Chronic pain at midlife is the World Menopause Day theme for 2026 (October 18). The International Menopause Society says it affects a significant proportion of women during and after the menopause transition and is still underestimated in research and care.[1] Here is what the evidence says about how common aches are, who may have a harder transition, and what the evidence shows: movement, with low-quality but encouraging data, and hormone therapy as a conversation to have with your clinician.
How common aches are
A 2026 systematic review pooled 37 observational studies covering 93,021 women. Muscle or joint pain was reported by 40% of premenopausal women, 57% of perimenopausal women and 59% of postmenopausal women, a 1.35-fold higher risk in perimenopause than before it.[2] The studies varied a lot and were observational, so this shows an association, not that menopause causes the pain. Aches have many other causes. For the wider picture of what women say they know about menopause, see Menopause Symptoms: Only 37% of Women Feel Informed.
Pain may come first
A British birth-cohort study followed people born in 1958. Women with chronic pain (lasting longer than three months) at age 44 had higher odds of falling into the higher menopausal symptom groups at age 50: an odds ratio of 2.90 for the high-burden group, and 1.50 for a group defined mainly by hot flashes and night sweats.[3] This is an association in self-reported data from one generation of British women, so it cannot prove cause. The practical point is simple: if you already live with chronic pain, say so to your clinician before the transition gets rough, not after.
What the evidence shows
Movement
A Cochrane overview of 21 reviews (381 studies, 37,143 participants) examined exercise for chronic pain in adults, including aerobic, strength, flexibility and balance training, yoga, Pilates and tai chi. Physical function improved in 14 reviews, mostly by small-to-moderate amounts. Pain severity improved in several reviews but not consistently, and the review authors reported no negative effects, though only 25% of the included studies actively reported adverse events. The most common side effect was soreness that faded after a few weeks.[4] The evidence was rated low quality, mainly because the studies were small. The conditions covered included osteoarthritis, fibromyalgia and low back pain, not menopause specifically.
Practical read: pick a form of movement you will actually repeat, build up gradually, and expect some soreness at first. Strength training was one of the program types studied; the review did not rank types against each other. If you have a diagnosed joint condition, ask your clinician what to start with.
Hormone therapy
In the Women’s Health Initiative estrogen-alone trial, 10,739 postmenopausal women who had had a hysterectomy took oral estrogen or a placebo. After one year, 76.3% of the estrogen group reported joint pain versus 79.2% of the placebo group, and the difference lasted through year three. Joint swelling went the other way: 42.1% versus 39.7%. The authors called the effect on pain modest but sustained.[5] This was a secondary analysis of a trial designed around other outcomes, and it covered postmenopausal women without a uterus taking a single oral estrogen dose, not women in the menopause transition, so it cannot tell you whether hormone therapy will ease your aches. It is a reason to raise pain, not just hot flashes, when you discuss options. Timing and personal risk matter. Hormone therapy has risks as well as benefits, and they depend on your age, health history and time since menopause, so ask your clinician to walk through them. The treatment window is covered in our post on the Gallup menopause survey.
Before your appointment
- Track pain for two weeks. Rate it 0 to 10 each day, note where it hurts, how many hours you slept, and what eased it.
- Note the timeline. When did the aches start relative to changes in your cycle? Have you had chronic pain before?
- Report swelling as well as pain. The two moved differently in the hormone trial above.
- Ask three questions. What else could explain this pain, and what should we rule out? Would movement, hormone therapy or both be reasonable for me? When should we recheck?
- Do not accept “just aging” as the whole answer. Pain that lasts longer than three months counts as chronic and deserves a proper evaluation.
For a script to bring with you, see how to talk to your doctor about severe menopause symptoms. For the symptoms people miss, read Perimenopause Is Not Just Hot Flashes.
Only a clinician who knows your history can say what is causing your pain or whether hormone therapy fits you. Don’t start, stop or change a medication on your own.
References
[1] International Menopause Society. World Menopause Day 2026: Chronic Pain At Midlife. imsociety.org, 2026. Population: not a study; society campaign page. Link: https://www.imsociety.org/education/world-menopause-day-2026/. Finding as used: World Menopause Day is held every year on 18 October; the 2026 theme is chronic pain at midlife, which the society says affects a significant proportion of women during and after the menopause transition yet remains underestimated in both research and care. ↑︎
[2] Kruse C, McKechnie T, Dworsky-Fried Z, et al. Musculoskeletal Manifestations of Perimenopause: A Systematic Review and Meta-Analysis of 93,021 Women. JBJS Open Access, 2026;11(1):e25.00254. Population: 37 observational studies across 22 countries, 93,021 women. DOI: https://doi.org/10.2106/jbjs.oa.25.00254. Finding as used: muscle or joint pain prevalence was 40% (95% CI 32%-49%) in premenopausal, 57% (48%-65%) in perimenopausal and 59% (50%-67%) in postmenopausal women; perimenopausal versus premenopausal risk ratio 1.35 (95% CI 1.25-1.46); heterogeneity was high (I2 88.6%) and the authors state the findings are observational and need confirmation. ↑︎
[3] Borra C, Hardy R. The association between chronic pain and the clustering of menopausal symptoms: Evidence from a British birth cohort study. Maturitas, 2025;203:108756. Population: National Child Development Study (born 1958 in England, Scotland and Wales); chronic pain assessed at age 44, menopause symptoms at age 50; latent class analysis n = 4,897, structural equation models n = 3,308. DOI: https://doi.org/10.1016/j.maturitas.2025.108756. Finding as used: chronic pain (lasting longer than 3 months) at 44 was related to greater odds of belonging to higher menopausal symptom burden classes at 50; odds ratio for the high symptom burden class 2.90 (95% CI 2.21-3.81) and for the vasomotor symptom class 1.50 (95% CI 1.16-1.94). ↑︎
[4] Geneen LJ, Moore RA, Clarke C, Martin D, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev, 2017:CD011279. Population: 21 reviews, 381 studies, 37,143 participants (264 studies, 19,642 participants examined exercise versus no exercise or minimal intervention). DOI: https://doi.org/10.1002/14651858.CD011279.pub3. Finding as used: physical function significantly improved in 14 reviews with small-to-moderate effect sizes; pain severity favorable in several reviews but inconsistent; no negative effects; only 25% of included studies actively reported adverse events; most adverse events were increased soreness or muscle pain that subsided after a few weeks; evidence quality low because most included studies had fewer than 50 participants; conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia and low back pain. ↑︎
[5] Chlebowski RT, Cirillo DJ, Eaton CB, Stefanick ML, et al. Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial. Menopause, 2018;25(11):1313-1320. Population: 10,739 postmenopausal women with hysterectomy randomized to conjugated equine estrogens 0.625 mg/d or placebo; post hoc analysis. DOI: https://doi.org/10.1097/gme.0000000000001235. Finding as used: at 1 year joint pain frequency was lower with estrogen (76.3% vs 79.2%, P = 0.001), with the difference persisting through year 3; joint swelling frequency was higher with estrogen (42.1% vs 39.7%, P = 0.02); the authors concluded estrogen alone results in a modest but sustained reduction in the frequency of joint pain. ↑︎
Kurt Greiner
Kurt is a digital strategist and IT professional blending emerging technology with practical application to help businesses and individuals streamline their digital presence. His current work focuses on the intersection of intentional living and technological resilience, exploring how individuals can leverage modern tools to navigate the second half of life with purpose.
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