70% of Midlife Women Experience This — And Most Chiropractors Aren’t Talking About It

If you see a significant number of women in their 40s and 50s in practice – and most chiropractors do – there’s a good chance you’re already managing patients with the musculoskeletal syndrome of menopause without naming it as such. A narrative review published in Climacteric (2024) makes the case that these patients deserve a more unified, informed, and proactive clinical framework – and it has direct implications for how we assess and manage this population.

What Is the Musculoskeletal Syndrome of Menopause?

This term was introduced in this paper to describe the cluster of MSK symptoms driven by estrogen decline during the menopausal transition. It includes:

• Generalized joint pain and arthralgia — experienced by more than 50% of perimenopausal women, even when imaging is completely normal
• Sarcopenia — accelerated loss of lean muscle mass and strength, at approximately 0.6% per year after menopause
• Bone density loss — an average 10% reduction in bone mineral density during perimenopause, leading to osteopenia and osteoporosis risk
• Tendon and ligament vulnerability — estrogen plays a structural role in connective tissue integrity; its decline increases injury risk
• Adhesive capsulitis and cartilage fragility — higher rates of frozen shoulder and osteoarthritis onset cluster around the menopausal transition
• Intervertebral disc changes — estrogen has protective properties in disc tissue; its loss contributes to degenerative changes

An estimated 70% of midlife women will experience this syndrome, with 25% reporting severe symptoms – and critically, 40% will have no structural findings on imaging. That last point is clinically important: a normal X-ray or MRI does not rule out significant MSK dysfunction in this population.

Why Estrogen Is the Unifying Factor

Estradiol – the most biologically active form of estrogen – influences virtually every type of MSK tissue: bone, muscle, tendon, cartilage, ligament, and adipose. Its decline during perimenopause triggers five primary downstream changes: increased systemic inflammation, decreased bone density, accelerated joint degeneration, sarcopenia, and impaired muscle regeneration through loss of satellite cell activation.

This helps explain why perimenopausal women can present with diffuse joint pain, new-onset shoulder problems, worsening back pain, and fatigue simultaneously – these are not unrelated complaints, they are expressions of a single hormonal transition affecting multiple tissue types at once.

What Clinicians Can Do

The paper identifies several evidence-informed management strategies that fall within or adjacent to chiropractic scope:

Menopausal hormone therapy (MHT) — beyond your scope to prescribe, but worth understanding: MHT meaningfully slows the MSK consequences of estrogen loss, and appropriate referral and collaborative care with a physician or menopause specialist is part of comprehensive management

Resistance exercise is the single most consistently supported intervention — heavier loads in lower repetition sets are more effective for preserving muscle power than high-rep, light-weight training; ideally combined with increased protein intake

Vitamin D3 and magnesium — daily supplementation shown to reduce bone turnover markers and support bone mineral density; vitamin K2 also shows benefit for bone density in osteoporotic women

Fracture risk screening — the FRAX tool and DEXA scanning are underutilized; current guidelines recommend osteoporosis screening at age 65, but earlier screening should be considered for women with risk factors or prior fractures

📋 Clinical Takeaway: When a perimenopausal or postmenopausal woman presents with joint pain, new muscle weakness, shoulder issues, or worsening back pain – especially with normal imaging – consider the musculoskeletal syndrome of menopause as a unifying framework. Prioritize resistance exercise, assess bone density risk, discuss nutritional support, and refer for MHT evaluation where appropriate. These are not separate problems; they share a common hormonal driver.

This Week’s Research Review

“The Musculoskeletal Syndrome of Menopause” – published in Climacteric (2024), reviewed by Dr. Ceara Higgins.

📄 Get the full review FREE until the end of June – including a complete breakdown of the pathophysiology, supplementation evidence, exercise recommendations, and clinical application guidance: [Access the review here]

📚 Or subscribe for access to the entire catalogue of new and existing reviews: [Subscription options here]

About the Author

Dr. Shawn Thistle, DC – 20+ years in clinical practice, founder of RRS Education and www.shawnthistle.com, research review and knowledge transfer specialist.