Muscle and joint pain during menopause & the other system no one told you about

Rinse, wash, repeat.

You've been going through the cycle and getting nothing from it.

Doctor visits lead to imaging lead to physical therapy (or other therapies) for months —maybe a year. You followed every instruction, did every exercise, and... today you still wake up stiff.

Your movement modifications are now part of who you are, and your body has almost forgotten its true potential. Your daily plan revolves around what your body can handle.

And you decide that you're happy enough.

So you've accepted this is just how it is now – you're in a state of quiet shrinking and you don't even know it.

But what if the problem isn't your joints, your age, or even how much pain tolerance you have?

What if everything you tried was treating the wrong system entirely? What if the chronic pain management for women you need starts with understanding a system most doctors never mention or even really know why it is so relevant?

A middle aged woman holding her shoulder as it glows red to signal pain in her joint and surrounding soft tissue.

The missing piece in your pain puzzle

Your fascial network is the intelligent web that connects everything in your body. Think of it as your body's internal scaffolding — a thin but incredibly strong spiderweb that holds everything in place: your muscles, bones, and organs. It travels underneath the skin, around your muscles, bones, and around your organs. It gives you the structure that you crave back in your arm muscles.

When this web is healthy, it's flexible and glides smoothly. Your arm floats easily above your head and your body can crouch low without pain.

But during hormonal transitions, fascial stiffness becomes a real problem that creates the menopause joint pain and muscle aches that may start during perimenopause you're experiencing (you'll see below why this can happen).

Research from the University of Padova shows that human superficial fascia is a distinct anatomical structure. This means it is alive with specific cells, nerves coursing in and out, and vascularization properties. This thin, fibrous membrane extends continuously throughout the body and is composed of irregularly collagen fibers and elastic fibers.

Most women don't know this system exists, let alone that it's the key to feeling strong and mobile again.

Your fascial pain allows for the smoothness of movement without restriction when you lift your arm behind your back to put on your coat, take off a sports bra, or reach overhead to get your favourite mug.

When fascia becomes restricted? Those are the twinges of sharp pain, reduced movement ability, and the way you've started moving differently to avoid painful positions.

You haven't tried everything. You just haven't tried the right thing yet.

Why your fascia fails during hormonal changes

Estrogen plays a crucial role in maintaining fascial health. Think of it as the hormone that keeps your internal spiderweb supple and well-hydrated.

Fascia runs throughout your entire body – from the tips of your toes and fingers continuously without a break to your hips, shoulders, lower back, neck, and torso. It's all connected.

Imagine a sponge layer lying on top and around every single muscle, immediately underneath your skin. When this layer is hydrated, like a wet sponge, you have mobility and flexibility. Your joints move smoothly.

But if you let this sponge dry out? Movement becomes challenged, reduced, stiff, and painful. Have you ever tried to bend a stiff, dried out sponge?

Research published in Dermato-Endocrinology demonstrates that estrogens significantly modulate skin and fascial physiology. During perimenopause and menopause, estrogen deficiency results in decreased collagen content, decreased elasticity, increased wrinkling, and increased dryness of connective tissues.

Research from Italian scientists shows exactly how your hormones change your body's connective tissues. They took samples of the thin tissue layer under your skin (this is your fascia) and tested what happens when hormone levels change – just like they do during your monthly cycle and menopause.

Here's what they discovered:

When estrogen is low (like after menopause): Your body makes more of the tough, rigid type of collagen and less of the stretchy, flexible kind. Think of it like your tissues becoming more like beef jerky instead of a rubber band.

When estrogen is high (like during ovulation): Your body flips the switch – making less rigid collagen and way more flexible collagen. Your tissues become more like that rubber band again.

This isn't just a small change. We're talking about your body completely switching which type of building material it uses based on your hormone levels.

This explains why so many women suddenly wake up one morning and feel like something in their body has "changed overnight" during menopause. Your tissues literally did change – they became stiffer and less flexible because your body started using different building blocks. You're just noticing it now.

Doctors have a name for this: "musculoskeletal syndrome of menopause." It's that collection of aches, stiffness, and reduced mobility that most conventional treatments completely miss because they're not looking at the real cause.

The inflammatory connection to muscle, joint, and fascial pain

Recent research published in the American Journal of Physiology reveals an important finding regarding inflammation and stiffness: Deep layers of adipose tissue – this is the layer beneath your superficial fascia beneath the skin – is rich for inflammatory and tissue remodeling pathways compared to superficial tissue.

This means that during the hormonal transitions of menopause, not only does your fascia become stiffer due to collagen shifts we discussed above, but the deeper tissues become more prone to inflammation. This creates a storm for widespread pain and dysfunction.

Studies show through ultrasound that individauls with chronic low back pain have less fascia movement and flexibility between their tissues compared with healthy controls without back pain. These mechanical properties of fascia and its stiffness directly correlate with pain and disability scores.

What influences your fascial health

We can improve fascia when we focus on improving our tendons, muscles, strength, power, stability, balance, and flexibility. However, fascia itself must also be specifically targeted to ensure its continuous ability to perform.

There are key factors that influence fascial health:

• Nutrition and hydration

• Resistance training and power training

• Electrolyte balance

• Stress management

• Balanced body system functions

The good news? Addressing fascial dysfunction isn't complicated. It's not hard to begin working with your fascia, and the movements aren't new or complicated – just fine-tuned.

Where to start: Simple steps for fascial health

The first thing I tell women to do is pay attention to how much they hydrate in a day. You may think you drink enough water (we all do), but the only way to really know is to measure it.

Then we must consider the meals you're eating. Eating throughout the day not only ensures we're getting nutrients, it also supplies our body with essential electrolytes to hold hydration in the body.

Your fascia needs both water and the minerals to keep that water where it belongs.

Here is what really gets your tissue rehydrated: performing exercises that target your fascial system.

When you contract muscles, you're pumping blood to muscles, tendons, and fascia. Certain types of contractions first decrease, then increase blood flow. This pumping effect of blood brings nutrients to the area and helps get rid of the things that could be adding to stiffness and pain.

It's like wringing out a sponge and then absorbing water into it again.

Simple exercises for immediate relief

Hip opener for fascial mobility: Hold a mid-range squat 3 times for 10 seconds. If this is easy, begin to hold weight while maintaining perfect form. This technique opens up restricted tissue in your hips and pelvis.

Core and shoulder activation: Hold a plank or side plank for 30 seconds, three times. This loads the shoulders and activates core fascia, addressing the upper body stiffness common during hormonal transitions.

Low back fascial release: Swing your leg briskly from side to side. This helps improve low back pain – if not get rid of it altogether – by creating more gliding between the layers of skin, muscle, and fascia. This simple movement addresses connective tissue restrictions that contribute to chronic discomfort.

None of this is hard. It's just a different way to look at the same system that has been asking for help for a very long time.

Hormone research and your pain

The most fascinating finding from recent fascial research is how quickly tissue responds to hormonal changes.

This explains why some women experience more dramatic changes in stiffness and pain during certain phases of their cycle, and why hormonal approaches to treatment can be so effective for fascial-related pain.

Understanding how estrogen affects fascial health can help you make informed decisions about your treatment options. Whether you choose hormone therapy or not, supporting your fascial system through targeted movement, proper hydration, and stress management can significantly improve how you feel in your body.

The fascial system also contains a rich network of blood and lymphatic vessels. When this system becomes dysfunctional, it can affect circulation, lymphatic drainage, and immune function – creating a cascade of symptoms that go far beyond simple "muscle tension."

Moving forward with fascial health

Your body isn't broken. Your pain isn't inevitable. You can have more freedom of movement. You've just been working on the wrong system.

The research is clear: your fascial network is a sophisticated, hormone-responsive system that requires specific attention during hormonal transitions.

By understanding how hormones affect your connective tissues, you can finally address the root cause of your pain rather than just managing symptoms.

It's time to work smarter, not harder, with the web that connects everything together.

References

1. Fede, C., Clair, C., Pirri, C., Petrelli, L., Zhao, X., Sun, Y., Macchi, V., & Stecco, C. (2025). The human superficial fascia: A narrative review. International Journal of Molecular Sciences, 26(3), 1289. https://doi.org/10.3390/ijms26031289

2. Fede, C., Pirri, C., Fan, C., Albertin, G., Porzionato, A., Macchi, V., De Caro, R., & Stecco, C. (2019). Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production. PLoS ONE, 14(9), e0223195. https://doi.org/10.1371/journal.pone.0223195

3. Thornton, M. J. (2013). Estrogens and aging skin. Dermato-Endocrinology, 5(2), 264-270. https://doi.org/10.4161/derm.23872

4. Tomita, N., Roy-Cardinal, M.-H., Chayer, B., Daher, S., Attiya, A., Boulanger, A., Gaudreault, N., Cloutier, G., & Bureau, N. J. (2025). Thoracolumbar fascia ultrasound shear strain differs between low back pain and asymptomatic individuals: Expanding the evidence. Insights into Imaging, 16(1), 18. https://doi.org/10.1186/s13244-024-01895-2

5. Yamada, K., Kubota, Y., Kosaka, K., Yamaji, Y., Akita, S., Tokumoto, H., Kuroda, M., & Mitsukawa, N. (2025). Human deep subcutaneous adipose tissue is enriched for inflammatory and tissue remodeling pathways. American Journal of Physiology-Cell Physiology, 329(5), C1161-C1172. https://doi.org/10.1152/ajpcell.00463.2025