Menopause Musculoskeletal Syndrome (MMS) wasn’t something I’d ever heard about in my 30s or 40s—yet it’s a critical issue that should be on our radar well before menopause begins.
This isn’t new science—but it’s rarely mentioned in routine care. Women should be given this information early, while they still have time to take proactive steps. That said, the next best time to start is now.
MMS refers to a constellation of physical changes triggered by estrogen loss during menopause that affects bones, joints, tendons, and muscles. It’s underdiagnosed, underdiscussed, and silently affects millions of women.
While it’s long been known that menopause can lead to osteoporosis, MMS goes further—recognizing the full-body impact of estrogen loss on:
- Muscle mass and strength (sarcopenia)
- Joint pain and stiffness
- Tendon health
- Balance and coordination
- Bone density
These aren’t isolated symptoms. Together, they form a syndrome—a pattern of interrelated changes that increase the risk of frailty, falls, and fractures as we age.
The Science Behind It
Estrogen isn’t just a reproductive hormone—it plays a protective role across the entire musculoskeletal system. It supports:
- Muscle maintenance and regeneration
- Bone remodeling
- Cartilage lubrication and joint health
- Tendon and ligament elasticity
When estrogen declines in menopause, our body’s ability to maintain these systems also decline—leading to pain, stiffness, fatigue, and gradual strength loss.
Left unaddressed, these symptoms can spiral into inactivity, weight gain, and an increased risk of injury or chronic disease.
When estrogen drops:
- Inflammation rises. Cytokines—chemical messengers released by the immune system, like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)— contribute to joint pain, morning stiffness, and accelerated muscle breakdown (catabolism).
- Bone remodeling slows. Normally, your bones are in a constant cycle of breaking down and rebuilding. Estrogen keeps this balanced. Without it, bone resorption (loss) speeds up, while bone formation slows down, increasing the risk of osteopenia and osteoporosis.
- Muscle maintenance declines. Estrogen supports muscle protein synthesis and satellite cell activation (important for muscle repair). When levels fall, you lose muscle mass (sarcopenia) and strength more rapidly—especially if you’re not resistance training or eating enough protein.
- Tendon and ligament tissue weaken. Estrogen helps maintain the collagen structure in tendons and ligaments. Lower levels can lead to reduced elasticity, stiffness, and higher injury risk (especially rotator cuff or Achilles issues).
- Insulin sensitivity drops. Estrogen plays a role in how your body uses glucose for energy. Without it, you may become more insulin resistant—meaning your body doesn’t use insulin as efficiently, leading to:
- Higher fasting glucose levels
- Increased belly fat
- A greater risk of prediabetes or type 2 diabetes
All of these changes create a syndrome, not isolated symptoms—where inflammation, instability, and weakness reinforce each other.
While this isn’t new science, it’s rarely discussed in routine care. Many women are dismissed with “It’s just aging, arthritis”
What Makes It Worse
Several lifestyle and metabolic factors can accelerate or worsen MMS, especially if they go unaddressed:
- Sedentary lifestyle – Inactivity weakens muscles, bones, and coordination
- Low protein intake – Without enough protein, your body can’t rebuild muscle or maintain strength
- Chronic stress or inflammation – Both increase cortisol, which breaks down bone and muscle over time
- Excess alcohol – Interferes with nutrient absorption, weakens bones, and worsens sleep and recovery
- High blood sugar or insulin resistance – Even borderline levels (aka “pre-diabetes”) drive inflammation and fat gain
- Vitamin D deficiency – Impairs calcium absorption and muscle function
The upside? These are modifiable factors—which means it’s never too late to take back control and change the trajectory of your health.
The Missing Link: Metabolic Syndrome and Menopausal Muscle Loss
Many women in midlife notice frustrating changes: belly fat that won’t budge, rising blood sugar, joint pain, or sudden stiffness. Too often, these symptoms are treated separately—or shrugged off as “normal aging.”
But they may all point to a bigger picture: metabolic syndrome.
Metabolic syndrome is a cluster of risk factors that increase your risk for heart disease, diabetes, and now—research suggests—accelerated musculoskeletal decline. It includes:
- High fasting glucose (≥100 mg/dL)
- Waist circumference over 35 inches
- High blood pressure (≥130/85 mmHg)
- Low HDL cholesterol (<50 mg/dL)
- High triglycerides (≥150 mg/dL)
If you have three or more, you meet the clinical definition. But even one or two markers are early warning signs that your body is becoming metabolically stressed.
Here’s the connection: as estrogen declines during menopause, insulin sensitivity drops. You may become insulin resistant or “pre-diabetic” without ever being told. Blood sugar might still look “normal,” but insulin may already be elevated. Blood sugar might still look “normal,” but insulin could be elevated—causing fat storage around the belly, increasing inflammation, and putting stress on your joints, tendons, and muscles.
The result is sarcobesity: a combination of muscle loss and fat gain that increases the risk of falls, fractures, cardiovascular disease, and type 2 diabetes.
And yet? Too many women are dismissed or undiagnosed—simply told to “watch their diet” or “come back in 6 months.” That’s not enough. You deserve better.
What You Can Do About It
This isn’t about fear—it’s about taking powerful, informed action.
No matter your age, diagnosis, or starting point—here’s what you can do.
1. Lift Weights—Consistently
Strength training is the single most effective way to:
- Preserve muscle mass
- Protect bones and prevent fractures
- Improve balance, coordination, and confidence
It’s never too late to start. Begin with bodyweight or light resistance—and build from there with consistency.
2. Eat Enough Protein
Aim for 1 gram of protein per pound of body weight—especially if you’re active or losing weight.
👉 See Protein in a Day for a practical daily breakdown
- Rebuilding muscle
- Supporting bone health
- Regulating appetite and blood sugar
3. Support Bone and Joint Health
Consider these supplements—discuss them with your provider:
- Calcium – from food + supplements if needed
- Vitamin D3 – essential for calcium absorption and immune support
- Vitamin K2 – helps direct calcium into bones (not arteries)
- Magnesium – supports bone formation, muscle function, and sleep
- Boron, zinc, silica – trace minerals that aid in bone metabolism
- Collagen peptides – may help tendons, ligaments, skin, and joint comfort
4. Consider Creatine Monohydrate
Creatine (3–5g daily) isn’t just for athletes—it can:
- Increase muscle strength and power
- Support cognitive function
- Potentially improve glucose control
- Some providers may still be unfamiliar with creatine’s benefits for midlife women—especially when it comes to muscle and metabolic health.
Note: If you’re taking creatine, your kidney labs—especially serum creatinine—may appear slightly elevated (this was the case for me). This doesn’t necessarily indicate kidney dysfunction, but rather reflects increased muscle turnover or supplementation.
Ask for additional markers like eGFR or cystatin C if there’s concern.
5. Know Your Numbers—Advocate for Testing
Ask your doctor to test:
- DEXA scan – to assess bone density and body composition
- A1C and fasting insulin – to screen for blood sugar and early insulin resistance
- Vitamin D levels – for immune and bone support
- Inflammatory markers – like CRP or ESR
- Micronutrient panel – especially if fatigue or muscle loss is present
Want to Go Deeper?
The concept of Menopause Musculoskeletal Syndrome (MMS) was introduced in a 2024 peer-reviewed paper in Climacteric.
👉 Download the full MMS research article (PDF)
Bring it with you to your next appointment to help start an informed, collaborative conversation with your provider.
🔍 Use this MMS Discussion Guide to identify symptoms, track risk factors, and get the care you deserve.
The Bigger Picture
MMS isn’t just about aches and pains—it’s about healthspan: how well you move, feel, and function as you age—not just how long you live.
Too many women are being dismissed, misdiagnosed, or overlooked entirely. They aren’t given the tools to stay strong, mobile, and independent for the long haul.
Let’s change that—together. Now is the time to get informed, get strong, and speak up for better care.
Related Reading: Invisible in Research, Invisible in Care: The Research Gap That’s Costing Women Their Health
Learn why doctors aren’t talking about MMS—and how women are finally pushing back.
“Women are not small men. Stop giving us data based on them.”
— Dr. Stacy Sims
