Muscle Aches During Menopause: Causes, Muscle Loss and What Helps

Muscle aches, stiffness and tension are common around menopause, and the NHS lists them among menopause symptoms. At the same time, muscle mass starts to decline, which can affect strength, balance and energy. Poor sleep and stress add to aches. Vitamin D deficiency, thyroid problems and some medicines are worth ruling out. Strength training helps most.

What do menopause muscle aches feel like?

• A general achy or bruised feeling
• Stiffness, especially after rest or first thing in the morning
• Tension in the neck, shoulders and upper back
• Cramps or tightness
• Muscles tiring more quickly, or taking longer to recover after exercise

Aches often overlap with joint pain and fatigue.

Why can menopause cause muscle aches?

• Hormone changes. Estrogen affects muscle tissue, repair and inflammation. As it falls, muscles may recover more slowly and feel achier.
• Muscle loss. The SWAN study found that, around the start of the menopause transition, women began to lose lean mass rather than gain it. This continued until about two years after the final period. Losing muscle can make everyday activities more tiring.
• Poor sleep, which lowers pain tolerance and slows recovery. See sleep problems.
• Stress and tension, which can tighten muscles, especially in the neck and shoulders.
• Reduced activity, which leads to stiffness and further muscle loss.

Why does muscle loss matter?

Muscle supports balance, mobility, metabolism and bone strength. SWAN found greater muscle loss during the transition was linked with lower bone density and higher fracture risk afterward.

The 2024 international guideline on premature ovarian insufficiency notes that low estrogen may reduce muscle mass, strength and performance, raising the risk of sarcopenia, the age-related loss of muscle. See weight and metabolism after menopause and bone health.

What else can cause muscle aches?

See perimenopause or something else.

What will a clinician assess?

A clinician may ask where and when the aches occur, whether you have weakness as well as pain, and about your sleep, mood, activity and medicines. They may examine your muscles and joints and suggest blood tests, such as vitamin D, thyroid function, markers of inflammation or a muscle enzyme test.

What treatments help?

Strength training

Resistance exercise is the most effective way to maintain and build muscle at any age. NICE advises explaining to people going through menopause the importance of maintaining muscle mass and strength through physical activity. Aim for:

• At least two sessions a week working the major muscle groups
• Gradual progression, adding weight, repetitions or resistance over time
• Guidance from a physiotherapist or trainer if you’re new to it

Staying active every day

Walking, cycling, swimming and other regular activity reduce stiffness and improve mood and sleep.

Nutrition

• Protein at each meal supports muscle maintenance, especially alongside strength training.
• Vitamin D. If you’re deficient, treatment can relieve aches and weakness.

Hormone therapy

Older NICE guidance noted limited evidence that HRT may improve muscle mass and strength. The 2024 POI guideline suggests hormone therapy prescribed for other reasons may benefit muscle health in people with early menopause. Hormone therapy isn’t prescribed for muscle aches alone, but may help if they come with other menopause symptoms. See early menopause.

Treating other causes

Vitamin D deficiency, thyroid problems, fibromyalgia or medicine side effects each have specific treatments.

Practical steps that may help

• Warm up before exercise, and cool down with gentle stretches afterward.
• Use heat, such as a warm bath or heat pack, for stiffness and tension.
• Stretch daily, focusing on the neck, shoulders, hips and back.
• Break up sitting every 30 to 60 minutes.
• Protect your sleep, because recovery happens during sleep.
• Manage stress with relaxation, breathing or activities you enjoy.
• Stay hydrated.

A simple strength routine to start with

Try one or two sets of 8 to 12 repetitions, two or three times a week:

1. Sit-to-stand from a chair, for legs and hips
2. Wall push-ups, for chest and arms
3. Band or dumbbell rows, for the upper back
4. Glute bridges, for hips and lower back
5. Calf raises holding a support, for lower legs and balance
6. Farmer’s carry: walk holding a bag or weight in each hand, for grip and core

Increase the challenge gradually. If you have osteoporosis, joint problems or a heart condition, ask a physiotherapist to tailor the routine.

Protein basics

Muscle needs protein, particularly when combined with strength training. Include a source at each meal, such as eggs, dairy, fish, poultry, legumes, tofu or lean meat. Needs vary with age, activity and kidney health, so ask a dietitian if you’re unsure.

When should you get help?

Book an appointment if aches persist, limit your activities, or come with other symptoms.

See a clinician promptly if you have:

• Muscle weakness, for example difficulty climbing stairs or getting up from a chair
• Severe muscle pain with dark or reduced urine, especially after starting a new medicine or intense exercise
• New shoulder and hip stiffness, particularly over 50
• Muscle pain with fever, rash, weight loss or feeling generally unwell
• Headache with jaw pain when chewing, scalp tenderness or vision changes. Seek same-day care.

Questions to ask at your appointment

1. Could my muscle aches be linked to menopause?
2. Should I have blood tests, such as vitamin D or thyroid function?
3. Could any of my medicines be causing muscle pain?
4. What kind of strength training would suit me?
5. Would hormone therapy help, given my other symptoms?

See your first menopause appointment.

Related symptoms

Joint pain · Fatigue · Sleep problems · Low mood

For long-term muscle and bone health, see healthy aging after menopause.

Frequently asked questions

Can menopause cause body aches?

Yes. The NHS lists muscle aches and joint pains among menopause symptoms. Poor sleep, stress and muscle loss can add to them.

Does menopause cause muscle loss?

Research from SWAN found women begin to lose lean muscle around the start of the menopause transition. Strength training helps maintain it.

Should I take vitamin D for muscle aches?

If you’re deficient, vitamin D can help. Ask for a blood test, and follow recommended doses, since too much can be harmful.

Is it safe to exercise with muscle aches?

Usually yes, and gentle activity often helps. Stop if you have sharp pain, and see a clinician if you have weakness or severe pain.

Are night-time leg cramps linked to menopause?

Leg cramps are common in midlife and have many causes, including dehydration, some medicines and prolonged sitting. They’re not clearly linked to menopause itself. Gentle stretching before bed may help. Frequent cramps, or cramps with swelling or weakness, should be checked.

References

1. NHS: Symptoms of menopause and perimenopause
2. NICE guideline NG23: Menopause, identification and management (2024 update: maintaining muscle mass)
3. NICE NG23 recommendations (earlier wording on HRT and muscle)
4. Greendale GA et al. Changes in body composition and weight during the menopause transition. JCI Insight, 2019
5. Menopause-related changes in body composition and subsequent bone density and fractures: SWAN
6. ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024
7. Mayo Clinic Press: Menopause symptoms? It could be a copycat

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.