has a mechanism.Running warmWhy do I get hot flushes and run warm in perimenopause?It starts as warm nights, then becomes a flush that arrives without warning, day or night. The thermostat that held for decades has narrowed.New anxietyWhy am I anxious for the first time in perimenopause?A new edginess. Anxiety in a way that is unfamiliar, often worst in the days before a period. For many women it is the symptom that is hardest to attribute to the transition.Read nextMagnesium in perimenopauseWhich form to take, whether the spray does anything, and why this is the one supplement I raise with almost every woman in the transition.

References

Sources used on this page.

Every figure and finding above traces to one of these.

The relationship of reports of aches and joint pains to the menopausal transition: a longitudinal study

Szoeke et al., Climacteric 11(1), the Melbourne Women's Midlife Health Project, 2008.

The 438 Australian-born women followed 8 years, aches and stiff joints as the most commonly reported symptom, its association with the transition, body mass index, negative mood and employment, and the twelve-year X-ray follow-up in 224 women showing symptom reports not necessarily indicative of radiological osteoarthritis.

Musculoskeletal pain and menopausal status

Dugan et al., Clinical Journal of Pain 22(4), the SWAN study, 2006.

The 2,218 women, one in six with daily aches and pains, and significantly more pain reported in early perimenopause, late perimenopause and postmenopause than premenopause after age adjustment.

The musculoskeletal syndrome of menopause

Wright et al., Climacteric 27(5), 2024.

The proposed term, the collection of joint pain, muscle loss, bone loss and osteoarthritis progression as ovarian hormones fall, and the estimates of more than 70% of women experiencing musculoskeletal symptoms and 25% disabled by them.

Menopause

Jean Hailes for Women's Health, accessed September 2026.

Aches commonly affecting the hands, knees, hips, shoulders and lower back, stronger in the morning and fading later, increased pain sensitivity reported by some women, and ageing, inactivity, injury and arthritis as other causes.

It is not just menopause: symptom clustering in the Study of Women's Health Across the Nation

Harlow et al., Womens Midlife Health 3, 2017.

Symptoms clustering across the transition over 16 years rather than arriving singly.

Shorter reproductive time span and early menopause increase the risk of ACPA-negative inflammatory arthritis in postmenopausal women with clinically suspect arthralgia

Heutz et al., Rheumatology 64(6), 2025.

Among women with joint pain suspicious for rheumatoid arthritis, postmenopausal status associated with roughly three times the risk of ACPA-negative inflammatory arthritis, and early menopause and fewer reproductive years raising it further, which is the reason the inflammatory picture is sent to a GP this week.

Written by Davina Hearne, 11 September 2026.

Davina Hearne qualified in 2012 at Wellpark College of Natural Therapies in New Zealand, with three NZQA Level 6 diplomas taken together over three years: Naturopathy, Herbal Medicine and Nutrition.

Davina Hearne is a New Zealand qualified naturopath, herbalist and nutritionist. She is not a medical doctor. This is health education from a qualified non-physician practitioner. It is not medical advice and does not establish a practitioner relationship.

Start tonight

Look at the joints tonight, then walk after dinner.

The aching is real, it is the most commonly reported symptom of the transition in Australian data, and it is mostly not the joint wearing out. Movement loosens what rest stiffens, muscle holds what oestrogen used to, and a better night lowers the volume on all of it. Look at both hands and both knees in daylight first, because a swollen or hot joint is the one thing on this page that should not wait for a fortnight of walking.

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