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One day, you jump out of bed without a second thought. The next, even getting up feels like an effort: your knees crack, your hips complain, and your back seems to remind you to take things a little slower. If you have caught yourself thinking, "When did my body start doing this?" you are not alone. During perimenopause and menopause, many women notice changes in their joints, muscles, bones, balance, bladder, and pelvic health. New aches and stiffness may appear seemingly out of nowhere, while activities that once felt easy may suddenly require more effort.
Researchers have increasingly recognized the connection between menopause and musculoskeletal health. In 2024, a clinical review introduced the term Musculoskeletal Syndrome of Menopause (MSM) to describe the collection of musculoskeletal symptoms associated with the loss of estrogen during the menopause transition. The authors estimated that more than 70% of women experience musculoskeletal symptoms during this transition, with approximately 25% experiencing disabling symptoms.
And while the musculoskeletal system is one important part of the picture, menopause can also affect the pelvic and genitourinary systems.
What Is Musculoskeletal Syndrome of Menopause (MSM)?
Musculoskeletal Syndrome of Menopause is an umbrella term describing musculoskeletal symptoms and conditions associated with the hormonal changes of menopause. These changes can involve joints, muscles, bones, tendons, connective tissues, strength and physical function, balance and mobility.
Estrogen has important effects throughout the musculoskeletal system. As estrogen levels fluctuate and eventually decline during the menopause transition, some women experience changes in how their muscles, joints, and connective tissues feel and function.
A recent systematic review and meta-analysis involving more than 93,000 women also found that musculoskeletal symptoms are common during the perimenopausal transition, supporting the importance of recognizing these complaints as a significant aspect of women's midlife health.
What Can MSM Look Like?
Symptoms vary from woman to woman. Some women may experience:
- Joint pain or aching
- Morning stiffness
- Knee, hip, shoulder, hand, or back discomfort
- Muscle weakness
- Loss of muscle mass
- Reduced exercise tolerance
- Tendon or connective-tissue symptoms
- Changes in osteoarthritis symptoms
- Reduced balance
- Changes in mobility
- Loss of bone density
The 2024 MSM review specifically identified arthralgia, loss of muscle mass, loss of bone density, and progression of osteoarthritis among the musculoskeletal changes associated with menopause. However, menopause should not automatically be blamed for every new ache or pain. Arthritis, previous injuries, inflammatory conditions, thyroid disorders, neurological conditions, medication effects, and other health conditions can cause similar symptoms.
That's why persistent or significant symptoms deserve an appropriate medical evaluation.
Why Does Estrogen Matter?
Estrogen is often discussed in relation to reproductive health, but its effects extend throughout the body. Changes in estrogen during menopause are associated with changes in bone and musculoskeletal health. Bone loss can accelerate around the menopausal transition, making bone health particularly important during midlife. Osteoporosis is often called a "silent" disease because people may not know they have it until a fracture occurs. This makes prevention and early identification important. Maintaining muscle strength is also essential. Strong muscles support mobility, balance, and independence, and they can help reduce the risk of falls. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends combining weight-bearing exercise, resistance training, and balance activities to support bone health and reduce fall and fracture risk.
What About the Pelvic Floor?
This is an important distinction. Pelvic-floor symptoms are related to menopause, but they are not simply another name for Musculoskeletal Syndrome of Menopause. Estrogen changes after menopause can affect the tissues of the vagina, vulva, urethra, and bladder. These changes are commonly described as Genitourinary Syndrome of Menopause (GSM).
Women may experience:
- Urinary urgency
- Urinary leakage
- Increased urinary frequency
- Vaginal dryness
- Vaginal discomfort
- Pain with sexual activity
- Pelvic pressure or heaviness
- Changes in pelvic-floor muscle function
- Recurrent urinary symptoms
Urinary symptoms are common during and after menopause, but they can have multiple causes.
A Cochrane review found that local vaginal estrogen may improve urinary-incontinence symptoms in postmenopausal women, while systemic estrogen showed different effects on urinary symptoms. This is an important example of why treatment should be individualized and discussed with an appropriate healthcare professional.
How Physical Therapy Can Help During Menopause
Physical therapy cannot stop the hormonal changes of menopause, but it can help you improve how your body moves and functions.
A physical therapist can assess your:
- Strength
- Balance
- Mobility
- Joint function
- Movement patterns
- Flexibility
- Functional limitations
- Exercise tolerance
- Pelvic-floor function
Treatment is individualized, but may include several components.
The Role of Pelvic Floor Physical Therapy: If you're experiencing urinary, bowel, sexual-health, or pelvic symptoms during menopause, pelvic-floor physical therapy may be an important part of your care. Research summarized by the International Menopause Society supports pelvic-floor muscle training as a potential treatment option for some women with genitourinary symptoms of menopause.
A Whole-Body Approach to Menopause
One of the most important lessons from the emerging discussion around MSM is that the body doesn't function as a collection of separate parts.
Your joints affect how you move.
Your muscles affect your balance.
Your balance affects your fall risk.
Your bone health affects your long-term independence.
And your pelvic-floor function can affect bladder, bowel, sexual, and daily activities.
That's why a whole-body approach matters. Rather than treating every symptom in isolation, physical therapists can look at how these changes interact and how they affect your ability to participate in the activities you enjoy. You are not "just getting older." Your body is changing and there are evidence-based ways to help you move, function, and feel stronger through every stage of life.
References
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric.2024;27(5):466–472. doi:10.1080/13697137.2024.2380363.
Musculoskeletal Manifestations of Perimenopause: A Systematic Review and Meta-Analysis of 93,021 Women. PubMed. 2026.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Exercise for Your Bone Health. National Institutes of Health.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Preventing Another Broken Bone. National Institutes of Health
International Menopause Society. Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause.
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