If Your Body Feels Like It's Falling Apart After 45, It's Not In Your Head—It's A Medical Syndrome

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Of the more than 47 million women in the world who begin the menopause transition each year, more than 70 percent of them will experience musculoskeletal symptoms—and 25 percent will be disabled by them. Those startling stats are based on research by Vonda Wright, MD, an orthopaedic sports surgeon and author of Unbreakable. And yet, many women that Dr. Wright sees in her practice are only aware of more-talked-about symptoms like night sweats, hot flashes, and brain fog. The musculoskeletal symptoms—which includes arthritis, tendonitis, and osteopenia, and are linked to the drop in estrogen that happens during menopause—seem to come as a surprise.
'[Women] come into my office and, without prompting, they'll say, 'I don't know what's happening, but I feel like I'm falling apart because it's not just one body part, it's multiple body parts,'' Dr. Wright says. Many of these female patients also mention being dismissed by their PCPs and having their issues chalked up to aging. "We are getting older, but that is not the end of the explanation," Dr. Wright says.
She hopes that her paper—and giving these symptoms a name—helps to solve this problem: 'If the woman goes into a doctor's office and says, 'my knee hurts, my back hurts. I'm gaining weight'—that is a lot to talk about in 15 minutes. But with the power of nomenclature, a midlife woman who educates herself can say, 'I'm 46, I know my estrogen is going down. I think I have the musculoskeletal syndrome of menopause.' And that is something that you can wrap a conversation around versus trying to solve each problem individually.'
This approach of using a name to label and identify a health issue has had success in the past. In 2012, a team of experts put forth the term genitourinary syndrome of menopause (GSM) to describe symptoms including genital dryness, pain during sex, and urinary urgency or recurrent urinary tract infections.
Like with musculoskeletal symptoms, 'if you go in naming five or six things [related to the genital or urinary organs], it's overwhelming, but if you give a name to it, then we can research it, and then we can talk about it with a common language,' Dr. Wright says.
Other experts in the field agree that publicizing a term like this and getting the information out to more women and providers is important: 'Coining this term 'musculoskeletal syndrome' gave patients validity that this is a real thing that happens in menopause,' says Paru David, MD, an internist in Women's Health Internal Medicine at Mayo Clinic Arizona. Dr. David sees many patients exhibiting the symptoms of this syndrome. '[They] will tell me 'I became postmenopausal and, overnight, I felt like I became an old lady... everything hurts.''
The good news is that understanding why this happens—and how to fight back—can help you treat or prevent these symptoms altogether.
What Musculoskeletal Syndrome Actually Is
The symptoms related to this syndrome all have to do with the loss of estrogen that leads to inflammation in the body. 'Estrogen is a potent anti-inflammatory, so without estrogen, we're highly inflamed,' Dr. Wright says.
Estrogen sits on the receptors on every tissue in the body, including the musculoskeletal system, which includes tendon, ligament, bone, the discs in your back, cartilage, fat, muscle, and stem cells. Less of the hormone can lead to excruciating pain and loss of motion without an injury or event.
Dr. Wright has patients come in knowing something is wrong but insisting nothing happened, exactly, to trigger it. 'As I explore their age and that they're perimenopausal, I know that means their estrogen has declined,' she says.
How the Loss of Estogen Impacts the Body
Tendons and ligaments: 'The ligaments and tendons become more brittle and are more susceptible to injuries such as tennis elbow, Achilles tendonitis, [and] plantar fasciitis,' Dr. Wright says. This weakening of the tendons and ligaments can also lead to tendon tears while lifting weights or playing sports—even if you lifted the same amount of weight you'd done in the past or didn't make any new moves, Dr. David says.
Muscle: 'Although it's critical at this time of life to make muscle, we make it less effectively,' Dr. Wright says. In a 2024 systematic review in Muscles, researchers noted that the decline in estrogen during menopause leads to reduced muscle strength in addition to mass, although hormone replacement therapy (HRT) can mitigate some of this in addition to resistance training, and certain dietary interventions. (More on those soon.)
Bone: Bone is dependent on estrogen for a process known as remodeling. 'Bone is in a consistent state of building and breaking down; every 10 years, we get a whole new skeleton,' Dr. Wright says. 'When the cells that break down bone [are] not controlled, then we have more breakdown than we do building, and that's when we become osteopenic, which is moderate loss of bone density, or osteoporotic, which means weak bone, [which] puts us in much more danger of fracture.'
Dr. Wright says her personal 'hill to die on' is the fact that bone health is a lifelong concern. 'Yet none of us pay attention to our bones unless we're looking in the mirror at our gorgeous cheekbones or our clavicles,' she says. 'But the reality is that without estrogen, we're going to lose 15 to 20 percent of our bone density in the five to seven years surrounding perimenopause and menopause. And if we have not laid down enough bone by the time we're 30, which is very common, then we get to perimenopause and we rapidly start losing bone to the tune of one in two women will develop an osteoporotic fracture in their lifetime.'
Joints: 'Before age 50, men have a much higher incidence of arthritis usually due to trauma,' Dr. Wright says. But after 50, women are the ones typically experiencing rapid progression of arthritis in the knee and hip, she adds. This is because cartilage—which helps with shock absorption—has estrogen receptors and without estrogen sitting in those receptors, the cartilage starts to break down. That leads to women over 50 dealing with joint pain in their hands, knees, and hips. Similarly, the gel-like cushions between the disks in your spine can break down and cause back pain, which impacts 50 percent of women, Dr. Wright says. Frozen shoulder—when the joint becomes stiff and starts to hurt for no apparent reason—is another condition she often sees in menopausal women.
'The other thing from an inflammatory standpoint that women experience, which I think is often mislabeled as fibromyalgia, is arthralgia, which is total-body pain due to inflammation,' Dr. Wright says. 'It's not one joint. It is your whole body [that] feels inflamed and painful.'
How to Know If You Have Musculoskeletal Syndrome
There's no quick and easy test for this syndrome. 'You can't really do an x-ray or imaging that confirms and says, 'this is definitely due to the loss of estrogen,'' says Dr. David. Instead you need to work with your provider to put together a full picture. If a woman is postmenopausal and not on hormones and says she cannot exercise the way she has in the past, or that she's dealing with more injuries or pain, and/or other symptoms like hot flashes and night sweats, those would be clear indicators, Dr. David says.
Both doctors say that women tend to underreport symptoms—don't be one of them. 'Sometimes patients will say, 'oh, it's just in my mind,' and they're doubting themselves, but then when they come in, I tell them, no, this is a real thing that's happening due to that loss of estrogen,' Dr. David says. 'Don't feel like you can't come to your provider or to a menopause specialist to discuss this, because women need to have these things addressed.'
How to Reverse (Or Prevent!) Musculoskeletal Syndrome
'What I want women to do to treat the musculoskeletal syndrome of menopause is multifactorial,' Dr. Wright says. Here, all the ways to empower yourself to prevent—and fight—back.
1. Stay educated.
'Number one, you have to be educated,' Dr. Wright notes. For this reason, she and her team decided to pay whatever money was necessary so that the paper on the syndrome would not be placed behind a paywall. 'I encourage people to print the paper, read the paper, print another one, take it to your doctor, [and] give it to five girlfriends so that everybody knows,' she says. 'The more literate you are in midlife, the more powerful you can be to feel better.'
2. Talk to your provider about hormone therapy—asap.
"I encourage all of my patients to go on hormone optimization with estradiol [and], if they have a uterus, with micronized progesterone,' Dr. Wright says, adding that sometimes she gives them low-dose testosterone as well. 'Women just want to feel like themselves and do what they've always done, and these three things, I have found in my own life and [in] the women that I serve, can go a long way [in combatting] the root cause of some of the reasons we don't in midlife,' Dr. Wright says. Dr. David's patients, too, tell her they feel much better—they're joints and muscles don't hurt as much, for example—once they're on hormone therapy.
That said, hormone optimization is a decision every woman needs to make for herself and with her provider, the doctors agree. But, Dr. Wright says to make that decision sooner rather than later. 'I think we should be making it in the critical decade, which in my book is 35 to 45 when most of us still have our estrogen flowing,' she says. That way, when you start feeling perimenopause, and possibly overwhelmed, you already know what you're going to do and where you're going to get it.
3. Start lifting heavy if you're not already.
'I have a lot of patients that think that they have to go into a gym and do heavy lifting, and I tell them small weights can really help preserve your bone density and probably help with keeping your muscle mass,' Dr. David says. 'Make sure that you're not doing more than what your body can do,' she says. 'Especially if you've had a period of time where you haven't done physical activity, you can't necessarily jump in and begin where you left off. You might have to build back up to that level.'
4. Follow the 80-20 rule of exercise.
'We can stop burning ourselves out with high-intensity interval training every day and do the 80-20 method,' Dr. Wright says. That means that 80 percent of the time, you work at a lower heart rate with activities like brisk walking, cycling, or using the indoor rower. Then, twice a week, you push your heart rate as high as your doctor says is safe for you—but for short (perhaps 30 seconds) periods of time with longer (say, one to two minutes) periods of recovery.
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Working at those ends of the spectrum, in addition to heavy lifting, is the key to changing body composition and maintaining muscle. Dr. David adds that stretching regularly is also important to prevent joint injuries.
5. Consider working with a physical therapist.
If you're experiencing some of these symptoms already, working with a physical therapist can be very beneficial, Dr. Wright says, because they can assess you, understand where you are, understand your limitations, and then prescribe exercises that you can build upon.
Dr. David, too, says finding a physical therapist that's educated around menopause can be a wise move during this time of life: 'I do get worried that sometimes patients will say, 'I just need to work out with a personal trainer, and that will really help me,' and they may not understand where you're coming from,' Dr. David says. 'A physical therapist, especially one who understands musculoskeletal syndrome, can understand where these patients are coming from, what they are able to do without harming themselves further, and then build upon that.'
6. Eat an anti-inflammatory diet.
'I prescribe anti-inflammatory nutrition,' says Dr. Wright. The key components of this, she says, are to avoid added sugar and to focus on protein and specifically fiber-rich carbs (e.g., whole fruit instead of fruit juice). 'For bone health, make sure that you're getting enough calcium [and] that you're getting enough vitamin D to help absorb that calcium,' Dr. David adds. The aforementioned 2024 review also notes that omega-3 fatty acids can be effective in supporting muscle health across all life stages.
If this list has you feeling overwhelmed, fear not, Dr. Wright says. Just start with one thing. Maybe start by taking two walks this week, then cut back on sugar next week, then layer on protein, and finally, weight lifting. 'You layer on one at a time [and] it simply becomes your lifestyle,' she says. 'It's not a diet. It is not a six-week exercise program. It's just how you live—and all of these things will help your musculoskeletal pain stay in check.'
And while the sooner you start some of these lifestyle habits, the better, it's also never too late: 'There is never an age when your body will not respond to the positive stress, the strategic stress, in the form of all the things on this list," Dr. Wright says.
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