When It’s Not Hormones—Other Causes of Muscle & Joint Pain in Perimenopause

Pain in Midlife Isn’t Just “Hormonal”

Fatigue, joint pain, muscle tension, and body aches are among the 34 symptoms commonly associated with the menopause transition. If you're a frequent reader of this blog, you already know that estrogen receptors are found throughout the body—including in muscles and joints. As estrogen levels decline, these areas can feel achy or inflamed.

But here’s the thing: not all pain is hormonal. Some women are told to “wait it out” or “accept it,” assuming that once they reach post-menopause, the pain will fade. In reality, there are many other treatable causes of discomfort that deserve attention.

This post offers a broad overview of non-hormonal contributors to muscle and joint pain in midlife. It’s not a diagnostic tool or treatment guide, but it may help you reflect on whether posture, nutrient gaps, mechanical strain, or inflammation could be part of your pain story.

Posture & Movement-Related Causes of Muscle & Joint Pain

This is a big one. Most of us have been compounding poor posture with repetitive strain for years—and now it’s catching up.

• Sedentary lifestyles (desk work, long commutes, lack of movement) reduce joint lubrication and muscle activation.

• Repetitive strain (carrying kids, leaning on one hip, crossing legs, poor lifting mechanics) creates chronic imbalances.

• These patterns lead to kinematic dysfunction—weak glutes, tight hips, hunched shoulders, and underactive back muscles. Pain may be local or referred (low back, neck, knees).

Signs to watch for: Pain that worsens with certain positions, asymmetrical discomfort, or relief with movement.

Source and an in-depth article from Stanford Environmental Health about posture

Nutrient Deficiencies That Mimic or Worsen Pain

Nutrient gaps are often overlooked but can significantly impact how your body feels.

• Vitamin D: Low levels can cause deep muscle aches and increase inflammation.

• Magnesium: Deficiency may lead to cramping, tightness, and poor recovery.

• Omega-3s: These fats help regulate inflammation—low intake can worsen chronic pain.

• Iron & B12: Essential for oxygen delivery and nerve health; low levels can cause fatigue and myalgia.

If you’re feeling achy and tired, consider reviewing your nutrient intake or asking for lab testing.

Tendon and Soft Tissue Conditions in Midlife Women

Certain musculoskeletal conditions are more common in women during the perimenopausal and postmenopausal years:

• Frozen Shoulder (Adhesive Capsulitis): Gradual shoulder pain and stiffness, often worse at night. Estrogen decline may contribute to capsular tightening.

• Achilles Tendinopathy: Heel pain and stiffness, especially in the morning or after walking. Estrogen supports tendon health—its decline can impair repair.

• Bursitis (Hip, Shoulder, Knee): Localized joint pain aggravated by pressure or movement. Hormonal changes may increase inflammation in bursae.

These conditions are treatable but often misdiagnosed or dismissed. If your pain is positional or persistent, seek evaluation.

Sleep, Stress, and the Pain Amplification Loop

Stress, Poor Sleep, and Pain are extremely intertwined.

Poor sleep doesn’t just leave you tired—it makes pain worse.

• Lack of deep sleep impairs tissue repair and increases pain sensitivity.

• Pain disrupts sleep, creating a vicious cycle.

• Chronic stress raises cortisol, tightens muscles, and slows healing.

Breaking this loop—through sleep hygiene, nervous system support, or magnesium—can dramatically improve comfort.

Body Composition Changes and Pain

Midlife changes in body composition directly affect joint and muscle health:

• Weight gain: Adds mechanical stress to joints, especially knees and hips.

• Muscle loss (sarcopenia): Reduces joint stability and shock absorption.

• Visceral fat: Produces inflammatory chemicals that worsen pain perception.

These changes are reversible. Strength training, protein optimization, and anti-inflammatory nutrition can help restore balance.

Thyroid and Autoimmune Conditions

Midlife is a common time for thyroid and autoimmune conditions to emerge:

• Hypothyroidism: Can cause diffuse muscle aches, stiffness, and fatigue.

• Autoimmune conditions (RA, lupus, fibromyalgia): May present with joint pain, morning stiffness, or systemic symptoms.

If your pain is symmetrical, persistent, or accompanied by fatigue or brain fog, ask your provider about further testing.

When to Seek Help

You don’t need to wait until pain becomes unbearable. Seek help if you experience:

• Sudden swelling or redness in a joint

• Persistent night pain

• Joint deformity or loss of function

• Systemic symptoms like fatigue, rashes, or unexplained weight changes

Pain is a signal—not a sentence. You deserve clarity and support.

You’re Not Broken—You’re Just Not Being Heard

Pain in midlife is common, but it’s not inevitable. Whether it’s posture, nutrient gaps, tendon strain, or something deeper, there are many treatable causes worth exploring.

If something in this post resonates, bring it to your practitioner. Ask questions. Get curious. You deserve to feel strong, mobile, and supported—at every stage of life.