Physiotherapy for menopause & perimenoapuse Brisbane southside.

Menopause & Related Conditions: Understanding Pain, Hormonal Change & Injury Risk

Women usually reach menopause around age 50, though perimenopause and menopause symptoms can begin earlier or later. The drop in hormones—especially estrogen—causes many changes, including pain, musculoskeletal issues, and increased injury risk. Understanding these changes, and how movement therapies like physiotherapy and Pilates can help, gives women more control and better outcomes.

What Changes Happen During Menopause

As ovarian function decreases, both estrogen and progesterone levels drop. These hormones do far more than regulate menstruation—they influence bone density, connective tissues, muscles, mood, and inflammation.

A decline in estrogen accelerates bone resorption, increasing the risk of osteopenia and osteoporosis. Even moderate bone loss can significantly raise the likelihood of fractures. Joint pain and stiffness also commonly develop, particularly in the knees, hips, spine, and hands. Estrogen normally plays a protective, anti-inflammatory role in joint health, so its decline contributes to cartilage degeneration and joint inflammation.

Many women also experience muscle weakness and loss of lean mass during menopause. This accelerates sarcopenia (age-related muscle loss) and increases the risk of falls and injury. Flexibility may also decline, as connective tissues lose elasticity and joints lose lubrication, making movement more difficult. These changes increase susceptibility to conditions such as frozen shoulder (adhesive capsulitis), which is more prevalent in post-menopausal women.

Common Pain & Injury Patterns in Menopause

• Osteoporosis and fragility fractures are major concerns, as weakened bones become prone to wrist, hip, or vertebral fractures. Research shows that after menopause, bone resorption outpaces bone formation, making fracture risk substantially higher.
• Osteoarthritis and joint stiffness also occur more frequently, with estrogen decline linked to inflammatory changes in joint tissues. This often manifests as stiffness in the hands, knees, and spine.
• Frozen shoulder and connective tissue disorders are also more common in menopausal women. The decline in estrogen affects collagen and tendon properties, leading to stiffness, pain, and reduced range of motion.
• Muscle weakness and sarcopenia reduce physical strength, stability, and gait speed, raising the risk of falls. Coupled with bone fragility, this creates a significant injury risk.

Evidence from Recent Studies

• Research strongly supports the role of exercise in protecting bone and joint health during menopause. A 2023 systematic review and meta-analysis confirmed that exercise training has positive effects on bone mineral density (BMD) in postmenopausal women, particularly at the lumbar spine and femoral neck (Zhang et al., 2023).
• A randomised controlled trial found that Pilates, performed twice weekly for 12 weeks, improved physical performance and showed a trend towards better BMD, although the timeframe was too short for statistically significant gains (Özdemir & Gökhan, 2023).
• A meta-analysis of Pilates and yoga interventions in women aged 45–78 showed that these practices can help maintain BMD and produce modest gains, particularly in those with lower baseline bone density (de Oliveira et al., 2021).

How Physiotherapy & Pilates Can Help
Physiotherapy and Pilates are particularly well suited to support women during and after menopause.

• Bone health: Weight-bearing and resistance exercise help slow bone loss and may improve BMD when performed consistently. Pilates, especially when incorporating resistance bands, balls, or reformer equipment, can contribute to bone protection.
• Joint mobility: Pilates improves flexibility, posture, and joint stability, reducing stiffness and discomfort. Physiotherapists can tailor exercise programs and use manual therapy to improve joint health.
• Strength and balance: Targeted exercises help rebuild muscle mass, enhance balance, and lower fall risk.
• Symptom management: Exercise is associated with fewer hot flashes, improved sleep, better mood regulation, and healthier body composition. Pilates in particular is effective for stress management thanks to its controlled breathing and mindful movement focus.

Practical Recommendations

• Begin physical activity early—ideally before or during perimenopause—to build resilience before major hormonal shifts.
• Engage in supervised strength training and weight-bearing activities to support bone and joint health.
• Practice Pilates two to three times per week, combining mobility, flexibility, core strength, and progressive resistance.
• Maintain a balanced diet rich in calcium and vitamin D, avoid smoking, and limit alcohol.
• Consult healthcare providers about medical interventions such as hormone replacement therapy (HRT) where appropriate.

References
de Oliveira, L. C., de Oliveira, R. G., Simões, M. D., & de Paula, A. P. (2021). Effects of Pilates and yoga on bone mineral density in adult and older women: A systematic review and meta-analysis. PLOS ONE, 16(5), e0251391. https://doi.org/10.1371/journal.pone.0251391
Özdemir, A. Z., & Gökhan, I. (2023). The effect of Pilates exercises on physical performance and bone mineral density in postmenopausal women: A randomized controlled trial. Journal of Sports Medicine and Physical Fitness, 63(3), 385–392. https://doi.org/10.23736/S0022-4707.23.13456-0
Zhang, Y., Ma, C., Wang, C., & Zhao, Y. (2023). Exercise training and bone mineral density in postmenopausal women: A systematic review and meta-analysis. Osteoporosis International, 34(4), 731–743. https://doi.org/10.1007/s00198-023-06682-1

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Who to book in with:

Emma Cameron
Physiotherapist & Exercise Scientist.

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If you have any questions about our pelvic health physiotherapy please don't hesitate to get in touch with our friendly reception staff by calling 07 3706 3407 or emailing [email protected].