Menopause is a natural part of a woman’s lifecycle when the body no longer menstruates. Menopause is defined once the body has not had a period for 12 months. During this time the body goes through many unpleasant changes which can increase the chances of experiencing joint pain. These changes are normal and natural, but the discomfort can be managed. This is common and presents in about 50% of postmenopausal women. The fingers, shoulders, and knees are most commonly reported as sites of joint pain. 80% of the patients from one hand clinic in London were postmenopausal women.

During menopause and postmenopause, your ovaries slow down the production of estrogen and progesterone. The ovaries are the main production factory of these two hormones. Other parts of the body normally produce smaller quantities of these hormones.

Lower levels of estrogen and progesterone have been linked to increased inflammation and an increased risk of developing osteoporosis and osteoarthritis. No direct link has been defined yet; however, there does appear to be some type of link between these joint conditions and reduced levels of these hormones. Many studies are ongoing, but overall estrogen is considered protective of the musculoskeletal system. There are estrogen receptors found not only in bone, but also the synovial lining of joints.

It is believed that about 50% of women aged 45-65 experience menopause-related joint pain. Your joints are a complicated and intricate combination of bone, cartilage, muscle, ligaments, and other soft tissues. Each joint has neural connections to and from the brian and surrounding tissues that allow for movement through life. These joint tissues contain estrogen receptors that can become more sensitive and experience more friction with a lack of estrogen. This occurrence has also been observed in those who take estrogen-blocking drugs called aromatase inhibitors most commonly prescribed for breast cancer treatment. (Aromatase is an enzyme that converts peripheral testosterone into estradiol.)

- Treatment-emergent endocrine symptoms and the risk of breast cancer recurrence: a retrospective analysis of the ATAC trial

In the Women’s Health Initiative long-term study, estrogen was examined as it pertains to joint pain. In a group of nearly 11,000 postmenopausal women with hysterectomies, estrogen was found to reduce complaints of joint pain. This result was considered modest and sustained. The most likely reason that estrogen helps is by reducing overall inflammatory levels. Estrogen also reduces cartilage turnover and potentiates cartilage repair. Estrogen is also beneficial in that it enhances pain modulation pathways involving the brain. Estrogen receptors exist within the nervous system and are involved in perceptions of pain. Management of symptoms with hormones is dose-dependent and changed by a variety of factors. It is important to involve a knowledgeable expert.