Understanding Muscle and Joint Pain in Midlife Women: The Musculoskeletal Syndrome of Menopause
Anna Harrelson • June 22, 2024

Managing Muscle and Joint Pain During Menopause: Understanding the Impact of Estrogen on Musculoskeletal Health

I am diving into a topic that is near and dear to me as it was, in hindsight, my bodies way of telling me I was in perimenopause.  It's a topic that many women experience but often don’t discuss enough: muscle and joint pain during the menopause transition. This discomfort is part of what’s known as the musculoskeletal syndrome of menopause. Let’s explore the physiology behind this and how you can combat it effectively.



The Role of Estrogen in the Musculoskeletal System

Estrogen plays a crucial role in maintaining musculoskeletal health. Estrogen receptors are present in various tissues, including muscles, tendons, ligaments, and bones. These receptors help regulate:

  • Collagen Production: Estrogen stimulates collagen production, maintaining the strength and elasticity of connective tissues.
  • Bone Density: Estrogen helps maintain bone density by balancing the activity of osteoclasts (cells that break down bone) and osteoblasts (cells that build bone).
  • Muscle Mass: Estrogen influences muscle mass and strength, which can affect overall physical function.
  • Anti-inflammatory Effects: Estrogen has anti-inflammatory properties that help reduce inflammation in the joints and muscles. This can alleviate pain and stiffness associated with menopause.


During menopause, the decline in estrogen levels leads to several changes:

  • Decreased Collagen: Reduced collagen production makes tendons and ligaments less elastic, leading to stiffness and pain.
  • Bone Loss: Lower estrogen levels accelerate bone loss, increasing the risk of osteoporosis and fractures.
  • Muscle Weakness: Muscle mass and strength decrease, contributing to overall musculoskeletal discomfort.
  • Increased Inflammation: The anti-inflammatory effects of estrogen diminish, leading to higher levels of inflammation, which can exacerbate joint and muscle pain.


Prevalence and Diagnosis of Musculoskeletal Disorders

  • Osteoarthritis (OA): OA affects more than 30 million adults in the U.S., with women being more likely to develop it after menopause.
  • Inflammatory Arthritis: Conditions like rheumatoid arthritis (RA) often onset between ages 40 and 60, with women being more commonly affected.
  • Fibromyalgia: This condition is diagnosed in about 2-4% of the population, predominantly women, often triggered or exacerbated by menopause.
  • Frozen Shoulder: Also known as adhesive capsulitis, it affects 2-5% of the population, with a higher incidence in women aged 40-60. It is characterized by stiffness and pain in the shoulder joint, often linked to hormonal changes during menopause.

These conditions are frequently treated with medications that manage symptoms but may not address the root cause related to hormonal changes.


Combatting Musculoskeletal Pain in Menopause

  1. Hormone Replacement Therapy (HRT)
  • HRT can help mitigate the decline in estrogen levels, supporting musculoskeletal health. Consult with your menopause doctor to see if HRT is right for you.
  1. Regular Exercise
  • Strength Training: Helps maintain muscle mass and bone density. Focus on weight-bearing exercises like lifting weights, squats, and resistance band workouts.
  • Flexibility Exercises: Yoga and stretching routines can improve flexibility and reduce stiffness.
  • Cardio: Activities like walking, swimming, and cycling promote overall health and support joint function.
  1. Balanced Nutrition
  • Calcium and Vitamin D: Essential for bone health. Include dairy products, leafy greens, and fortified foods in your diet.
  • Anti-inflammatory Foods: Incorporate foods rich in omega-3 fatty acids (like fish and flaxseeds), antioxidants (berries and nuts), and whole grains to reduce inflammation.
  1. Supplements
  • Calcium and Vitamin D Supplements: If dietary intake is insufficient, consider supplements.
  • Magnesium: Supports muscle and nerve function, helping to reduce cramps and spasms.
  1. Hydration
  • Staying hydrated is crucial for joint lubrication and overall health. Aim for at least 8 glasses of water a day.
  1. Adequate Rest
  • Ensure you get enough sleep to allow your body to repair and regenerate tissues. Aim for 7-9 hours of quality sleep each night.
  1. Professional Support
  • Physical Therapy: A physical therapist can provide tailored exercises to improve strength and flexibility.
  • Chiropractic Care: Can help manage pain and improve joint function through adjustments and other treatments.


Conclusion

Menopause brings various changes that can impact your musculoskeletal health, but understanding these changes and taking proactive steps can help manage and reduce muscle and joint pain. By incorporating a balanced approach of HRT, regular exercise, proper nutrition, and professional support, you can maintain your musculoskeletal health and improve your overall quality of life during the menopause transition and beyond.


Stay active, eat well, and take care of your body!

Dr. Anna

WonderCreek Health Blog

By Anna Harrelson April 11, 2025
You’re not crazy. You’re not lazy. And no, you’re not just "getting older." If you’re dragging through your days, feeling foggy, heavy, or worn out—but your labs are "normal"—you’re not alone. One of the most overlooked causes I find in my practice is suboptimal ferritin levels. Let’s break it down—with science, a little wit, and a whole lot of hope. Your Body: A High-Performance Machine Imagine your body like a beautifully engineered, high-performance car. Hormones are your spark plugs. Micronutrients are your engine oil. Proteins are your gears and pulleys. Without the right balance of all these building blocks, the engine sputters. It doesn’t matter how good the outside looks—if you're low on fuel or missing key fluids, you’re not getting out of the driveway. And iron —stored as ferritin—is a huge part of that fuel system. What Is Ferritin, and Why Should You Care? Ferritin is your body's iron storage protein. It’s like your gas tank. Not your current speed, not your miles per gallon—your actual reserve of fuel. Iron is essential for carrying oxygen to every cell in your body. It's crucial for energy production (ATP) in your mitochondria. It supports your thyroid, neurotransmitter function, hair growth, immune system, and even mood. If you’re low on ferritin, you might still show " normal " hemoglobin or hematocrit—so traditional screening won’t catch it until you’re running on fumes. Symptoms of suboptimal ferritin can include: Fatigue and poor exercise tolerance Brain fog or poor concentration Mood swings or low mood Headaches Hair shedding Shortness of breath with minimal exertion Restless legs or poor sleep Sound familiar? But My Labs Say I'm Normal... Here's the kicker: most lab ranges are designed to flag anemia — not optimal function. You could have a ferritin of 12 and be told " everything looks fine " — but feel absolutely awful. For most women, especially those who are still menstruating or recently stopped, ferritin levels under 40–60 ng/mL can cause symptoms . Many functional and integrative medicine specialists aim for 70–100+ ng/mL to support optimal energy, cognition, and hair health. Low-normal is not optimal. When your engine light is blinking, topping off the tank halfway doesn’t cut it. Why You Might Be Low Menstruation: Every period can deplete iron stores, especially if cycles were heavy. Pregnancy and postpartum: Even years later, many women never rebuild their iron stores. Gut health issues: Poor absorption due to low stomach acid, celiac disease, or IBS. Dietary patterns: Plant-based diets can be low in easily absorbed heme iron. Chronic inflammation: Inflammatory signals can "hide" your iron from circulation. Food First, But Realistic Yes, food matters. Red meat, poultry, seafood, lentils, spinach, and pumpkin seeds all contribute iron. But rebuilding storage? That’s a bigger lift. Think of dietary iron like filling up your gas tank 10–15% at a time. Helpful, but slow if you're starting on empty. Sometimes you need a boost. That’s where targeted supplementation can help—whether it’s gentle oral iron (like iron bisglycinate) or occasional intravenous iron if needed. And by the way, ever wonder why "senior" vitamins have no iron? Because postmenopausal women typically don’t lose blood monthly. We don’t want too much iron. But we also can’t function with too little. Balance is everything. Final Thoughts If you’re feeling run down, foggy, achy, or unlike yourself—it’s not "all in your head." Your body is whispering (or screaming) for better support. And sometimes the missing piece isn’t fancy. It’s basic, foundational, and fixable. Ferritin matters. Iron matters. You matter. At Wondercreek Health, I believe in digging deeper, connecting the dots, and helping you rebuild the strong, steady foundation your body deserves. Because you weren’t designed to run on empty. Iron-Rich Foods to Boost Your Levels Beef, lamb, liver (heme iron is best absorbed) Dark poultry (chicken thighs, turkey) Shellfish (clams, oysters, mussels) Lentils and chickpeas Spinach and swiss chard Pumpkin seeds and cashews Fortified cereals and oatmeal Tofu and tempeh Tip: Pair iron-rich foods with vitamin C (like bell peppers, oranges, or strawberries) to boost absorption! Ferritin Target Chart Ferritin Level What It Means <15 ng/mL Severe deficiency 15–40 ng/mL Low stores (symptoms likely) 40–60 ng/mL Borderline (may still have symptoms) 70–100+ ng/mL Optimal for energy, cognition, hair health Individual needs vary—always interpret ferritin in the context of your full health picture! When to Suspect Low Iron Feeling tired despite good sleep Exercise feels harder than it used to Brain fog or poor memory Unexplained hair thinning Pale skin or brittle nails Frequent headaches Restless legs or poor sleep Shortness of breath climbing stairs If you’re nodding along to several of these, it’s worth a closer look at your ferritin levels.
By Anna Harrelson March 30, 2025
Let’s start with this: there is nothing shameful or trivial about wanting a healthy sex life. If you're in your 30s, 40s, 50s, or beyond and wondering where your libido went, why sex feels different (or uncomfortable), or why no one ever warned you about vaginal dryness, you’re not alone. And you’re not imagining it. At Wondercreek Health, I talk to people every week who feel confused, dismissed, or ashamed about the sexual changes happening in their bodies. Many are thriving in every other area of life—careers, caregiving, health—but when it comes to intimacy, they feel stuck or unseen. So let’s say this together: sexual health is part of whole-person health. And pleasure is not optional . It’s a reflection of nervous system safety, hormonal balance, connection, and self-awareness. It belongs to you. What Happens to Sexual Health in Midlife and Beyond? Hormonal shifts during perimenopause and menopause can affect every part of your sexual experience. But so can chronic stress, birth control, antidepressants, trauma, and the weight of daily responsibilities. This is never just one thing. Common symptoms include: Vaginal dryness, burning, or itching (genitourinary syndrome of menopause, or GSM) Pain with sex (dyspareunia) Loss of libido or arousal Less intense or harder-to-reach orgasms Urinary urgency or UTIs Pelvic floor tension or dysfunction These changes aren’t "just in your head" and they’re not a moral failure. They reflect real shifts in tissue, blood flow, hormones, and brain chemistry. Sex Isn’t Just for Someone Else’s Benefit Let’s say the quiet part out loud: many of us were raised to believe that sex was about someone else's pleasure. That we should be desirable, responsive, available—regardless of how we felt. That conditioning runs deep. But sex isn’t about performance. It’s about connection, intimacy, and pleasure—for you. Pleasure is your birthright. Intimacy can be tender, playful, spiritual, or wild— but it should never feel like pressure. Your desire may look different than someone else's, and that’s okay. This is true whether your partner is male, female, nonbinary, or you're navigating intimacy solo. There is no one-size-fits-all experience. Why Your Desire Might Feel "Off" Sexual changes can happen at any age. Oral contraceptives (OCPs) can suppress libido by lowering free testosterone. SSRIs and other antidepressants are well known to impact arousal and orgasm. Perimenopause often starts in the mid-30s, long before you notice hot flashes. Chronic stress and the mental load of caregiving, multitasking, and decision fatigue can leave no room for desire. Because here’s the reality: desire doesn’t live in your genitals. It starts in your brain . And when your brain is overloaded with to-dos, responsibilities, or unspoken resentment, it’s nearly impossible to shift into a space of curiosity, connection, and arousal. Unwinding the mind can be hard. For some of us, it means learning to use tools like mindfulness, breathwork, somatic practices, therapy, or just having space and time away from the demands of the world. Creating room for desire isn’t selfish. It’s a form of self-trust and reclamation. The Good News: This Is Treatable Sexual health doesn’t have to decline just because estrogen does. There are safe, effective, empowering ways to reconnect with your body and reclaim your pleasure. 1. Local vaginal estrogen (or DHEA or testosterone): Restores tissue health, lubrication, and blood flow Improves comfort, arousal, and pelvic health Safe for most people, even those with a history of breast cancer (with appropriate guidance) 2. Systemic hormone therapy: Can improve libido, mood, sleep, and confidence Testosterone therapy (when indicated) can support arousal and orgasm 3. Pelvic floor physical therapy: Addresses pain, tension, and coordination issues Supports better sensation and comfort 4. Nervous system regulation: Practices like breathwork, somatic therapy, or trauma-informed care help shift from "fight or flight" into connection When the nervous system feels safe, desire can return 5. Sex therapy or coaching: Helps explore personal blocks, relationship dynamics, and pleasure mapping Let’s Talk About Desire You might notice you don’t feel spontaneous desire anymore— but that doesn’t mean you’re broken . For many people, responsive desire (desire that follows arousal) becomes the norm in midlife. And it’s perfectly valid. Touch, connection, and intimacy may need more warming up. But your ability to experience pleasure is still intact—and it can grow deeper, richer, and more grounded as you reconnect with your body on your own terms. Final Thoughts You don’t need to be fixed. You deserve to be heard. You deserve to feel good in your body. Sexual health is not about keeping up with anyone else’s timeline or expectations. It’s about reclaiming what intimacy and connection mean to you in this season of life. At Wondercreek Health, I’m here to help you connect the dots, reduce shame, and support you with science-backed, judgment-free options that honor your experience. Because this is not the end of your sexual story. It might just be the beginning of the most powerful chapter yet.
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