Muscle pain in menopause

Getting out of the sofa is harder than it was a year ago. A workout that used to leave barely a trace now leaves you stiff for days. Your muscles feel tense without your having done anything heavy. Maybe you assume it comes with getting older, maybe it worries you. Either way, you will find an answer here: why muscle pain shows up now, what your muscles need and when it is better to have it checked.

How women describe it

"My muscles ache and I didn't even do anything."

"I recover far more slowly after exercise than I used to."

"I feel stiff, as if my body is older than I am."

"At night I get cramps in my calves."

Sound familiar? You are in large company. A large share of women develop muscle and joint complaints during the menopause transition, up to seven in ten in some studies.¹ Researchers call it myalgia, the medical term for muscle pain. Women simply call it stiff, tender or tired muscles that recover more slowly than they are used to.

It often starts in perimenopause, the years before your final period, when your oestrogen begins to fluctuate. Precisely because it comes on so gradually, hardly anyone connects it to hormones straight away.

What happens in your muscles

Oestrogen does more than regulate your cycle. It helps your muscles recover after exertion, dampens inflammatory responses and supports the connective tissue that keeps your muscles supple. When your oestrogen levels fluctuate and fall in perimenopause, that can contribute to recovery running less smoothly. You then stay stiff longer after a workout, a muscle aches sooner and your body feels more sensitive. Pinning it on one cause rarely works, because age, workload, sleep and stress all feed in.

A second shift comes on top of that. With age, muscle mass gradually declines, a process called sarcopenia. That belongs to ageing, and in some women it seems to speed up around menopause, with falling oestrogen playing a part.² Less muscle mass means less strength and a body that copes less well with fatigue and load.

There is good news in that story too. Your muscles respond to training at any age. The very tissue you risk losing now is the tissue you rebuild with the right stimulus.

Muscle pain rarely travels alone. Poor sleep, stress, low mood and a higher weight all become more common in the same phase, and each of them sharpens pain. That is why one week feels heavier than the next.

Why do I recover more slowly after exercise?

This is perhaps the most concrete difference women feel. Before menopause, your muscle tissue bounced back easily after effort. Oestrogen supports that recovery process, and without that support your muscle needs more time and more building blocks to repair itself.

In practice that means two things. You need a little more recovery time between hard sessions. And you need enough protein, spread across the day, because muscle is built from protein. For women in and after menopause, the recommendation comes to roughly 1 to 1.2 grams of protein per kilo of body weight per day.² That is more than many women are used to, and it makes a noticeable difference to strength and recovery.

What you can do yourself

Movement is not a side note here, it is the core. And above all the kind that genuinely challenges your muscles.

• Strength training, twice a week. This is one of the best-evidenced ways to slow muscle loss and build strength. It can help with the pain too, though that depends on the type of pain. Start light, with your own body weight or light weights, and build up gently. A physiotherapist or coach helps you start safely.
• Keep moving in low-impact ways too. Walking, swimming, cycling or yoga keep you supple and support recovery on the other days.
• Eat enough protein. Spread it across your meals: at breakfast, lunch and dinner. Think eggs, dairy, legumes, fish, poultry or tofu.
• Look after your vitamin D. A deficiency is common in Belgium and weighs on muscle function. Have it checked if in doubt and top it up if needed.
• Protect your sleep and lower your stress. Poor sleep amplifies pain, and pain disrupts sleep. Anything that supports your sleep often helps your muscles too.

Give it time. Strength and recovery build over weeks, not days, and the first gain often shows in how you get out of bed in the morning. It can help to note for a few weeks when the pain flares and what eases it. That overview makes the conversation with your GP or physiotherapist more concrete and helps you find the right direction faster.

For quick relief, heat can relax the muscles. Magnesium is sometimes tried for night-time cramps, though the evidence for muscle pain itself is limited. An anti-inflammatory such as ibuprofen can help temporarily, but use it in moderation and talk to your doctor if you need it often.

Muscle pain or something else: when to pay attention

Menopause is the likely explanation if your pain came on gradually, sits on both sides of your body and moves with your sleep and your workload. Even so, it is not the only possible cause, and a few situations warrant a doctor.

An underactive thyroid and a vitamin D deficiency both cause muscle pain and fatigue, and both are quick to spot with a blood test. Did you start a cholesterol-lowering drug (a statin) and the muscle pain came afterwards? Raise it with your doctor, because statins can cause muscle complaints.

Pay extra attention to severe pain and morning stiffness in the shoulders and hips that comes on suddenly after the age of fifty. That pattern can point to polymyalgia rheumatica, an inflammatory condition that needs prompt treatment. Also get it checked for pain in a single muscle with swelling, for clear loss of strength, for fever or unintended weight loss, or for dark urine after severe muscle pain.

Is your pain mostly in the joints themselves, with stiffness and tender knees, hips or hands? Then read our page on joint complaints. If you want to know how your bones change in this phase, our page on osteoporosis helps.

Does hormone therapy help?

Hormone therapy is not prescribed first and foremost to treat muscle pain. Some women do notice that muscle and joint pain improves when they start it for other menopause symptoms, and guidelines recognise that this effect is possible.^3,4,5,6 It is not a guarantee.

If you are considering hormone therapy for, say, hot flushes or poor sleep, a possible improvement in your muscles is a welcome extra to discuss. A care provider who knows menopause well looks at what is useful and safe in your situation, together with you.

Where to find help

Is the pain hanging on, or weighing on your daily life? You don't have to figure this out alone.

Your GP (huisarts) is a good first stop. With a blood test they can rule out other causes, such as a thyroid problem, a vitamin D deficiency or inflammation, and refer you on if needed. A physiotherapist helps you into strength training safely, especially if the pain is holding you back. For the broader menopause approach, your GP refers you to a gynaecologist, and some Belgian hospitals run a dedicated menopause clinic.

Want to talk directly to someone who works on menopause every day? On Uma you will find care providers who specialise in (peri)menopause. Your consultation takes place online, you discuss all your symptoms together, including the ones you hadn't yet connected, and you leave with a concrete plan. Uma is active mainly in Belgium, the Netherlands, Luxembourg and France, but any woman in Europe can consult a care provider on Uma. Prescriptions are valid across Europe.

Sources

1. Wright, V.J., Schwartzman, J.D., Itinoche, R. & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472.
2. Geraci, A. et al. (2021). Sarcopenia and Menopause: The Role of Estradiol / Aging of the Musculoskeletal System: How the Loss of Estrogen Impacts Muscle Strength.
3. Rozenberg, S. et al. (2026). Guidelines Menopause. Belgian Menopause Society.
4. National Institute for Health and Care Excellence (2024). Menopause: identification and management. NICE Guideline NG23.
5. BCFI (2025). Hormone therapy during perimenopause: benefits and drawbacks.
6. RIZIV/INAMI (2024). Consensus conference: The management of menopause.

The content on this page is intended for informational purposes and does not replace medical advice. Please consult a physician for a personal assessment.