Joint Pain During Menopause 

By Vandana Suresh | Sept. 16, 2024

In the latter half of a woman’s third decade of life, her ovaries start their journey to a deep slumber. With the ovaries’ functional decline, estrogen and progesterone levels also drop steadily until menopause, putting women at higher risk for health issues, such as arthritis and osteoporosis. Despite the pivotal role hormones play in a woman’s well-being, the effects of hormone therapy (HT) on joint health have yet to be thoroughly studied.

Osteoarthritis (OA) is equally prevalent between men and women up to age 50, but after that, it becomes more common and severe in women. Women are also more likely to have joint replacement surgery for their OA. Furthermore, women on estrogen-blocking medications for cancer treatment and those transitioning into menopause experience accelerated arthritis and joint pain, indicating the importance of hormones.

“Estrogen is anti-inflammatory, and its receptors are all over the whole body, including your muscles, bones, joints, tendons and ligaments,” says Jocelyn Wittstein, MD, associate professor of orthopedic surgery at Duke University. “So, if its levels are going down, the bones and joints aren’t seeing as much estrogen, and this withdrawal could increase [joint pain] in the hands, shoulders and knees — really any joint.”

Starting women on HT is thought to help reduce the adverse effects of menopause, including arthritis. While HT has been shown in studies, like the 2022 Women’s Health Initiative (WHI), to prevent bone loss and reduce fractures in postmenopausal women without osteoporosis, there are no similar studies for osteoarthritis in women transitioning to menopause. However, a reexamination of the data of women who continued HT for their menopausal symptoms beyond the trial’s conclusion revealed that they tended to experience less pain in their bones and joints.

“The women in the WHI study were only asked whether they had joint pain, so the questions were not well-defined,” says Anne Ford, MD, obstetrician and gynecologist at Duke University. “To better understand the impact of hormone therapy, more specific questions about joint pain and arthritis need to be asked.” Drs. Wittstein and Ford are working together to address the gap in knowledge and arthritis care for women. Their objective is to create a registry containing survey data collected from women about their menstrual status, menopausal symptoms, joint pain and locations, and whether they are using HT for their symptoms and its dosage, among other information. They emphasize that this data will be crucial in evaluating the effectiveness of HT for menopausal arthritis.

“There is a big intersection between women’s [health] and orthopedic health,” says Dr. Wittstein. “It’s important that we, as physicians, don’t work in silos. There is a significant health care disparity in terms of the management of arthritis in male and female patients. We must collaborate in the care of our patients.”