# Research Brief

## Question

What does current evidence say about musculoskeletal pain during perimenopause and menopause?

## Short Answer

Joint and muscle pain are commonly reported during the menopause transition. A 2026 systematic review of 37 observational studies found higher reported prevalence in perimenopausal and postmenopausal groups than in premenopausal groups. This supports an association, not proof that hormonal change caused an individual's pain. Specific conditions and causes were often poorly reported, and study results varied considerably. [S1]

## Evidence Labels

- **Established:** consistently recognized or supported by converging evidence.
- **Emerging:** suggestive but incomplete evidence.
- **Uncertain:** evidence is insufficient for confidence.
- **Contested:** credible findings or interpretations conflict.
- **Experience:** lived reports, not automatically scientific evidence.

## Established

1. **Joint and muscle pain are recognized menopause-associated symptoms.** NICE includes musculoskeletal symptoms such as joint and muscle pain among symptoms associated with menopause. This describes an association and does not identify the cause of pain in any person. [S5]
2. **Musculoskeletal pain is common across midlife, including before menopause.** In a 2026 meta-analysis, pooled prevalence of muscle or joint pain was 40% in premenopausal participants, 57% in perimenopausal participants, and 59% in postmenopausal participants. [S1]
3. **The observed association cannot establish individual causation.** The 2026 review included observational studies, reported substantial between-study heterogeneity, and found that specific musculoskeletal conditions were underreported. [S1]
4. **Menopause is a life transition, not a disease.** Experiences vary, and symptoms can affect wellbeing and quality of life. [S6]

## Emerging Evidence

1. A longitudinal cohort of 609 people in an urban Chinese community reported increasing prevalence and severity of muscle and joint pain as menopause stages progressed. Because this is one population and an observational design, it adds evidence of a pattern but does not isolate menopause as the cause. [S2]
2. A randomized Women's Health Initiative analysis found a modest, sustained reduction in joint-pain frequency with estrogen alone among postmenopausal participants with prior hysterectomy. This does not show that hormone therapy is an appropriate pain treatment for everyone. [S4]

## Uncertain / Unknown

- Why pain begins or changes for a particular person.
- How much of the population-level pattern is attributable to hormonal change versus aging, sleep, mood, existing conditions, injury, activity, body composition, or other factors. [S1, S2]
- Which specific musculoskeletal conditions, if any, are most strongly linked to menopause stage. [S1]
- Which interventions reliably improve generalized musculoskeletal pain in menopausal populations. [S3]

## Contradictions / Contested

Hormone therapy findings are mixed. A randomized analysis of estrogen alone reported a modest reduction in joint pain in a narrowly defined population [S4], while a 2025 systematic review and meta-analysis found no significant pooled difference in generalized musculoskeletal pain between ever-users and never-users of hormone replacement therapy and described conflicting results for several conditions. The review emphasized heterogeneity and the need for purpose-built studies. [S3]

## Important Nuances

- Population-level prevalence cannot determine why one person hurts.
- “Musculoskeletal pain” combines broad reports of muscle or joint pain; it is not a single diagnosis. [S1]
- Midlife pain may have multiple overlapping contributors, some unrelated to menopause.
- Hormone-therapy decisions involve benefits, risks, health history, formulation, and personal preferences; this brief does not evaluate or recommend treatment.
- The studies use sex-specific population terms. Editorial copy should welcome anyone experiencing perimenopause or menopause without implying that all women—or only women—have these experiences.

## Experience

No reader testimony or qualitative lived-experience source was included in this Sprint 01 corpus. Editorial outputs must not manufacture a quote, composite story, or personal experience.

## Claims We Should NOT Make

- “Menopause causes all joint or muscle pain.”
- “Falling estrogen is proven to be the cause of your pain.”
- “Joint pain confirms perimenopause.”
- “Hormone therapy will treat or prevent musculoskeletal pain.”
- “A normal observation pattern rules out another condition.”
- Any instruction to start, stop, or change medication or treatment.

## Useful Questions for Readers

- When did the discomfort begin, and has its pattern changed?
- Where is it, when is it most noticeable, and what does it make harder to do?
- Does it vary alongside sleep, activity, menstrual-cycle changes, or other symptoms?
- What context and health history would help a clinician assess possible causes?
- Are there changes that feel new, severe, persistent, or concerning enough to discuss promptly with an appropriate professional?

## Sources

1. **[S1]** Kruse C, et al. “Musculoskeletal Manifestations of Perimenopause: A Systematic Review and Meta-Analysis of 93,021 Women.” *JB & JS Open Access*. 2026;11(1):e25.00254. Systematic review/meta-analysis; 37 observational studies. PMID 41523660. https://pubmed.ncbi.nlm.nih.gov/41523660/
2. **[S2]** Huang F, et al. “Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study.” *Pain*. 2024;165(11):2644–2654. PMID 38787639. https://pubmed.ncbi.nlm.nih.gov/38787639/
3. **[S3]** “The effect of hormone replacement therapy on musculoskeletal pain in menopausal women: A systematic review and meta-analysis.” 2025. PMID 41344380. https://pubmed.ncbi.nlm.nih.gov/41344380/
4. **[S4]** Chlebowski RT, et al. “Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial.” *Menopause*. 2013. PMID 23511705. https://pubmed.ncbi.nlm.nih.gov/23511705/
5. **[S5]** National Institute for Health and Care Excellence. “Menopause: identification and management (NG23), Recommendations.” Updated 2024. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
6. **[S6]** World Health Organization. “Menopause.” Fact sheet. 2024. https://www.who.int/news-room/fact-sheets/detail/menopause

## Provenance Note

This brief was produced through the documented manual fallback using the named original sources because no authenticated NotebookLM session was available in the workspace. Source records and claims were checked against PubMed, NICE, and WHO pages on 2026-08-07. It is formatted identically to an automated NotebookLM handoff so the downstream workflow is unchanged.

## Last Reviewed

2026-08-07