Joint Pain in Menopause: Causes, HRT, Exercise and Red Flags

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Go to A&E or call 999 if you have very bad joint pain after a fall or injury, you can't walk or put weight on a joint, a joint has moved out of place, or you have any tingling or no feeling around a joint after an injury. Don't drive yourself.
Ask for an urgent GP appointment or get help from NHS 111 if a joint is swollen and the skin around it feels hot or has changed colour, you have severe pain in one joint that started suddenly, you find it hard to move a joint, or you have joint pain and feel generally unwell, with a high temperature (although not everyone has one) or feeling hot, cold or shivery. It can be a joint infection or gout, which need treating quickly.
Ask for an urgent GP appointment or get help from NHS 111 if you have sore joints with conjunctivitis, sore eyes or problems with your vision, or sore joints with pain when you pee, discharge, or a rash or sores on your genitals.
Contact a GP immediately, go to 111.nhs.uk or call NHS 111: a new or frequent headache that usually comes on suddenly (your scalp may also feel sore or tender), pain in the jaw muscles or tongue when eating or talking, or problems with your sight, such as double vision or loss of vision in 1 or both eyes. With pain and stiffness around the shoulders, these can be signs of temporal arteritis (giant cell arteritis), which up to 1 in 5 people with polymyalgia rheumatica develop. If you suddenly can't see from 1 or both eyes, call 999 or go to A&E.
If you take an aromatase inhibitor (anastrozole, letrozole or exemestane): call a doctor or NHS 111 now if your muscles feel weak, or the joints or tendons in your ankles, legs, shoulders or arms feel weak, painful or swollen, and ask a doctor for advice urgently about a sudden attack of pain in a joint. Don't stop the tablets without talking to your doctor first.

See a doctor or physiotherapist if

See a GP if joint pain is stopping you doing normal activities or affecting your sleep, the pain or swelling is getting worse or keeps coming back, it hasn't improved after 2 weeks of treating it at home, or your joints are stiff for more than 30 minutes after waking up. In many areas you can refer yourself to NHS musculoskeletal services.
Swelling in several joints, or morning stiffness that lasts more than 30 minutes: see a GP. It can be an inflammatory arthritis such as rheumatoid arthritis rather than osteoarthritis.
Swollen, stiff joints in several fingers or both hands, with morning stiffness lasting more than 30 minutes. The National Institute for Health and Care Excellence (NICE) asks GPs to refer suspected rheumatoid arthritis urgently when the small joints of the hands or feet, or more than one joint, are affected, even if blood tests are normal.
See a GP if you have pain and stiffness for more than a week, especially if you're over 50, it's in both shoulders (often the neck and hips too) and the stiffness lasts longer than 45 minutes in the morning. It can be polymyalgia rheumatica.
Joint aches around the menopause, with symptoms such as hot flushes, poor sleep or low mood: contact your GP if you want to know your options.
Aches with tiredness, feeling cold, weight gain, constipation or low mood: see a GP. NICE says that in women around the menopause, the symptoms of thyroid problems may be mistaken for the menopause.
Pain in many parts of your body that has gone on for a long time, with tiredness, poor sleep or problems concentrating: see a GP if you think it could be fibromyalgia.
Joint and muscle pain with extreme tiredness that doesn't go away however much you rest, or a rash that comes on after being in the sun, often over the nose and cheeks: see a GP, as it can be lupus.
See a GP if you have joint pain, stiffness and swelling that keeps coming back, even if you don't have psoriasis. Psoriatic arthritis can also make a whole finger or toe swell.
See a GP if you have symptoms of gout for the first time (sudden, severe pain in a joint with hot, swollen, red skin), or you have gout and your usual treatments aren't helping.
Pain in your back, shoulders, ribs, pelvis or legs with weak muscles (difficulty climbing stairs or getting out of a chair), or swollen, painful wrists: see a GP. Very low vitamin D can soften the bones (osteomalacia), and a blood test can check.
Bone pain that is constant or worse at night, especially with a lump, unexplained weight loss, fever or tiredness, or a past history of cancer.
If you take hormone therapy after breast cancer, speak to your treatment team as soon as possible if joint or muscle pain worries you, becomes unmanageable, affects your sleep or daily activities, or you notice changes in feeling, balance or mobility.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

Aches in several joints, stiff after rest, without hot swelling, often with hot flushes or poor sleep

Common around the menopause, and usually eased by moving. This page covers it, from what helps to the signs that need checking.

Bony bumps on the end or middle joints of the fingers, stiff for less than 30 minutes in the morning

Usually hand osteoarthritis, which often starts in the years around the last period. Our hand arthritis guide has the hand exercises.

Read: Hand and finger arthritis →Sore, swollen or stiff finger joints

Usually osteoarthritis, sometimes a jammed finger or an inflammatory arthritis. Our finger joint pain guide sorts them.

Read: Finger pain →An ache at the base of the thumb when you pinch, grip or open jars

Often arthritis at the base of the thumb. Our thumb arthritis guide covers splints and exercises.

Read: Thumb arthritis →A finger that clicks, catches or locks

Usually trigger finger. Our trigger finger guide covers what helps.

Read: Trigger finger →Tingling or numbness in the thumb and first fingers, often at night

Usually carpal tunnel syndrome. Our carpal tunnel guide covers splints and exercises.

Read: Carpal tunnel syndrome →A stiff, aching knee from your mid-40s, worse after rest and on stairs

Often knee osteoarthritis, the commonest new arthritis in women from 40. Strength work is the core treatment.

Read: Knee arthritis →Knee pain at other stages of a woman's life, from kneecap pain to pregnancy

Our knee pain in women guide sorts the causes by age.

Read: Knee pain in women →The outer hip, the groin or the buttock

Usually the outer hip tendons or hip arthritis. Our hip pain in menopause guide covers both, and bone health.

Read: Hip pain in menopause →A stiff, painful shoulder, worse at night

Often a frozen shoulder or the rotator cuff. Our shoulder pain in menopause guide covers them, and the heart signs.

Read: Shoulder pain in menopause →The back, or between the shoulder blades

Usually the back itself. Our back pain in menopause guide covers thin bones and spinal fractures too.

Read: Back pain in menopause →The neck, with or without headaches

Our neck pain in women guide covers the menopause years.

Read: Neck pain in women →

Several swollen, warm finger, wrist or foot joints, stiff for more than 30 minutes every morning

Possibly an inflammatory arthritis such as rheumatoid arthritis: see a GP soon, even if blood tests have been normal. Our rheumatoid arthritis exercise page covers staying active with it.

Both shoulders and hips stiff for more than 45 minutes every morning, over 50

Possibly polymyalgia rheumatica: see a GP. With a new headache, jaw pain when eating or problems with your sight, contact a GP immediately or NHS 111.

Aching joints after starting anastrozole, letrozole or exemestane

Common on these breast cancer tablets. Talk to your breast care team, and don't stop the tablets without advice.

Pain all over, not just in the joints, with poor sleep and tiredness

Possibly fibromyalgia: see a GP. Our fibromyalgia exercise page covers starting gently.

One hot, red, swollen joint, or a joint that hurts with a high temperature

Possibly an infection or gout: get help the same day from a GP or NHS 111.

Understand it

Common around the menopause, in several joints at onceStrong evidence

The NHS lists "muscle aches and joint pains" among the symptoms of perimenopause and the menopause, and says some symptoms, "such as joint pain", can continue after the menopause. Its joint pain page says perimenopause and the menopause "can also cause aching and painful joints due to lowered levels of oestrogen". The National Institute for Health and Care Excellence (NICE) lists joint and muscle pain among menopause symptoms, and the British Menopause Society lists joint aches.

Across 37 surveys of 93,021 women in 22 countries, muscle or joint pain was reported by 40% of women before the menopause, 57% in perimenopause and 59% after it: about 1.4 times as often around and after the menopause as before, with no fall after the last period. Most of the women were in East Asia (63%), the questions came from menopause symptom checklists, and the figures weren't adjusted for age. An earlier review put the figure in perimenopause at 71%, but its questions varied and it had reporting errors.

Sources 1, 2, 3, 4, 5, 6

The menopause, or age, weight, sleep and mood? The surveys can't tellMixed evidence

Aches rise in the menopause years, but so do age and other things that make aches worse, and the studies disagree on which matters. In the Study of Women's Health Across the Nation (SWAN), 1 in 6 of 2,218 US women aged 42 to 52 had aches and pains every day, and after allowing for age, health, mood, smoking and body mass index (BMI), only women past the menopause still had more aches than women before it. In 292 Seattle women followed for up to 16 years, joint pain rose with age, not with the stage of the menopause or measured hormones. In 438 Australian women, aches and stiff joints rose over 8 years with BMI, low mood and the transition. Before the Women's Health Initiative (WHI) trials began, about 30% of women aged 50 to 79 had moderate or severe joint pain or stiffness, about the same at every age.

For long-lasting low back pain, a careful Norwegian study of 11,332 women aged 40 to 69 found no link with being past the menopause once age was taken into account. Weight, low mood, poor sleep and night waking went with worse aches in every cohort, and those can change. A 2024 review proposed the name "musculoskeletal syndrome of menopause" for aches, muscle and bone loss and arthritis together; it is a proposal, not a diagnosis NICE or the NHS uses. A UK rheumatologist's review calls menopausal aches part of a wider picture with tiredness, low mood and poor sleep, and a diagnosis made once other causes are ruled out.

Sources 7, 8, 9, 10, 11, 12, 13

Which joints? Often several, and no one joint leadsEmerging evidence

In 743 women aged 35 to 64 in Beijing, frequent low back pain was reported by 33.4%, knee pain by 31.0%, neck pain by 29.7%, other joint pain by 25.6%, stiffness by 23.6% and swollen hand joints by 21.1%. In 609 Chinese women followed through the transition, knee pain rose from 37% to about two thirds after the menopause. In 13 New York women with new or worse joint pain in the transition, the back, hands or wrists, knees, shoulders and hips were all common, usually several at once. No large study gives one commonest joint, and most of the surveys are from Asia.

Sources 14, 15, 16, 13

Hand and knee osteoarthritis often start in these yearsStrong evidence

In 3.27 million Catalan adults aged 40 and over, new knee osteoarthritis was diagnosed in 8.3 women per 1,000 a year, hand osteoarthritis in 3.5 and hip osteoarthritis in 2.4, and women's risk of hand osteoarthritis compared with men's was highest at 50 to 55, almost 4 times. In a US population aged 40 to 84, hand osteoarthritis showed on X-rays in 44.2% of women and 37.7% of men, and was painful in 15.9% and 8.2%. In 92 women seen at an Oxford hand clinic, symptoms began a median of 3 years after the last period, and in 59% of those past the menopause within 4 years either side of it, a pattern from one clinic, looking back. Arthritis UK says osteoarthritis in the hands "mainly affects women and often starts around the time of the menopause".

Aches aren't the same as arthritis: in the Australian cohort, aches and stiff joints "are not necessarily indicative of radiological osteoarthritis". Bony bumps on the finger joints, or a knee or hip that stiffens after rest and aches with use, point to osteoarthritis; aches in many joints without bumps or swelling point to menopausal aches.

Sources 17, 18, 19, 20, 9

Other causes to know, and how common they areStrong evidence

Rheumatoid arthritis usually starts in the small joints of the hands and feet, on both sides, with swollen, warm joints and morning stiffness that often lasts longer than 30 minutes. In UK records about 5 women in 10,000 are diagnosed each year, and 0.93% of women have it. NICE asks GPs to refer it urgently when the small joints of the hands or feet, or more than one joint, are swollen, even if blood tests are normal. Polymyalgia rheumatica causes pain and stiffness around both shoulders, often the neck and hips, with morning stiffness of more than 45 minutes; most people with it are over 65, it is very rare under 50, and women have a lifetime risk of 2.4%. A joint infection is rare, about 8 in 100,000 people a year, but needs treating the same day.

Fibromyalgia, with pain all over, poor sleep and tiredness, affects nearly 1 in 20 people, more often women, usually starting between 25 and 55. NICE warns that in women around the menopause, the symptoms of thyroid problems may be mistaken for the menopause. Very low vitamin D can soften the bones (osteomalacia), causing pain in the back, shoulders, ribs, pelvis or legs and weak muscles. Lupus brings joint and muscle pain with extreme tiredness and a rash after sun, often over the nose and cheeks, and psoriatic arthritis brings joint pain and swelling that keeps coming back, sometimes with a whole finger or toe swollen. Gout is more likely after the menopause, the NHS says.

Sources 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35

Joint pain from the tablets used after breast cancerStrong evidence

Aromatase inhibitors (anastrozole, letrozole and exemestane) lower oestrogen further, and joint pain is one of their commonest side effects: about 46% of women taking them report it, across 21 studies of 13,177 women, and 47% of 200 women in one clinic did. Hands, wrists and knees are often affected, with stiffness in the morning. In one study of 503 women, 24.3% stopped their first tablet within 2 years because of muscle and joint symptoms.

Breast Cancer Now says the pain is "often mild and temporary but for some people it can be more severe and longer lasting". The NHS says: "Do not stop taking anastrozole without talking to your doctor first." A break or a switch to another tablet is a decision for your specialist team.

Sources 36, 37, 38, 39, 40, 41

When a test or scan helpsStrong evidence

No test confirms menopausal aches, and NICE says perimenopause and the menopause can be diagnosed from symptoms from 45, without blood tests. NICE diagnoses osteoarthritis without a scan from 45 when activity brings on joint pain and morning stiffness lasts 30 minutes or less; X-rays matter only when something doesn't fit, and what X-rays show often doesn't match how much a joint hurts.

Blood tests and X-rays help when the pattern suggests something else: for suspected rheumatoid arthritis, though NICE says they shouldn't delay referral. For aches that persist, a GP may check a blood count, kidney, liver and calcium tests, markers of inflammation, thyroid function and vitamin D, and other tests depending on the pattern, a UK review says. Women starting an aromatase inhibitor are offered a bone density scan.

Sources 3, 42, 43, 23, 13, 44

How it usually goesMixed evidence

The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer, and that joint pain can continue after the menopause. The surveys show aches as common after the last period as during the transition, so the idea that they always settle within a year or two is expert opinion, not cohort data. Hand osteoarthritis pain may ease over years, though the bumps stay. No one can promise a timescale, but what you do with exercise, sleep and weight changes how much aches get in the way.

Sources 1, 5, 13, 45, 41

What helps, and how strong the evidence is

HRT: a small effect in older women, and a decision with your GPMixed evidence

No trial has recruited women for joint pain and tested HRT for it; the evidence comes from joint symptoms counted as side outcomes in large trials of women mostly in their 60s, and from analyses done after the event. In the WHI trial of oestrogen alone (10,739 women aged 50 to 79 who'd had a hysterectomy), joint pain was reported by 76.3% after a year against 79.2% on a placebo, while joint swelling was a little more common with oestrogen (42.1% against 39.7%). With oestrogen plus progestin (16,608 women, average age 63), joint pain or stiffness eased in 47.1% of the women who had it, against 38.4%. In a UK, Australian and New Zealand trial of 3,721 women, average age 63, aching joints or muscles were reported by 57% against 63% after a year. In 969 women with heart disease, knee pain didn't change.

Aches can come back for a while after stopping: about twice the odds of pain or stiffness after oestrogen plus progestin stopped, and 5.4% more women reported joint pain after oestrogen alone stopped. NICE recommends HRT for hot flushes and night sweats, makes no recommendation for joint pain, and calls the evidence that HRT improves muscle "limited". The NHS says a GP "should explain the benefits and risks and help you decide", and NICE asks clinicians to "discuss with the person the benefits and risks associated with each potential management option". Whether these small, older-age effects apply to women with troublesome aches near the menopause isn't known.

Sources 46, 47, 48, 49, 50, 10, 3, 51, 52

HRT for hand osteoarthritis is untestedEmerging evidence

The only trial was a feasibility study of 28 women aged 40 to 65 with painful hand osteoarthritis, which tested whether a full trial could be run, not whether the treatment works. Hand pain fell in both groups, by about the same amount, and a full trial would need about 296 women. Its authors note this use of the medicine is "outside of the license".

Sources 53, 54

Exercise: the core treatment for osteoarthritis, borrowed for menopausal achesStrong evidence

No trial has tested exercise for menopausal aches as such, so this evidence is borrowed from osteoarthritis. NICE makes therapeutic exercise, such as local muscle strengthening and general aerobic fitness, a core treatment for osteoarthritis, says pain may rise at first, and says sticking with it long term increases the benefit; it is backed by reviews of 139 knee trials (12,468 people) and of hip trials. For hand osteoarthritis, 7 trials of 534 people (most of them women) found exercise eased pain by about half a point on a 0 to 10 scale, improved function a little and eased stiffness, from low-quality evidence, and the gains faded when programmes ended; a Norwegian trial of 80 women improved the daily activities they'd chosen.

Women's Health Concern, the British Menopause Society's patient arm, lists "joint and muscle pain relief" among exercise's benefits, "contrary to popular belief", and NICE asks clinicians to explain the importance of keeping muscle mass and strength through the menopause.

Sources 42, 55, 56, 57, 58, 59, 3

Exercise and the joint pain of breast cancer tabletsMixed evidence

In 121 women with joint pain on aromatase inhibitors, a year of 150 minutes of aerobic exercise a week plus supervised strength training twice a week cut their worst joint pain by 29%, against a 3% rise without it. But a 24-week walking programme didn't prevent joint pain in 320 women starting the tablets (58.2% against 56.2%), acupuncture was 0.92 points better than sham acupuncture on a 0 to 10 scale, less than the 2 points thought to matter, and a Cochrane review calls the evidence for exercise very uncertain.

Sources 60, 61, 62, 63

Running and exercise don't wear out healthy jointsEmerging evidence

Across 17 studies, hip or knee osteoarthritis was found in 3.5% of recreational runners, 13.3% of competitive runners and 10.2% of people who didn't run. These are observational studies, but they don't support the idea that regular activity wears joints out.

Source 64

Supplements: little evidenceEmerging evidence

NICE says "Do not offer glucosamine" for osteoarthritis, and that the safety, quality and purity of unregulated menopause preparations may be unknown. We found no trial of collagen for menopausal joint pain; a 2026 review of collagen studies covers skin and osteoarthritis, not the menopause. In one 8-week trial of 74 women past the menopause, curcumin improved a muscle and joint score by 5.3 points, just short of a change thought to matter, with stomach ache and headaches reported.

Sources 42, 3, 65, 66

Weight, sleep and moodEmerging evidence

Higher weight went with more aches in the midlife cohorts: in the Beijing survey, obese women had about twice the odds of knee pain. For osteoarthritis, NICE says any weight loss helps people living with overweight. Poor sleep, night waking and low mood went with worse pain in the cohorts, though no trial shows that better sleep eases menopausal aches. NICE recommends cognitive behavioural therapy (CBT) made for the menopause for sleep problems with hot flushes and night sweats.

Sources 14, 15, 8, 42, 3

How much pain is OK while you exercise?

0 to 2 is safe, up to 5 is acceptable, and back to usual by the next morningEmerging evidence

Borrowed from our knee pain guide: rate your joint pain from 0 to 10 during and after exercise. In the pain-monitoring model used in knee trials, 0 to 2 counts as safe, up to 5 as acceptable and above 5 as too much. By the next morning the joint should be back to its usual level; if it isn't, do a little less next time, not nothing. NHS inform's hand exercises use the same scale (0 to 3 minimal, 4 to 5 acceptable, 6 to 10 excessive) and ask that pain is no worse the morning after.

NICE says joint pain may rise when you start exercising with osteoarthritis and regular exercise still helps, and across 7 trials of long-lasting pain, exercise that allowed some pain did slightly better in the short term than pain-free exercise. With several sore joints, judge each session by the joint that complains most, and keep a lighter day between harder ones (our suggestion). In a flare, cut the repetitions for a few days rather than stopping (our suggestion, as in our hand arthritis guide).

Never a pain-rule question: a joint that becomes hot, red and swollen, a high temperature, both shoulders stiff with a new headache or jaw pain when eating, sudden weakness, or new joint pain or swelling on an aromatase inhibitor. See the warning signs.

Sources 67, 68, 42, 69

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Move every joint, every day

About weeks 0 to 2, daily, morning and evening. Ease morning stiffness and keep every joint moving through its comfortable range, with walking or cycling on most days. Warm stiff hands in warm water first. With a diagnosis such as hand, thumb or knee arthritis, that guide's plan comes first, and with rheumatoid arthritis, polymyalgia rheumatica or joint pain from breast cancer tablets, your team's advice does. No trial has tested a plan for menopausal aches: the stages follow NICE's osteoarthritis advice, NHS inform's pacing and the UK osteoporosis consensus.

Tendon glides (hand tendon gliding exercises) demonstrated on the 3D figure

3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment

4 to 6 of each position, holding each for 5 s, up to 4 times a day · The move page's dose, from an NHS hand-therapy leaflet. It shouldn't be painful, though the fingers may feel stretched, as the move page says

Harder: Ball squeeze

Wrist & forearm flow demonstrated on the 3D figure

3D demoWrist & forearm flowBeginner · No equipment

2 to 3 slow repetitions at a time through the day, building to 2 sets of 8 · NHS inform's pacing for hand exercises

Easier: Wrist circles · Harder: Wrist flexor stretch

3D demoCat-cowBeginner · No equipment

8 waves, slower than feels natural · The move page's dose. With osteoporosis, keep the rounding small (our suggestion, from the UK consensus)

Harder: Half lord of the fishes (Ardha Matsyendrasana)

Thoracic rotation demonstrated on the 3D figure

3D demoThoracic rotationBeginner · No equipment

6 rotations each side, moving with the breath · The move page's dose

Easier: Side-lying open book · Harder: World's greatest stretch

Supine heel slide demonstrated on the 3D figure

3D demoSupine heel slideBeginner · No equipment

10 slow repetitions each side, once or twice a day · The move page's dose (editorial)

Harder: Hip windshield wipers

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

10 to 20 minutes on most days · Editorial, building towards the NHS's 150 minutes a week; walking outdoors or a stationary bike counts the same

Harder: Treadmill jogging

Move on when: Morning stiffness eases within about 30 minutes of getting up, a 20-minute walk is comfortable, and your joints are back to their usual level the next morning (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build strength, 2 or 3 days a week

About weeks 2 to 8: strength on 2 or 3 days a week, with the stage 1 moves on the other days. Strength for the legs, back, arms and hands is the core of the osteoarthritis guidelines and of NICE's menopause advice on muscle.

Sit to stand from a chair demonstrated on the 3D figure

3D demoSit to stand from a chairBeginner · A bench or box

2 sets of 8 to 12, stopping with 2 or 3 repetitions to spare · The starting dose on our menopause exercise page (editorial). Use a firm chair that can't slide or tip, as the move page says

Easier: Sit to stand, pushing on the thighs · Harder: Bodyweight squat

3D demoStep-upBeginner · A step

2 sets of 8 each leg on a low step, holding a rail · Editorial. Lower yourself under control rather than dropping off the edge, as the move page says

Easier: Low step-up · Harder: Dumbbell step-up

Wall push-up demonstrated on the 3D figure

3D demoWall push-upBeginner · A wall

2 sets of 8 to 12 · The starting dose on our menopause exercise page (editorial). Move to a steeper angle if your wrists or shoulders complain, as the move page says

Harder: Push-up

3D demoBand rowBeginner · A band + An anchor point

3 sets of 10 to 15, stopping 2 to 3 repetitions short of failure · The move page's dose (editorial)

Harder: Supported single-arm dumbbell row

Ball squeeze demonstrated on the 3D figure

3D demoBall squeezeBeginner · Other / check instructions

12 squeezes with a soft ball, 3 times a week · As in our hand arthritis guide, which follows a Norwegian trial's programme (editorial). Use a soft ball with thumb base arthritis, and rest it if a finger joint is hot and swollen, as the move page says

Easier: Tendon glides (hand tendon gliding exercises) · Harder: Band finger extension

Band finger extension demonstrated on the 3D figure

3D demoBand finger extensionBeginner · A band

12 repetitions, 3 times a week · As in our hand arthritis guide (editorial)

Easier: Ball squeeze · Harder: Plate pinch

Move on when: Every set passes the pain rule for 2 weeks, and you can do 12 sit to stands without using your hands (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Stronger for the long term: muscle, bone and balance, then everyday life

From about week 8, and ongoing: strength 2 or 3 days a week, impact on most days and balance at least twice a week, as the UK osteoporosis consensus advises from midlife. Walking, gardening, carrying, work and the gym come back by the written steps below.

Dumbbell goblet squat demonstrated on the 3D figure

3D demoDumbbell goblet squatIntermediate · A dumbbell

2 sets of 8 to 12, building to 3 sets at the most you can lift 8 to 12 times with good technique · The UK osteoporosis consensus dose; squat to a chair at first (editorial)

Easier: Bodyweight squat · Harder: Barbell front squat

Dumbbell Romanian deadlift demonstrated on the 3D figure

3D demoDumbbell Romanian deadliftIntermediate · A dumbbell

The same dose, light at first · The UK consensus dose. Get a current disc-related back problem assessed before loading a hinge, as the move page says

Easier: Hip-hinge practice · Harder: Single-leg Romanian deadlift

Shoulder press with a band demonstrated on the 3D figure

3D demoShoulder press with a bandBeginner · A band

2 to 3 sets of 8 to 12 · Editorial, within the range on our menopause exercise page

Harder: Push press

Farmer's carry demonstrated on the 3D figure

3D demoFarmer's carryIntermediate · A dumbbell + A kettlebell

3 walks of 20 to 30 m · Editorial. With thumb base arthritis or trigger finger, start light with thick or padded handles, as the move page says

Harder: Suitcase carry

Heel drop (impact for bone) demonstrated on the 3D figure

3D demoHeel drop (impact for bone)Beginner · No equipment

20 to 30 drops at first, building toward about 50 on most days, for example 5 sets of 10 · The move page's dose, which it credits to the UK osteoporosis consensus. Stop with foot, knee, hip or back pain, as the move page says

Harder: Jump rope (basic bounce)

Single-leg stand demonstrated on the 3D figure

3D demoSingle-leg standBeginner · A wall

2 holds of 20 to 30 s each leg, beside a counter · As on our menopause exercise page (editorial)

Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix

Move on when: Our suggestion: a normal week of walking, work and chores leaves your joints no worse the next morning. Keep two strength days a week for good: NICE says sticking with exercise long term increases the benefit, and our workout plans for women over 40 and over 50 are a long-term home.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Mornings, hands and tools (written steps)

Our 3D figure can't show these. Each step names its source or is our suggestion.

1. Warm stiff hands in warm water before you use them: "Sometimes just putting your hands in warm water can help, especially if they tend to feel stiff in the morning" (Arthritis UK). A warm shower helps other stiff joints (our suggestion).
2. Use gadgets such as electric tin openers, and tools with softer, chunkier handles; use both hands for jobs you'd usually do with one; and choose taps, handles and fastenings that are easier to work (Arthritis UK).
3. Carry shopping in a backpack or a trolley while your hands are sore, rather than in bags held in your fingers (Arthritis UK).
4. Take more breaks, and switch between harder and easier jobs (Arthritis UK).
5. A splint can support a sore hand during repetitive tasks for a few weeks, but NHS inform says it's "not advised to wear this all the time".
6. For hand and knee osteoarthritis, NICE offers an anti-inflammatory gel first, and NHS inform calls ibuprofen gel the most effective painkiller for hand osteoarthritis. Ask a pharmacist which painkiller suits you (the NHS).
7. For a sore joint, the NHS suggests ice wrapped in a towel for up to 20 minutes every 2 to 3 hours, and says "do not completely stop moving the affected joint".

Sources 70, 71, 42, 2

Pacing, sleep and work (written steps)

These come from Arthritis UK, the NHS, NICE and Acas, except where a step is our suggestion.

1. Pace yourself: "Do not be tempted to do too much on a good day", and remember that "Too much rest can increase stiffness and weaken the muscles" (Arthritis UK). Spread heavy jobs through the day and the week.
2. Keep a regular sleep routine (the NHS's menopause advice), exercise in the daytime but not within 4 hours of bed, and make your bed comfortable (the NHS's insomnia advice).
3. If hot flushes and night sweats are spoiling your sleep, ask your GP about CBT made for the menopause, which NICE recommends.
4. At work, talk to your manager early: Acas asks employers to consider changes such as rest areas, temperature control and flexible working for menopause symptoms.

Sources 20, 72, 73, 3, 74

Bone health, HRT and supplements (written steps)

These come from the NHS and NICE.

1. Look after your bones from now on: regular weight-bearing and strength exercise, calcium-rich food, no smoking, and alcohol within limits (the NHS). The NHS suggests a 10 microgram vitamin D supplement a day in autumn and winter, and no more than 100 micrograms a day.
2. Talk to your GP about your menopause symptoms and the options, including HRT. It's your choice, and the NHS says a GP should explain the benefits and risks and help you decide; NICE asks GPs to discuss bone health at menopause reviews.
3. If you're weighing up HRT: the NHS says HRT tablets slightly raise the risk of blood clots and stroke, while patches, gels and sprays don't, and NICE says the same about clots. Aches can come back for a short time when you stop, less so if the dose is reduced gradually.
4. Before buying a supplement for joint pain, remember NICE's warning that the safety, quality and purity of unregulated preparations may be unknown, and ask a GP about vitamin D or thyroid tests if you have the symptoms on this page.

Sources 72, 32, 3, 51, 52

On an aromatase inhibitor (written steps)

These come from Breast Cancer Now and the NHS. Your breast care team's advice comes first.

1. Keep active: Breast Cancer Now suggests 150 minutes a week, which you can break up, for example into 25-minute sessions. In one trial, aerobic exercise with supervised strength training twice a week eased joint pain on these tablets.
2. Ask a pharmacist to suggest a painkiller for mild aches, and see your doctor if the pain doesn't go away (the NHS).
3. Don't stop or pause the tablets on your own: "Do not stop taking anastrozole without talking to your doctor first" (the NHS). A break or a switch is your specialist's decision.
4. Speak to your treatment team as soon as possible if the pain worries you, becomes unmanageable, affects your sleep or daily activities, or you notice changes in feeling, balance or mobility (Breast Cancer Now).

Sources 40, 39, 75, 60

Positions to swap, and why

Habit or position	Why it matters	Instead
Resting sore joints completely	Arthritis UK says too much rest increases stiffness and weakens the muscles, and the NHS says don't completely stop moving a painful joint.	Daily joint moves, starting with tendon glides and a short walk.Try: Tendon glides (hand tendon gliding exercises)
Doing everything on a good day	Arthritis UK says don't be tempted to do too much on a good day: pace yourself.	Spread heavy jobs and longer walks across the week.Try: Treadmill walking
Hanging from a bar while finger or thumb joints flare	It puts your whole body weight through sore finger joints (our suggestion).	A soft ball squeeze, then build grip back gradually.Try: Ball squeeze
Small, tight grips held for a long time (thin pens, phones, secateurs)	Arthritis UK's joint protection advice is softer, chunkier handles and regular breaks.	Chunkier handles, both hands, and breaks between tasks.
Wearing a hand splint all day	NHS inform says a splint helps during repetitive tasks for a few weeks, but isn't advised all the time.	The splint for repetitive tasks only, with the hand moves in stage 1.
Waiting weeks with several swollen, stiff joints	It can be rheumatoid arthritis, which NICE asks GPs to refer urgently, even with normal blood tests.	See a GP soon.
Buying supplements to fix the aches	NICE says don't offer glucosamine for osteoarthritis and warns that unregulated menopause preparations may vary in safety and purity; we found no good trial in menopausal aches.	The staged plan, and a GP for vitamin D or thyroid questions.
Starting or stopping HRT, or stopping breast cancer tablets, on your own	HRT is a decision about all your menopause symptoms, aches can return for a while after stopping it, and aromatase inhibitors shouldn't be stopped without your doctor.	A conversation with your GP or your breast care team.
Only walking, for your joints and bones	Strength work is the core of osteoarthritis treatment, and the UK consensus asks for strength and impact for bone, not walking alone.	Strength 2 or 3 days a week, starting with sit to stands.Try: Sit to stand from a chair
Heel drops that hurt your feet, knees or hips	The move page says stop with foot, knee, hip or back pain.	Brisk walking and strength first, then build impact gently.Try: Treadmill walking

Routines to follow

Joint care workout: move and strengthen every joint

A 25-minute session for healthy joints: slow circles to take every joint through its range, then a strength circuit for hips, knees, ankles, shoulders and grip.

25 minBeginner13 movesA wall, A bench or box

Arthritis exercise routine: a joint-friendly circuit

A 30-minute joint-friendly circuit built like the GLA:D and ESCAPE-pain programmes: a gentle warm-up, chair, step and band strength moves, balance, then stretches.

30 minBeginner14 movesA bench or box, A step

Wrist and forearm routine

Wrist mobility and forearm strength for desk work, climbing, push-ups and handstands.

10 minBeginner7 movesA wall, A dumbbell

Pilates for arthritis: a 25-minute joint-friendly class (no kneeling)

A gentle 25-minute Pilates class for arthritis: lying, side-lying, chair and standing moves, with no kneeling or weight on your hands, and flare-day options.

25 minBeginner16 movesA bench or box, Something with weight

Yoga for menopause: a 35-minute practice for strength, balance and winding down

Thirty-five minutes of standing strength, balance, back strengthening and a long relaxation for the menopause, with no deep forward folds or shoulder stands.

35 minBeginner15 movesFirm cushion

Strength and balance workout

Strength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.

45 minBeginner14 movesA wall, A dumbbell

Bone-strengthening workout

Impact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.

40 minBeginner14 movesA kettlebell, Other / check instructions

10-minute morning stretch

A gentle, no-equipment stretch routine to wake up the spine, hips and shoulders in ten minutes.

10 minBeginner10 movesNo equipment

More moves for this area

Questions people ask

Can the menopause cause joint pain?

Aching joints are a recognised symptom: the NHS lists muscle aches and joint pains among menopause symptoms, and says perimenopause and the menopause can cause aching, painful joints. In surveys, about 4 in 10 women report aches before the menopause and nearly 6 in 10 around and after it. The surveys can't separate the menopause from age, weight, sleep and mood, which all play a part.

Why do all my joints hurt in the menopause?

Menopausal aches usually affect several joints at once, such as the hands, knees, hips, shoulders and neck, with stiffness after rest. Falling oestrogen is the usual explanation, but age, poor sleep, low mood and weight also go with worse aches in studies. Joints that are hot or swollen are different, and need checking.

Is it the menopause or arthritis?

Menopausal aches are usually several joints aching and stiff, without hot swelling. Bony bumps on the finger joints, or a knee or hip that stiffens for 30 minutes or less after rest from your mid-40s, point to osteoarthritis, which NICE diagnoses without a scan. Several swollen, warm joints with morning stiffness of more than 30 minutes point to an inflammatory arthritis such as rheumatoid arthritis, which needs a GP soon.

Can the menopause make my joints swell?

Aching and stiffness are the menopause pattern; swelling is the point to get checked. Swollen joints in several fingers, both hands or the feet, with long morning stiffness, need a GP soon. A hot, swollen joint with a high temperature needs help the same day.

How long does menopause joint pain last?

The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer, and that joint pain can continue after the menopause. Surveys find aches as common after the last period as during the transition. No one can promise a timescale, but strength work, activity and sleep make aches easier to live with.

Why are my joints stiff in the morning?

Stiffness after rest is common with menopausal aches and osteoarthritis, and usually eases within 30 minutes of moving. Warm water for stiff hands and gentle joint moves help. Stiffness lasting more than 30 minutes in several joints, or more than 45 minutes in both shoulders and hips if you're over 50, needs a GP.

Does HRT help joint pain?

A little, on average, in large trials of women mostly over 60: HRT lowered how often aches were reported by about 3 to 9 percentage points, and aches came back for a while after stopping. No trial has tested HRT for joint pain on its own, and NICE doesn't recommend it for joint pain alone. It's a decision about all your menopause symptoms, made with a GP.

Can HRT, or stopping HRT, cause joint pain?

We found no trial showing that HRT causes joint pain, though joint swelling was slightly more common with oestrogen in one large trial. Stopping can bring aches back for a while: about 5% more women reported joint pain after stopping in one trial. The NHS says reducing the dose gradually makes symptoms less likely to return in the short term.

Why do my hands and fingers hurt in the menopause?

Hand aches are common, and hand osteoarthritis often starts around this time: at one UK clinic, most women's symptoms began within 4 years either side of their last period. Warm water, hand exercises and chunkier handles help. Swollen joints in several fingers with long morning stiffness need a GP.

Why do my knees hurt in the menopause?

Knee aches are among the commonest around the menopause, and knee osteoarthritis is the commonest new arthritis in women from 40. Strength work for the thighs and hips is the core treatment, and losing weight helps if you're living with overweight. Our knee pain in women and knee arthritis guides have the details.

Do supplements help menopause joint pain?

We found no good trial: NICE says not to offer glucosamine for osteoarthritis, there's no trial of collagen for menopausal aches, and one small curcumin trial fell just short of a meaningful change. The NHS does suggest a vitamin D supplement in autumn and winter, and very low vitamin D can cause bone pain, which a GP can check.

What's the best exercise for menopause joint pain?

Strength training 2 or 3 days a week, daily joint movement, and regular walking, cycling or swimming, built up gradually. Pain up to about 5 out of 10 that settles by the next morning is fine. The plan on this page builds from gentle daily moves to strength, impact and balance for your bones.

When to get help first

Get urgent medical help if

See a doctor or physiotherapist if

Where does it hurt?

Understand it

Common around the menopause, in several joints at onceStrong evidence

The menopause, or age, weight, sleep and mood? The surveys can't tellMixed evidence

Which joints? Often several, and no one joint leadsEmerging evidence

Hand and knee osteoarthritis often start in these yearsStrong evidence

Other causes to know, and how common they areStrong evidence

Joint pain from the tablets used after breast cancerStrong evidence

When a test or scan helpsStrong evidence

How it usually goesMixed evidence

What helps, and how strong the evidence is

HRT: a small effect in older women, and a decision with your GPMixed evidence

HRT for hand osteoarthritis is untestedEmerging evidence

Exercise: the core treatment for osteoarthritis, borrowed for menopausal achesStrong evidence

Exercise and the joint pain of breast cancer tabletsMixed evidence

Running and exercise don't wear out healthy jointsEmerging evidence

Supplements: little evidenceEmerging evidence

Weight, sleep and moodEmerging evidence

How much pain is OK while you exercise?

0 to 2 is safe, up to 5 is acceptable, and back to usual by the next morningEmerging evidence

The exercise plan: 3 stages

Move every joint, every day

Build strength, 2 or 3 days a week

Stronger for the long term: muscle, bone and balance, then everyday life

What to change for now

Mornings, hands and tools (written steps)

Pacing, sleep and work (written steps)

Bone health, HRT and supplements (written steps)

On an aromatase inhibitor (written steps)

Positions to swap, and why

Routines to follow

Joint care workout: move and strengthen every joint

Arthritis exercise routine: a joint-friendly circuit

Wrist and forearm routine

Pilates for arthritis: a 25-minute joint-friendly class (no kneeling)

Yoga for menopause: a 35-minute practice for strength, balance and winding down

Strength and balance workout

Bone-strengthening workout

10-minute morning stretch

More moves for this area

Questions people ask

Related exercise guides

Other pain guides

Sources