Aching Joints and a Stiff Shoulder in Perimenopause: What's Known, What Isn't

Perimenopause joint pain is one of the most common reasons women in their forties end up in a clinic, and one of the least likely to be linked to perimenopause once they get there. A 2026 International Menopause Society (IMS) white paper estimates that around half of midlife women experience chronic pain, and describes it as often under-recognised, under-diagnosed and inadequately treated. If your knees, hands, hips or shoulders began to ache around the same time your cycles started to change, you are describing something real, well documented, and still poorly explained.

This post covers what the research does and doesn’t show. It also covers frozen shoulder, which has recently become a talking point because several well-known women have said they were surprised to learn it can show up at this stage of life. That’s the news hook. The evidence is more modest than the headlines, and more useful.

It Isn’t “Just Getting Older”

“You’re at that age” is the explanation many women are given for aching joints. It may be partly true, because joints do change with age. But it leaves out a large part of the picture.

The IMS paper, a 2026 white paper titled Chronic pain at midlife (Mailis et al., Climacteric, 2026), is a good place to start because it is a review written by pain specialists and menopause specialists together. Its central points are worth stating plainly:

• Chronic pain affects women disproportionately, and reproductive milestones influence how it shows up.
• The authors describe a two-way relationship between falling and fluctuating estradiol and musculoskeletal change, nervous-system and immune sensitisation, and the stress response. They stop well short of saying hormones cause joint pain. Their model is that several things stack on top of each other.
• Perimenopause tends to arrive with companions that make pain worse: hot flashes, disrupted sleep, low mood, brain fog and fatigue. The paper says these may contribute to the overall pain experience.
• Chronic pain at midlife often overlaps with other pain conditions, including fibromyalgia, migraine and chronic pelvic pain, so the authors argue it needs an integrated approach rather than a joint-by-joint one.
• It is under-recognised. The paper says so directly, and also points to gender stereotypes and unequal healthcare as reasons women’s pain gets less attention than it should.

Note what this is and isn’t. It’s an expert synthesis, which makes it a strong map of the field. It isn’t a trial showing that a specific treatment fixes perimenopausal joint pain, and it doesn’t say every ache at 47 is hormonal.

Why Sleep and Pain Feed Each Other

One reason the IMS paper takes a “whole picture” view is that several perimenopause symptoms influence how pain is felt. Poor sleep is the one most women recognise from their own experience. A body that hasn’t rested properly tends to hurt more the next day, and pain makes it harder to sleep the following night.

If that loop sounds familiar, our guides to perimenopause sleep problems and perimenopause exhaustion cover the sleep side in more detail. The point here is smaller: if you have aching joints and you’re also sleeping badly, treating them as two unrelated problems may be missing the connection that the specialists themselves highlight.

Frozen Shoulder: Why It Keeps Coming Up at 40–60

Frozen shoulder, medically called adhesive capsulitis, is a condition where the shoulder becomes painful and progressively stiffer, and moving it, especially reaching up or behind you, gets harder. It is described in the research literature as typically affecting women aged 40 to 60, and its cause is considered unclear. That age and sex pattern is why people keep asking whether menopause is involved.

Two studies are worth looking at closely, partly because neither says what the headlines imply.

A Korean shoulder clinic series

Yoon and colleagues (Menopause, 2018) looked at 310 people attending one hospital with shoulder pain: 197 perimenopausal and 113 premenopausal. They compared which diagnoses turned up in each group.

• Adhesive capsulitis was the most common diagnosis in both groups: 35.4% of the perimenopausal group and 31.8% of the premenopausal group. The difference was not statistically significant.
• Shoulder synovitis, an inflamed joint lining, was the second most common diagnosis in the perimenopausal group: 25.1%, against 6.2% in the premenopausal group. That difference was significant.

The honest reading is this. In that clinic, frozen shoulder was not more common in perimenopausal women than in premenopausal ones, so this study does not show a perimenopause link for frozen shoulder specifically. What it did suggest is that a different shoulder problem, synovitis, was far more common in the perimenopausal group. It’s one hospital in one country, and the study design can’t tell you why.

A treatment detail in the paper needs a clear warning. The authors treated the women diagnosed with synovitis with oral prednisolone for 9 to 12 weeks, and most reported improvement. That’s a prescription steroid course chosen by a specialist after a diagnosis, not a self-treatment, and it has well-known risks. It’s mentioned here only so the study is represented accurately, not as a suggestion for anything you should try or ask for.

A hormone-therapy pilot that was too small to say

The second paper is the one most often stretched. Reinke and colleagues (Climacteric, 2026) went through the records of one health system to see whether women using hormone therapy had lower odds of frozen shoulder. The cohort was 1,952 women aged 40–60: 152 on hormone therapy and 1,800 not.

Frozen shoulder was recorded in 7.65% of women not on hormone therapy and 3.95% of those on it. That looks like a halving, and it’s the kind of figure that gets repeated. But the result did not reach statistical significance (odds ratio 1.99, 95% confidence interval 0.86 to 4.58, p = 0.10), and the authors call it a pilot study that “did not demonstrate” a difference. Their conclusion is that larger prospective studies are needed.

Two further things matter. The women were described as menopausal, not perimenopausal, so the study can’t speak directly to the transition years. And it’s a record review, which can show an association but can’t show that hormone therapy changes the risk of anything.

So the fair summary is: a possible hint, from a small pilot, that the authors themselves say needs proper testing. It isn’t a reason to believe hormone therapy prevents or treats frozen shoulder, and nothing in this post should be read as saying it does. Whether hormone therapy is right for you is a conversation for you and your doctor, based on your whole health picture. Our post on HRT, diet and exercise in perimenopause covers how to think about that conversation without turning it into a prescription.

When the Shoulder Isn’t the Whole Story

Because the same age group is affected by many other things, pain that is persistent, one-sided, getting worse, or accompanied by other changes deserves a proper look rather than a guess. A few points are standard medical advice rather than anything specific to perimenopause:

• Shoulder or arm pain together with chest pressure, shortness of breath, sweating or feeling faint is an emergency. Call emergency services rather than waiting for a routine appointment.
• Joint pain with redness, heat, marked swelling or a fever needs prompt assessment.
• Pain that is new, severe, follows an injury, or wakes you repeatedly at night is worth raising with a GP rather than putting down to your hormones.

None of that is meant to alarm you. Most midlife joint aches are not emergencies. It’s here because “it’s probably perimenopause” is exactly the kind of assumption that can hide something else.

What Women Can Reasonably Do

There’s no proven perimenopause joint-pain fix, and any article that promises one is selling something. The IMS paper’s own conclusion is that lifestyle measures, hormonal and non-hormonal treatments and pain-management strategies may all have a role depending on the individual, delivered through a multidisciplinary route rather than a single product. That points toward a few sensible, low-risk moves that fit with what’s already known:

Get the diagnosis before the explanation. A GP or physiotherapist can tell the difference between frozen shoulder, synovitis, a rotator cuff problem and arthritis. Those lead to different treatment, so it’s worth knowing which one you have.

Keep moving, in a form your body tolerates. Gentle, regular movement is generally encouraged for most joint problems, and strength work in particular is well supported for midlife women’s muscle and bone, as covered in our post on strength training in perimenopause. A physiotherapist can adapt it around a painful shoulder or knee. “Rest completely until it stops hurting” is rarely the advice for a stiffening joint, but the details are for the person examining you.

Look at sleep as part of the pain picture, for the reason covered above.

Don’t ignore the rest of the transition. If hot flashes, mood changes and brain fog are all running alongside the aches, say so. The specialists’ point is precisely that they interact, so mention them together.

A Dated Record Helps Here Too

Pain is hard to describe in an appointment, and harder still to describe accurately three weeks after the fact. “My joints hurt a lot lately” gives a clinician very little. These give them considerably more:

• Which joints, and whether it’s one side or both
• Whether it is worse in the morning, after sitting, or after activity
• How long morning stiffness lasts
• How it tracks with bad nights, hot flashes, or the days around your period
• What you’ve tried and whether it changed anything

That is the same logic as our guide to what to bring to a perimenopause appointment: specifics turn a vague complaint into something someone can act on. Joint pain is one of the symptoms you can log in PeriFlow alongside sleep, mood and your cycle, so you can see over a few weeks whether it moves with anything. That’s a record of your pattern, not a diagnosis, and it can’t tell you why your shoulder hurts. What it can do is stop you having to rely on memory when you finally get ten minutes with a professional.

Frequently Asked Questions

Can perimenopause cause joint pain? Joint aches are widely reported at midlife, and the IMS white paper describes a relationship between falling estradiol and musculoskeletal change, nerve sensitisation and other factors. It doesn’t establish that perimenopause directly causes all midlife joint pain, and other causes are common, so persistent pain is worth having examined.

Is frozen shoulder a perimenopause symptom? It typically affects women aged 40–60, but that is not the same as being a perimenopause symptom. In the Korean clinic series, frozen shoulder was no more common in perimenopausal than premenopausal women. Its cause is considered unclear.

Does hormone therapy help frozen shoulder? Not shown. A pilot study found a lower rate of frozen shoulder in women on hormone therapy, but the difference was not statistically significant and the authors say larger studies are needed. Hormone therapy decisions should be made with your doctor.

How long does a frozen shoulder last? That varies from person to person and depends on the cause and treatment, so it’s best answered by the clinician who examines you rather than by a general article.

Should I stop exercising if my joints hurt? Not necessarily, but the right type and amount depends on what is causing the pain. A GP or physiotherapist can advise, particularly around a stiff shoulder, and pain that is sharp, severe or getting worse is a reason to stop and ask.

Which joints are affected most? The research discussed here doesn’t rank them. Hands, knees, hips, neck, back and shoulders are commonly mentioned, and the IMS paper treats midlife pain as a broader pattern rather than a single joint.

Sources

• Mailis A, Ang SB, Di Renna T, et al. Chronic pain at midlife (2026 International Menopause Society White Paper). Climacteric, 2026. PMID 42714958
• Yoon S, Lee DH, Bang J. Perimenopausal arthralgia in the shoulder. Menopause, 2018;25(1):98–101. PMID 28697046
• Reinke EK, Ford AC, Wahl E, et al. A preliminary pilot study to address design issues related to research on potential association of hormone therapy and adhesive capsulitis. Climacteric, 2026;29(3):478–483. PMID 41614260

This article is for general information and isn’t medical advice. If you have persistent, severe or worsening pain, see your doctor or a physiotherapist.

---

Know your phase. Eat right for it.

PeriFlow tracks your perimenopause cycle, even when it’s irregular, and tells you what to eat, when to fast, and how to move, adapted to the phase you’re actually in. Free 7-day trial.

Download PeriFlow

---

Related reading: Sleep and Perimenopause: Why Progesterone Decline Disrupts Your Nights, Strength Training in Perimenopause: Why It’s the One Exercise You Can’t Skip, What to Bring to Your Perimenopause Appointment, On HRT? What to Eat, How to Move, and What Actually Changes — An Evidence-Based Guide, Perimenopause Exhaustion: Why the Symptom You Were Told to Expect Isn’t the One You Got, Perimenopause Symptoms