Why Does Everything Start to Hurt After 40?

Musculoskeletal menopause: what happens to muscles, joints and tendons during the menopausal transition

I often hear women over 40 express roughly the same thought, even though each woman puts it in her own words:

“Irina, I feel as though my body has aged ten years in just one.”

Not long ago, her shoulder moved freely, and now lifting her arm overhead feels uncomfortable. In the morning, she needs time to get moving because her back and hips seem slow to switch on for the day. Her knees start making themselves known on the stairs, her feet ache after an ordinary walk, her Achilles feels tight, and her hands seem stiff. Recovery after training takes longer, even though a similar load once passed almost unnoticed.

And often, the most unsettling part is not any single pain. It is how unexpected it feels.

A woman looks at herself and thinks, “What happened? I was different only recently.”

This pattern is being discussed more and more by professionals who work with women in perimenopause and after menopause. A term has emerged in professional discussion: musculoskeletal syndrome of menopause.

This does not mean that every pain after40 should automatically be blamed on hormones. Nor is it a universal diagnosis that answers every question. It is better understood as an emerging professional framework that helps us look together at symptoms and changes that were often considered separately in the past: joint pain, loss of muscle strength, morning stiffness, changes in tendons and connective tissue, loss of bone mass and slower recovery.

And for many women, this story begins during perimenopause, while periods are still continuing.

The body can change earlier than we expect

A woman may be in her mid-40s, still working, caring for her family, training or walking a lot, and suddenly notice that familiar activities feel different.

The reason rarely fits into one simple formula.

Yes, the hormonal transition matters. Changes in oestrogen are linked with processes that affect bones, muscles and connective tissue. But hormonal change never happens in a vacuum. It arrives in the life a woman is already living.

And that life may already include poor sleep, long hours at a computer, constant stress, less strength training, weight changes, irregular eating and old injuries she has almost forgotten. A shoulder that troubled her ten years ago. An ankle after a past injury. A back that has spent years tolerating sedentary work.

That is why, as a trainer and health coach, I always try to look at the wider picture.

I want to know not only where it hurts, but also how a woman sleeps, how she moves through the week, whether she does any strength training, how she recovers, what has changed over recent months, and what her activity looked like before the pain appeared.

Because the body works as a system.

And sometimes one painful area gradually changes the whole system around it.

How pain can quietly shrink a life

Imagine a woman whose knee has started to hurt.

At first, she simply becomes more cautious. She walks less often, chooses the lift more often, and stops squatting because “it is better not to irritate the joint”. She skips one training session, then another.

A few months later, she really is moving less. Her thigh and gluteal muscles receive less load, balance gradually declines, movement becomes more guarded, and confidence keeps shrinking.

The knee now exists within a different system: the leg is weaker, movement control has changed, overall activity has dropped, and each step carries more tension.

A similar story can begin with a shoulder, a back or a foot.

That is why I do not like the blanket advice to “just take it easy”. Sometimes a temporary reduction in load is absolutely necessary. Sometimes assessment or treatment is needed. But very often the body does not need complete rest. It needs a different path: an appropriate stimulus, sensible dosage and time to adapt.

The starting point may look very modest. A few sit-to-stands, an exercise at the wall, calf raises, simple resistance-band work, gentle shoulder strengthening or a few balance exercises.

For one person, that is a light warm-up. For another, it is a genuine step back towards strength.

A good exercise does not automatically make a good program

In my work, I often meet highly intelligent and well-informed women. They read, research, save exercises, watch videos, try Pilates, walking, stretching, strength training and sometimes HIIT. At first glance, it can all look perfectly sensible.

But when you look more closely, different questions begin to appear.

Why were these particular exercises chosen? What is their purpose? Is there any progression in load? Are the muscles receiving enough stimulus? What happens to technique when she gets tired? Does the program account for an old injury, reduced balance or postural patterns? How does the body respond the next day? Why is stretching being added to an area that has lacked strength for years? Why is the hardest workout scheduled after the most exhausting workweek?

This is where the difference between a collection of good exercises and a real system becomes visible.

An exercise can be excellent in itself. But the real question is different: is it right for this person, at this dose, at this stage, right now?

After 40, I think this kind of precision becomes especially important. A woman often does not need to train harder. She needs to train smarter.

This is not only about muscles. Tendons also need load they can adapt to. A sudden jump in demand can irritate tissue, while avoiding load completely can gradually reduce its capacity to cope with ordinary life. That is why returning to activity is often built step by step, through an appropriate amount of work, resistance, speed and technique.

The story with bones is quieter still. Bone density can decline without pain, and sometimes a woman discovers unexpectedly after a DEXA scan that she has osteopenia or osteoporosis.

Walking is wonderful. I love it myself and often recommend it to clients. But when we are talking about muscles, bones and long-term function, walking alone is usually not enough. The body may also need resistance, strength work, balance, coordination and, when appropriate for the individual, safe impact loading.

Different tissues respond to different signals. The body needs that conversation.

Sometimes a professional perspective helps

This is where, in my view, the value of a personalised approach becomes especially clear.

A woman can know a great deal and still be unable to see her own full picture. That is normal. From inside our own lives, it is difficult to notice the same pattern repeating for months: removing all load whenever pain appears, then returning too quickly; stretching for years what actually lacks strength; or continuing an exercise simply because it helped someone else once.

When I work with a client, I do not look only at the painful area. I look at movement, strength, mobility, balance, previous injuries, response to load, recovery and what her ordinary week actually looks like.

Sometimes a small adjustment changes a great deal: removing an unnecessary exercise, replacing one movement with another, reducing volume, adding strength where there has been years of stretching, rebuilding load gradually, or distributing training differently across the week.

That is why I believe in a program that takes into account a woman’s real body, her history and her life.

Not an abstract woman over 40. Not an ideal program from the internet. A real person, today.

I want women to stop being afraid of their bodies

When something starts to hurt, it is very easy to begin seeing the body as fragile.

“I should not squat anymore.”

“I should not lift anything heavy.”

“It is my age.”

“I had better protect my joints.”

“Maybe training is no longer for me.”

I understand where that fear comes from. Especially when a woman has already tried to start, experienced a flare-up and stopped again.

But I also see another picture.

A woman starts at a level that genuinely suits her. Gradually, she strengthens her legs and back, regains control at the shoulder, and feels more confident on the stairs. She notices that morning stiffness eases more quickly, an ordinary walk no longer takes half a day to recover from, and it becomes easier to bend down, lift a bag or walk on uneven ground.

And gradually, a very important thought appears:

“My body is not as fragile as I feared.”

For me, this is one of the central goals of training after 40.

Not to make a woman ignore pain. Not to persuade her to push through it. But to help her body build capacity again.

What to try tomorrow

Big changes often begin with simple observation.

1. Make a small body map

In the morning, notice where you feel stiffness or pain: shoulders, lower back, hips, knees or feet. Rate the sensation from 0 to 10 and see what happens after a few minutes of movement.

Does it feel better? The same? Worse?

That is already useful information.

2. Check your response toa gentle warm-up

Try 5–10 minutes of calm movement: a short walk, gentle shoulder circles, a few sit-to-stands, calf raises, or easy weight shifts from one leg to the other.

The goal is not to have a good workout. The goal is to observe how your body responds.

3. Give your muscles one clear strength signal

This might be two sets of sit-to-stands, wall push-ups, a glute bridge, calf raises or a resistance-band row.

Choose one or two movements that suit your current condition.

4. Watch the next 24 hours

How do you feel in the evening? How did you sleep? What happens the next morning? Better, the same, or noticeably worse?

A good program is built around this feedback.

5. Check whether your body has what it needs to recover

Are you eating proper meals during the day and getting good sources of protein? Or does the day run on coffee and random snacks until you arrive home completely drained?

Muscles and connective tissues do not recover separately from the rest of life.

When pain needs medical clarity

At the same time, not every pain should be explained by menopause, age or lack of movement.

If pain persists, gets worse or clearly changes normal function, itis worth having it professionally assessed. This is especially important if there is significant swelling, redness, a hot joint, sudden weakness, numbness, loss of function, severe new night pain, fever, a recent injury or rapid deterioration.

Sometimes the best next step does not begin with a new exercise, but with understanding the cause.

For me, this is also part of working intelligently with the body: knowing when load needs to be adapted, and when medical clarity should come first.

The body after 40 can still become stronger

This is the thought I want to end with.

Forty, 45 or 50+ can be the time when a woman begins to train truly consciously for the first time. She knows herself better, asks better questions, feels less need to prove anything to other people, and understands more clearly the value of sleep, recovery and energy.

Yes, the body changes during perimenopause and after menopause.

But there is still an enormous amount we can work with: strength, mobility, balance, nutrition, sleep, recovery, intelligent progression and support.

Sometimes the first step is very small.

But it can be the point where a woman begins to notice not only what hurts. She also starts to see that her body can still learn, adapt and become stronger.

If you would like to start with support

If you are a woman 40+ in Eastern Sydney and your body has started to feel more stiff, sensitive or unpredictable, you can begin with a conversation.

In a one-to-one session, we can look at how you move now, where your body needs strength, where it needs mobility, how to choose the right load, and how to build a more confident return to training.

Calmly, gradually and with attention to your real starting point.

Sources

1.      Healthdirect Australia. Menopause Supports the statement that muscle and joint aches can be symptoms of menopause, and that symptoms often begin before periods stop.

2.      NICE Guideline NG23. Menopause: identification and management
Supports a contemporary approach to menopause as a life transition and the importance of maintaining muscle mass and strength through physical activity.

3.      Effect of resistance training on bone mineral density in postmenopausal women: a systematic review and meta-analysis, 2025A systematic review and meta-analysis of RCTs examining the effects of resistance training on bone density in postmenopausal women.

4.      Effects of different types of exercise on bone mineral density in postmenopausal women: a systematic review and network meta-analysis, 2025
Compares different types of exercise and their association with BMD in postmenopausal women.

5.      Australian Government. Physical activity and exercise guidelines for adults Supports recommendations for regular physical activity, strength exercises, functional movement and reducing prolonged inactivity.

6.       The emerging concept of the “musculoskeletal syndrome of menopause”
The term has entered professional discussion since 2024 as a way of bringing together changes in muscles, bones, joints and connective tissue around the menopausal transition. In this article, I use it as an emerging framework, not as an official diagnosis.

‍