Understanding What Happens During Midlife
For many women, the midlife years bring noticeable changes. Recovery after exercise or injury can take longer, little aches hang around, and energy levels may not feel what they once were. Watching parents or relatives deal with joint pain, falls, or osteoporosis can make you wonder — is there anything I can do differently?
The answer is yes.
Growing research shows that perimenopause and menopause bring unique shifts in the musculoskeletal system — our muscles, bones, joints, tendons, and ligaments. These changes are significant enough that researchers have coined a term for them: The Musculoskeletal Syndrome of Menopause.
And the good news? Physiotherapy and strength training can make a real difference.
What Is the Musculoskeletal Syndrome of Menopause?
Coined by researchers at the University of Central Florida, the Musculoskeletal Syndrome of Menopause describes a collection of symptoms linked to falling estrogen levels.
As estrogen declines, many women experience:
Muscle and joint pain
Loss of lean muscle mass
Reduced bone density
More frequent tendon or ligament injuries
Faster progression of arthritis
Slower recovery after injury
Up to 70% of women in midlife report these musculoskeletal symptoms — and for around a quarter, they can be quite severe, even when scans appear normal.
Estrogen plays a far greater role in physical health than most people realise. It helps build and repair muscle tissue, maintains bone density, supports healthy tendons and cartilage, and reduces inflammation. When estrogen levels drop, the effects are felt throughout the body — often as pain, stiffness, or reduced strength.
Why Physiotherapy Matters
Physiotherapists are uniquely placed to support women through this stage of life. At Spearwood Physio, we often see women managing conditions such as:
Shoulder or hip bursitis
Frozen shoulder
Plantar fasciitis
Tennis elbow or carpal tunnel syndrome
Osteoarthritis, osteopenia, or osteoporosis
Persistent lower back or pelvic pain
Beyond easing symptoms, physiotherapy provides proactive strategies to rebuild strength, resilience, and confidence. The right exercise prescription — especially strength-based training — directly targets the systems most affected by hormonal change.
The Power of Strength Training
Not all exercise provides the same benefits for bone and muscle health. Walking, Pilates, and yoga are excellent for flexibility, balance, and wellbeing — but they don’t provide the heavy loads required to build strength or maintain bone density.
A landmark Australian study — the LIFTMOR Trial — found that postmenopausal women with osteoporosis could safely complete supervised heavy resistance training. After only eight months, participants improved bone density, muscle strength, posture, and even regained some height.
With proper technique and progression, strength training is one of the most effective long-term investments in your musculoskeletal health.
Taking a Holistic Approach
Physiotherapy works best when it’s part of a holistic approach. Alongside strength training, consider:
Discussing Hormone Replacement Therapy (HRT) options with your GP
Prioritising sleep for recovery and hormonal balance
Managing stress, which can increase inflammation and pain
Eating a nutrient-dense diet rich in protein, calcium, and micronutrients
And a note on weight changes: some fat gain around menopause is normal and can even be protective, as fat tissue produces small amounts of estrogen. Over-restrictive diets or excessive exercise can sometimes backfire, worsening fatigue or bone loss.
Reframing Midlife: A Stage of Strength, Not Decline
Too often, women are told their aches and pains are simply “part of ageing.” But midlife doesn’t have to mean slowing down. With the right guidance, it’s possible to maintain — and even improve — your strength, mobility, and independence.
At Spearwood Physio, we help women understand their changing bodies and build a tailored plan to move well, stay active, and feel strong for decades to come.
Final Thoughts
Menopause is not the start of decline — it’s a stage of transition, and with the right support, it can be one of growth and strength. Physiotherapy and strength training offer powerful tools to keep your body resilient, reduce pain, and protect your long-term health.
Your body can adapt.
And with the right approach, midlife can be the start of a stronger, more confident you.
Coming up next: Exercise for Strong Bones and Muscles in Midlife Women— a practical guide to choosing the right types of exercise before, during, and after menopause.