Perimenopause, Pain & Injuries: Why Your Body May Feel Different

New aches, a stiff shoulder, unexplained tendon pain or episodes of dizziness in your 40s? It may not be “just getting older.” For some women, these physical changes can coincide with perimenopause.

Perimenopause is often associated with changes in menstrual cycles, hot flushes, night sweats, sleep and mood. But the menopause transition can also affect the musculoskeletal and nervous systems, with many women noticing changes in their joints, muscles, tendons, balance and physical recovery. In fact, perimenopause can cause 176 different symptoms!

As chiropractors, we often see women presenting with a new physical complaint who are surprised when we ask about changes in their menstrual cycle, sleep, recovery and other symptoms of perimenopause.

This doesn’t mean that every episode of back pain, shoulder pain or injury is caused by hormonal changes. Rather, the transition through perimenopause can be one piece of a much larger picture that influences how the body responds to physical load, recovery, sleep, stress and injury.

A 2026 systematic review and meta-analysis involving more than 93,000 women found that approximately 57% of perimenopausal women reported muscle or joint pain, compared with 40% of premenopausal women. The authors found a 35% higher relative risk of muscle or joint pain during perimenopause compared with the premenopausal period, although there was substantial variation between studies (Kruse et al., 2026).

So, what physical symptoms might women notice?

1. Joint pain and stiffness

One of the most common physical complaints during perimenopause is a general increase in joint pain, stiffness and aching.

This can affect the:

Some women describe feeling unusually stiff when getting out of bed or after sitting for a period of time. Others notice that joints which previously tolerated exercise without difficulty are becoming more sensitive.

The relationship between menopause and musculoskeletal pain is complex. Changes in oestrogen are thought to influence a number of tissues and physiological processes involved in pain, inflammation, connective tissue and musculoskeletal health. However, it is important not to oversimplify this relationship: current evidence demonstrates an association between menopause and musculoskeletal symptoms, but does not mean that reduced oestrogen is the sole cause of pain (Magliano et al., 2018; Watt et al., 2024).

You do not have to simply put up with persistent joint pain. If stiffness or aching is affecting your sleep, exercise, work or daily activities, a chiropractic assessment may help identify contributing movement, strength or load-related factors and guide an appropriate rehabilitation plan as well as providing pain relief. This is important to improve sleep and stress, which can both be worsened by pain, but also exasperate pain themselves - an ugly cycle.

2. “Frozen shoulder” - the perimenopausal shoulder

One particularly interesting condition is adhesive capsulitis, commonly called frozen shoulder.

Frozen shoulder causes increasing shoulder pain and restriction of movement. People may notice difficulty reaching overhead, putting on a bra, reaching behind their back or sleeping comfortably on the affected side.

Frozen shoulder is particularly common in women in midlife, and the timing overlaps considerably with perimenopause and menopause.

Research specifically investigating the relationship between hormonal changes and frozen shoulder is still developing. While frozen shoulder is associated perimenopausal women, we cannot currently say that perimenopause directly causes frozen shoulder.

A stiff and painful shoulder is worth assessing rather than simply attributing to posture or “wear and tear”. After an assessment, a treatment plan can be devised for pain relief, mobility and strength. Your chiropractor will help create long-term strategies, not just quick fixes.

3. Tendon pain and tendon injuries

Another area attracting increasing research interest is tendon health during and after the menopause transition.

Tendons are connective tissues that transfer force between muscles and bones. Tendinopathies can affect almost any tendon, including the:

Oestrogen receptors are present in connective tissues, including tendons, and researchers have proposed that changes in sex hormones may influence collagen turnover, tendon structure and the way tendons respond to mechanical loading.

Why might this matter?

A woman who has previously been able to increase her running, strength training, tennis or other exercise without difficulty may find that her body is suddenly less tolerant of the same training load. Suddenly she gets post exercise soreness (DOMS) that she didn’t previously get. Recovery feels harder and longer.

This does not mean she should stop exercising.

Quite the opposite.

It may mean that training load, recovery, strength, sleep and nutrition need to be considered more deliberately.

A useful way of thinking about this is:

The same load + changing hormones = potentially a different response.

If tendon pain is lingering, worsening or limiting your activity, do not feel that you have to push through it or stop moving completely. Your chiropractor can help assess the area, identify aggravating loads and develop a graded rehabilitation program to rebuild tendon capacity safely and progressively. They’ll also treat the area to provide relief!

4. Neck and back pain

Neck and back pain are common throughout adult life, so it would be silly to suggest that perimenopause is the direct cause of spinal pain.

However, the increase in overall musculoskeletal symptoms during the menopause transition means that some women may notice changes in their usual patterns of neck or back pain (Kruse et al., 2026).

Pain can also be influenced by several factors that frequently change during perimenopause, including:

Pain can also create a cycle that is difficult to break:

Pain interrupts sleep → poor sleep increases pain sensitivity → increased pain reduces activity → reduced activity can reduce strength and physical capacity.

You do not have to suffer through that cycle! Chiropractic care can help reduce neck and back pain. This may include lifestyle advice, hands-on care, movement tweaks and rehabilitation exercises designed to help you reduce pain, return to normal activities and improve your confidence with movement.

5. Muscle aches and feeling “older overnight”

One of the more frustrating experiences reported by women during perimenopause is the feeling that their body has suddenly become less resilient.

Someone might say:

“I used to be able to exercise and recover. Now everything hurts.”

In fact, more than half of perimenopausal women report joint or muscle pain (Kruse et al., 2026).

Changes in muscle mass and physical performance are also important considerations as women progress through midlife.

This is one reason resistance training becomes particularly valuable.

Rather than responding to increasing aches by becoming progressively less active, maintaining or developing strength can help support physical capacity, bone health, muscle function and confidence with movement.

If aches are making exercise feel intimidating, your chiropractor can help you identify a manageable starting point. Rehabilitation does not have to mean doing more than your body can tolerate. It should be tailored to your current capacity and progressed gradually as your strength, mobility and confidence improve.

6. Dizziness, balance and vestibular symptoms

Some women report:

Even your inner ears have oestrogen receptors! There is emerging evidence that hormonal changes during the menopause transition may interact with the vestibular system (inner ears), which helps the brain interpret head movement, spatial orientation and balance. Disturbances in the vestibular system give rise to dizziness, vertigo, floating, rocking and other sensations  

The nervous system is influenced by oestrogen and other hormonal changes in several ways. These effects encompass changes in energy metabolism, immune and inflammatory regulation, neurotransmitters, blood circulation, and neuroplasticity pathways.

These mechanisms may help explain why some women notice changes in balance, motion sensitivity, migraine, concentration or their ability to adapt to sensory information during perimenopause. They may also help explain why dizziness can feel worse when combined with sleep deprivation, stress, illness, dehydration or physical fatigue.

Why can dizziness feel worse during perimenopause?

Several factors may overlap:

• Hormonal fluctuations may influence vestibular processing and sensory integration.

• Hot flushes and sweating may contribute to dehydration or changes in blood pressure.

• Poor sleep may reduce the brain’s ability to process balance information efficiently.

• Migraine patterns may change during perimenopause and may include dizziness, even without a severe headache.

• Neck pain or reduced neck movement may contribute to altered balance or motion sensitivity in some people.

• Anxiety about dizziness can increase vigilance and make movement feel less predictable.

• Reduced activity can lead to deconditioning and lower confidence with balance.

This does not mean that dizziness is “all in your head.” It means that balance is controlled by several interacting systems, including the inner ear, eyes, brain, neck and musculoskeletal system.

How can chiropractic care help with dizziness?

The first step is finding the right diagnosis - what’s causing the dizziness? Depending on your symptoms, your chiropractor may assess:

• Neck movement and muscle function

• Balance and coordination

• Proprioception

• Headache or migraine features

• Movement-related dizziness

• Visual motion sensitivity

• Neurological symptoms

• Recent injuries or changes in activity

• Factors such as sleep, stress, hydration and recovery

You do not have to simply avoid movement because it makes you dizzy. In some cases, carefully graded exposure to movement, balance exercises, neck rehabilitation or vestibular rehabilitation may help improve confidence and tolerance. The right approach depends on the cause and pattern of your symptoms.

A chiropractic approach to dizziness generally involves several approaches simultaneously: home exercise program + hands-on treatments. Our chiropractors have extra training in dizziness here and so they go above and beyond with dizziness. This is also important as a preventative for falls later in life!

When is dizziness urgent?

Seek urgent medical assessment for sudden or severe dizziness, particularly if it occurs with:

• New weakness or numbness

• Facial drooping

• Difficulty speaking

• Double vision or sudden vision loss

• Severe new headache

• Fainting

• Chest pain

• Severe shortness of breath

• New difficulty walking

• Loss of coordination

• Persistent vomiting

• Sudden hearing loss

If dizziness is recurrent, unexplained or affecting your work, driving, exercise, sleep, mood or confidence, arrange an assessment rather than trying to manage it alone.

7. Headaches and migraine may also change

Hormonal fluctuations can influence neurological symptoms, and many women report changes in headaches or migraines around the menopause transition.

For some women, previously predictable menstrual migraine patterns can become less predictable during perimenopause because oestrogen levels fluctuate considerably before eventually declining.

Headaches and migraines can be managed or even cured depending on the cause  it’s important to have a thorough assessment first - particularly for any new onset headaches.

8. Why sleep and recovery matter

One of the biggest contributors to the physical experience of perimenopause may be recovery.

Night sweats, hot flushes, sleep disruption and other symptoms can interfere with sleep quality.

Poor sleep can then influence:

This creates an important feedback loop.

Hormonal changes → disrupted sleep → reduced recovery → increased sensitivity to physical load → pain or injury → reduced activity → further loss of conditioning.

Pain can make sleep more difficult, and sleep interruption can increase pain sensitivity. If you are caught in that cycle, you do not have to wait for it to resolve on its own.

A chiropractor may help address the musculoskeletal contributors to pain and provide a rehabilitation plan that supports movement and recovery. At the same time, sleep disruption, hot flushes, night sweats and other perimenopausal symptoms may require discussion with your GP or another appropriately qualified healthcare professional. Acupuncture and naturopathy can be particularly helpful for hormonal changes.

Breaking the cycle may require more than treating the painful area. It may involve improving mobility, rebuilding strength, adjusting exercise load, addressing recovery and coordinating care for hormonal or medical symptoms.

What does this mean from a chiropractic perspective?

At Body & Brain Centre, we view musculoskeletal symptoms within the context of the whole person.

For a woman experiencing new physical symptoms during perimenopause, an assessment may consider:

The musculoskeletal system

We may assess:

• Spinal and joint movement

• Muscle function

• Strength and control

• Movement patterns

• Load tolerance

• Previous injuries

• Work and exercise demands

The nervous system

Depending on the presentation, this may include consideration of:

• Balance

• Coordination

• Proprioception

• Vestibular symptoms

• Headache characteristics

• Neurological symptoms

• Sensory changes

• Movement-related dizziness

Lifestyle and recovery

We may also discuss:

• Sleep

• Exercise

• Training load

• Recovery

• Stress

• Nutrition

• Work demands

• Changes in physical activity

• Hydration

• Hot flushes and night sweats

The purpose isn’t to attribute every symptom to menopause.

It is to recognise that the body does not operate in isolated systems.

It is also to make sure you receive practical support rather than being told to simply tolerate pain, stiffness or dizziness because it is “part of getting older.” You deserve support and relief!

What can women do to support their musculoskeletal health during perimenopause?

There is no single “perimenopause exercise” or treatment that suits everyone.

However, several foundations are particularly important.

1. Keep moving

Regular physical activity is important for maintaining strength & bone density, cardiovascular health, mobility and physical capacity.

If pain or dizziness has caused you to stop exercising, the answer is often not complete rest. Instead, the goal is to identify an appropriate starting point and gradually rebuild capacity.

If you are unsure what is safe, seek guidance. Your chiropractor can help modify exercises, identify suitable alternatives and develop a graded return-to-activity plan.

2. Prioritise resistance training

Strength training is particularly valuable during midlife because maintaining muscle and physical capacity becomes increasingly important.

Progressive resistance training can help maintain strength and function and is an important component of healthy ageing. This includes lifting heavy weights where you can only manage 6-8 reps and having a proper 1-2 minutes recovery between sets.

If pain has interrupted your training, rehabilitation can help you return progressively rather than trying to resume your previous routine immediately.

3. Don’t ignore persistent tendon pain

If a tendon has become painful and is not settling, continually pushing through it may not be the best approach.

Conversely, completely avoiding loading a tendon for long periods can also reduce its capacity.

A tailored rehabilitation program can help determine an appropriate level of loading.

4. Address sleep

If sleep has changed dramatically during perimenopause, this deserves attention in its own right.

Improving sleep may be an important part of improving pain, recovery and exercise tolerance.

If pain is interrupting your sleep, chiropractic care and rehabilitation may help address relevant musculoskeletal contributors. If hot flushes, night sweats or hormonal symptoms are disrupting sleep, discuss these with your GP.

5. Consider the hormonal picture

Musculoskeletal symptoms can be one part of a much broader perimenopausal presentation.

If physical symptoms are occurring alongside changes such as:

• Irregular periods

• Hot flushes

• Night sweats

• Sleep disturbance

• Mood changes

• Brain fog

• New migraine patterns

• Changes in sexual or genitourinary health

it may be worth discussing perimenopause with your GP or another healthcare professional.

Hormone replacement therapy may be appropriate for some women, but it is an individual medical decision. Hormone therapy shows no significant overall reduction in generalised musculoskeletal pain (Overton et al., 2026).

When should you seek further assessment?

New symptoms during perimenopause should not automatically be attributed to hormones.

Don’t suffer through perimenopause-related pain

Perimenopause can be a time of significant physical change, but that does not mean you have to accept ongoing pain, stiffness, reduced movement or dizziness as something you simply have to endure.

If pain is interrupting your sleep, if stiffness is limiting your exercise, if tendon injuries are stopping you from doing the activities you enjoy, or if dizziness is affecting your confidence, seek help.

A chiropractor can assess your neuro-musculoskeletal and movement-related factors, provide appropriate care and develop a rehabilitation plan to help you move more comfortably and confidently. Where symptoms require further input from a specialist, your chiropractor can also help identify when referral or collaborative care is appropriate, and with who.

Perimenopause is a physiological transition - not a diagnosis for every ache

Perhaps one of the most useful messages for women is that you are not imagining the changes in your body.

The evidence increasingly supports an association between the menopause transition and musculoskeletal symptoms. At the same time, the science is more nuanced than saying “low oestrogen causes injuries.”

Your age, previous injuries, physical activity, sleep, stress, training load, muscle strength, bone health, general health and hormonal changes can all interact.

For some women, perimenopause may be the point at which previously manageable physical stresses begin to exceed their current capacity.

That doesn’t mean your body is breaking down.

It may mean that your body is asking for a different approach to movement, recovery and physical load.

Understanding that change can be the first step towards responding to it.

You do not have to suffer through the transition alone. With appropriate assessment, education, rehabilitation and coordinated healthcare, it may be possible to reduce pain, improve movement and regain confidence in your body.