Perimenopause Body Aches: Why Is My Whole Body Sore?!

You wake up feeling like you’ve run a marathon, even though you didn’t work out. Your body feels heavy, sore, and achy—almost like you’re coming down with something. But you’re not sick. If you’re a woman in midlife, body aches may be a little-known sign of perimenopause.

More than 70 percent of women going through perimenopause experience body aches, whole-body muscle soreness, muscle fatigue, stiff or swollen joints, aching bones, and other pain symptoms. ¹

“These kinds of discomforts are a very real and often frustrating part of the journey that can come on gradually and insidiously,” explains Natalie Kunsman, M.D., a family medicine physician who treats women in menopause. “People often have alternative explanations for these issues or hold onto diagnoses, such as old age or arthritis, and don’t investigate the core source.”

But it’s important to be aware of why it’s happening, because left unaddressed, perimenopause body aches and pains can lead to a cascade of events leading to worse health.

It goes like this: If you’re tired and in pain, you’ll move less, which can lead to muscle loss, weight gain, and decreased cardiovascular health, which ultimately increases your risk for chronic conditions, including osteoporosis, heart disease, and type 2 diabetes.

The simple litmus test Kunsman uses: If you’re in your 40s and have never felt these sensations before, plus you’re having other perimenopause symptoms—irregular periods, hot flashes, sleep disruption, mood swings, sexual dysfunction, loss of libido, and cholesterol changes—then signs point to perimenopause.

About the Experts

Kecia Gaither, M.D., M.P.H., FACOG, is double board-certified in obstetrics-gynecology and maternal-fetal medicine. She is currently the director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, New York.

Natalie Kunsman, M.D., M.S., is a board-certified family physician and integrative medicine physician who treats women in menopause.

How Hormone Fluctuations Cause Perimenopause Body Aches and Pains

Hormone fluctuations, particularly the decline of estrogen and progesterone in perimenopause, can lead to body-wide aches and pains.

Shifts in estrogen and progesterone affect numerous systems throughout the body that could cause aches. Estrogen, for example, keeps muscles and bones strong, lubricates joints, and reduces inflammation. ^{2 3 4}

The reduced anti-inflammatory effect and cartilage support caused by declining estrogen can lead to increased stiffness, muscle soreness, and joint pain, explains women’s health expert and OB-GYN Kecia Gaither, M.D.

Progesterone has a calming effect on the nervous system and helps dial down pain by interacting with brain receptors that influence how we perceive discomfort. ^{5 6 7 8} When it declines, it can cause heightened sensitivity of these pain receptors associated with the nervous system.

Together, low estrogen and progesterone in perimenopause and menopause prime the body for pain and slower repair.

Orthopedic surgeon and aging specialist Vonda Wright, M.D, first coined the term “musculoskeletal syndrome of menopause” in a 2024 paper to describe the constellation of muscle, joint, and bone pain that comes with declining estrogen levels during the menopausal transition. ⁹ Her research was the first to validate the experiences of many women who report feeling like their bodies are “falling apart” despite no obvious injury.

Menopause and inflammation

Estrogen is anti-inflammatory, so when levels decline during perimenopause, it can lead to chronic low-grade inflammation that causes diffuse aches and greater discomfort after exercise. ¹⁰

“Estrogen and progesterone work together to keep inflammation in check—and they function best when in balance,” explains Kunsman. “When estrogen levels start to fluctuate, it can raise histamine levels [which stimulates inflammation] and disrupt the regulation of anti-inflammatory cytokines (signaling proteins), leading to muscle and joint stiffness.”

As estrogen continues to decline in menopause, the immune system can shift into a more inflammatory state. ¹¹

Muscle loss in menopause

Weaker muscles provide less support to joints, potentially leading to joint instability, abnormal movement patterns, and increased pain.

Since estrogen supports muscle production, maintenance, and repair, its gradual loss during perimenopause means weaker muscles. This hormone-related atrophy strains connective tissues, exacerbating stiffness, aches, and pains, explains Gaither. “Estrogen defects accelerate muscle protein breakdown and fat infiltration into muscle fibers, weakening structural support.”

A 2020 study shows that menopause-related hormonal changes predispose women to both sarcopenia (loss of muscle mass) and also osteoporosis (loss of bone density), which can mean aches and pains in the short-term and mobility disability and fall-related fractures down the line. ¹²

Heightened pain sensitivity and menopause

Not only are you potentially in more musculoskeletal pain during perimenopause, but you might also feel it more acutely. “Hormones, especially estrogen, modulate pain signals,” Kunsman says. “If estrogen drops, pain perception may increase.” Hormonal changes literally alter how the brain and nervous system process pain signals.

Besides feeling pain more intensely during menopause, you might also perceive pain from stimuli that were previously neutral. According to a 2023 review in Pain Reports, estrogen regulates how sensory neurons and immune cells interact, and with less estrogen leading up to menopause, that interaction can shift in a way that increases pain perception. ¹³

“Because estrogen also helps modulate pain sensitivity, lower levels can heighten discomfort,” says Gaither.
This dynamic between low estrogen and pain perception may help explain why chronic pain conditions such as fibromyalgia often first appear or worsen during the transition to menopause. Research has found a significant association between the severity of fibromyalgia symptoms and menopausal status, with lower estrogen levels linked with greater pain. ¹⁴

Menopause gut health

Rollercoastering hormones during the perimenopause-to-menopause transition also impact the gut-hormone axis, which contributes to increasing body-wide discomfort. “Fluctuating estrogen levels alter gut bacteria responsible for hormone metabolism, worsening inflammation and symptoms like bloating and fatigue,” Gaither explains.

Research supports a strong link between gut health, inflammation, and pain during menopause. A 2020 study in JCI Insight found that declining estrogen reduces the diversity of gut bacteria, which can lead to increased gut permeability—commonly known as leaky gut. This allows inflammatory substances to pass into the bloodstream, triggering systemic inflammation that may contribute to joint and muscle pain during perimenopause.¹⁵

Menopause stress

Chronic stress, which is common in midlife when women tend to be balancing a career, kids going to college, and aging parents, leads to sustained elevations in the hormone cortisol. ¹⁶ This prolonged increase in cortisol dampens the body’s ability to regulate inflammation, resulting in greater inflammation and increased pain sensitivity over time.¹⁷

According to Kunsman, stress often pairs with poor sleep, which is also common during perimenopause. Lack of sleep can further raise cortisol and also lower growth hormone, negatively impacting muscle recovery and joint health. This creates a vicious cycle during perimenopause, in which stress worsens pain, and pain, in turn, aggravates stress.

How to Stop Menopause Body Aches

Hormonal therapies can help reduce perimenopause body aches, but so can some key lifestyle strategies. Kunsman recommends starting with the latter. “If the root cause of your new muscle and joint aches and pains is hormone decline or loss, optimizing lifestyle strategies is the first step,” she says, pointing to exercise, a lower inflammatory diet, and better sleep.

Move more

Staying active is one of the best things we can do to combat perimenopause body aches. Inactivity and deconditioning can lead to poor joint and muscle health and make us prone to injury, Kunsman notes. Here’s how regular movement can help with perimenopause body aches:

• Protects against muscle loss: Strength training helps preserve lean muscle mass. Research shows it to be one of the best non-pharmacological therapies to improve the combined impacts of menopause and aging. ¹⁸
• Reduces pro-inflammatory markers: Kunsman highlights that obesity from lack of exercise and poor diet promotes systemic inflammation, which can affect muscles, tendons, and joints. Research shows that moderate aerobic activity can lower pro-inflammatory cytokines, molecules that promote and intensify inflammation. ¹⁹
• Delivers pain relief via endorphins: Endorphins, the peptide hormones released by the pituitary gland and hypothalamus in response to pain or stress, are your body’s natural pain killers. Aerobic exercise increases their production, especially that of the feel-good neurotransmitter serotonin. ²⁰ Studies show that endorphins may even relieve the widespread body pain of fibromyalgia. ²¹
• Helps with weight control: As Kunsman explains, excess weight strains the musculoskeletal system. “It can throw off posture and place added pressure on the spine,” she says. “Over time, this mechanical stress wears down cartilage, increasing the risk of arthritis and chronic pain.”

Kunsman cautions that if you’re starting a new exercise regimen be sure to stretch and allow the body to rest between workouts. The menopause transition might diminish mitochondria count, the tiny powerhouse structures in our cells critical for creating energy. Without proper recovery, women in menopause might be more prone to injury from disuse, overuse, or abuse.

Adjust your diet

What we eat can dial inflammation up or down, creating discomfort and menopause body aches. These studies illustrate how making some dietary adjustments during the perimenopause years can help lower inflammation, easing the aches and pains that inflammation causes.

• Anti-inflammatory vs. pro-inflammatory foods: Minimize inflammation-triggering foods, including processed meats, refined sugars, fatty meats and dairy, omega-6 fats, and alcohol. Instead, aim to follow a Mediterranean-style diet of proven anti-inflammatory foods, including avocados, berries, broccoli, dark chocolate, fatty fish high in omega-3, mushrooms, and olive oil. ²² Gaither recommends increasing intake of phytoestrogens (soybeans and flaxseed) to mimic estrogen’s positive effects; leafy greens and turmeric to reduce joint inflammation; and calcium and vitamin D to help preserve bone density and muscle function.
• Probiotics: Research shows that supporting gut health via probiotics and fiber intake may modulate the immune system and reduce systemic ache-inducing inflammation. ²³ Scientific reviews point to Lactobacillus strains—such as Lactobacillus casei Shirota—as being effective for managing pain and inflammation. ²⁴ Gaither also recommends upping your fiber intake, with foods such as beans and whole grains, to support the gut microbiome.

Manage stress

Feeling calm and in control helps keep cortisol in check, which helps prevent and ease stress-induced inflammation and body aches through the release of endorphins, including the feel-good hormone serotonin. Try these research-backed strategies to manage stress:

• Take a walk, ideally in nature, to increase the feel-good hormone serotonin and boost your mood. ²⁵
• Make to-do lists and plan ahead to feel more in control instead of overwhelmed. ²⁶
• Practice gratitude, which a research review in 2022 suggests can reduce stress and depression. ²⁷
• Practice yoga, meditation, slow breathing, and mindfulness to help calm a busy brain. These improve mood-enhancing hormones and activate the parasympathetic nervous system which helps your body relax. ²⁸

Hormone Therapy: HRT, MHT, and EPT

Hormone replacement therapy (HRT), also commonly called menopause hormone therapy (MHT), typically involves estrogen or a combination of estrogen and progesterone. In some cases, testosterone is added to improve muscle mass, libido, mood, energy, and bone density.

MHT is proven to help relieve debilitating menopause symptoms including hot flashes, night sweats, vaginal dryness and joint pain. ²⁹ A study in the journal Menopause also found that women who took estrogen-based HRT suffered less joint pain even though they had more joint swelling. A study on fibromyalgia, however, did not find a link between estrogen and reduced pain. ³⁰

While past research raised concerns about hormone therapy—in particular the increased risk of endometrial cancer with estrogen alone, the addition of progesterone in combined hormone therapy (CHT) greatly reduces this risk in women who still have a uterus.³¹

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About the author

Nicola Bridges is an award-winning writer and editor covering health and wellness for outlets including U.S. News & World Report, Yahoo Life, Parade Magazine, People, The Star (Toronto), and The Minnesota Star Tribune.

About the reviewer

Carol Lynn, MD is a board-certified OB/GYN who specializes in menopause management. She is a member of the American Board of OB/GYN (ABOG) and the North American Menopause Society (NAMS).