Menopause: Symptoms, Muscle and Joint Health, HRT and Evidence

Women can begin experiencing perimenopause symptoms before their periods become irregular. Joint pain, headaches or palpitations may not immediately be connected with hormonal change. And when it comes to HRT, hormone testing and the growing menopause-wellness market, the information women encounter can become complicated.

Perimenopause symptoms can begin before periods become irregular; symptoms such as joint pain, headaches and palpitations may not immediately be associated with hormonal change and should be properly assessed; musculoskeletal changes can include joint pain, muscle aches, frozen shoulder, muscle loss and bone loss; hormone testing has specific clinical uses but a random snapshot may be difficult to interpret; HRT should be individualised; menopause products should be assessed by looking at the science and data behind them; and women should know themselves and seek the support they deserve.

What is the biggest misconception about menopause?

One of the misconceptions Ginny continues to hear is that a woman is too young to be experiencing perimenopause, or that regular periods mean it cannot have started.

“I hear women coming in saying they were told they were too young… or, ‘it can’t be perimenopause because your periods are still regular.’”

Ginny says perimenopause has traditionally been associated with changing menstrual cycles, hot flushes and sweats.

But she says symptoms can begin before periods change.

“Symptoms can start way before periods are changing, and way before the hot flashes and sweats.”

She gives anxiety and insomnia as examples.

What are some of the menopause symptoms women may not immediately recognise?

When asked for an unusual symptom, Ginny describes a crawling sensation across the skin.

“Your skin crawling, people feel insects crawling over the skin.”

But she says some of the more important symptoms are not necessarily unusual — they simply may not be associated with perimenopause.

She gives three examples:

palpitations, headaches and joint pains.

Ginny describes women being referred separately to cardiologists for palpitations, rheumatologists for joint pain and neurologists for headaches.

“Nobody’s joined the dots.”

She says those physical symptoms could be related to perimenopausal hormonal changes.

At the same time, Ginny stresses the importance of proper medical assessment rather than assuming every symptom is hormonal.

“We don’t want to always just assume it’s the hormones.”

Why can heart palpitations happen during perimenopause?

Ginny is careful about the limits of what is known.

“The short answer is we don’t exactly know.”

She discusses several possibilities.

Ginny says hormone receptors are found throughout the body and that different systems can therefore be affected by changing oestrogen levels.

She also says palpitations can occur as a physical manifestation of anxiety.

Another possibility she discusses is a change in tolerance to things such as caffeine and alcohol.

Someone who previously drank several coffees a day without difficulty may suddenly notice a much greater effect.

However, Ginny makes an important distinction when palpitations involve an irregular heart rhythm.

In that situation, she says it becomes:

“More a cardiology issue, rather than a hormone sort of issue.”

What is the musculoskeletal syndrome of menopause?

This is one of the areas Ginny has recently been speaking about.

She describes it as:

“A collection of musculoskeletal symptoms that can present in the perimenopause.”

The musculoskeletal system includes muscles, bones, joints, cartilage, ligaments and tendons.

Ginny says changing oestrogen levels can affect these areas.

Symptoms she discusses include:

• generalised joint pain
• generalised muscle aches
• frozen shoulder
• tendinopathies
• muscle loss
• bone loss

Ginny also discusses sarcopenia — muscle loss — and the importance of oestrogen to muscle bulk, quality and efficiency.

Another major part of the picture for her is bone health.

She talks about osteopenia and osteoporosis and says the loss of oestrogen after menopause can contribute to bone thinning.

When should joint pain and muscle aches become part of the menopause conversation?

Ginny’s answer is:

“Menopause should always be part of the conversation.”

That does not mean automatically attributing joint or muscle symptoms to menopause.

Ginny says women know what is normal for their bodies and may begin noticing changes and at that point:

“They should be getting themselves properly assessed.”

Assessment matters both to consider hormonal changes and to rule out other possible causes.

If symptoms are related to changing hormones, Ginny says treatment does not automatically mean hormone therapy.

She also discusses lifestyle approaches, including resistance training for muscles and weight-bearing exercise for bone health.

Do women need hormone tests to diagnose perimenopause?

Ginny describes hormone testing as a complicated area.

For women over 45 experiencing typical perimenopausal symptoms, her answer is clear:

“You don’t need to have tests to make that diagnosis.”

She says diagnosis can be made clinically based on age and typical symptoms, and:

“Doing the test doesn’t necessarily change your management.”

That does not mean blood testing has no place.

Ginny says other tests can be useful when considering alternative causes of symptoms.

She also describes hormone testing as particularly important in certain clinical situations, including investigating early menopause and premature ovarian insufficiency.

Why can a single hormone test be difficult to interpret?

Ginny explains that hormone levels fluctuate throughout the menstrual cycle.

That means:

“It’s often not helpful just doing a snapshot, kind of randomly.”

Timing matters.

She describes women buying tests online, receiving apparently normal results and then beginning to question what they are experiencing.

“Then they doubt themselves.”

A normal result at one point in time does not, in Ginny’s explanation, show what hormone levels may do as they continue to fluctuate.

She also acknowledges how complicated the subject can become.

“I think clinicians get confused around them.”

And if healthcare professionals find interpretation complicated, she says it is understandable that women do too.

What are women most confused about when it comes to HRT?

Ginny identifies continuing fear around HRT and breast cancer.

“There is still a lot of fear around HRT from a breast cancer point of view.”

She discusses the legacy of studies from around 25 years ago that changed prescribing practices and women’s perceptions of HRT.

Another significant source of confusion is treating HRT as though it were one single thing.

“Not all oestrogen is the same, and not all progesterones are the same.”

Ginny discusses different forms and delivery methods, as well as the different factors that may need to be considered for an individual woman.

For her, HRT is not:

“One size fits all.”

Instead:

“It does absolutely need to be individualised.”

She describes that individualisation in terms of:

“Individual risk, individual preference, and individual medical needs.”

Ginny also recommends speaking with somebody who has women’s-health and menopause training when more specialist input is needed.

How can women distinguish evidence-based menopause products from clever marketing?

Ginny admits that even as a menopause specialist, she is not immune to attractive packaging and persuasive advertising.

Her first piece of advice is memorable:

“Do not impulse buy in the middle of the night.”

Instead, she recommends looking beyond social-media claims and headlines.

“Go to the website, read the small print, and drill down into the science.”

Ginny is cautious about relying too heavily on reviews because individuals differ in their medical needs and lifestyles.

“We’re all so different.”

She therefore places greater importance on:

“The science, the data.”

Where can menopause marketing get ahead of the science?

Ginny welcomes the fact that menopause is being discussed more openly and that more products and support are becoming available.

But she also recognises the commercial forces around the menopause market.

For her, the balance is between increasing the help available to women and:

“Not being sold snake oil at vast expense.”

When Alex asks whether products need to be grounded in science and genuine benefits, Ginny agrees:

“Yes, definitely.”

What role should lifestyle play alongside medical menopause treatment?

Ginny’s response is immediate:

“That’s first things first.”

She sees lifestyle as relevant not only to managing perimenopausal and menopausal symptoms but to wider health.

Ginny discusses:

• diet
• quality sleep
• movement
• human connection
• reducing caffeine and alcohol
• stress management
• 
  

But knowing what to do is only one part of it.

“Those things can make a positive impact.”

The difficult part is making changes sustainably.

“You’ve got to do it consistently.”

Ginny prefers the word movement to exercise because she feels “exercise” can make activity seem intimidating.

She encourages starting gently and finding something that can remain part of life for years.

“Whatever works for you… that you can be consistent with.”

She also talks about women giving themselves permission to make time for their health.

“Don’t feel guilty for taking a little bit of time out.”

Should menopause be treated as an isolated hormonal event?

Ginny does not frame this as a simple yes-or-no question.

She says women who have experienced hormone-related difficulties earlier in life may also struggle with hormonal fluctuations during perimenopause.

She discusses PMS, PMDD, PCOS, endometriosis and adenomyosis in this context.

She also sees menopause appointments as an opportunity to think beyond immediate symptom management.

“This is actually now part of your longer-term health.”

For Ginny, the priority remains helping women feel better and manage what they are experiencing, while also thinking about health over the years ahead.

What do employers misunderstand about menopause?

Ginny talks about women going through menopause while also reaching significant stages of their professional lives.

She describes women leaving jobs, reducing hours or taking sick leave when they do not feel adequately supported.

That can also mean employers lose:

“Experience, work place diversity, but also that institutional memory.”

Ginny describes menopause as:

“A phase for women.”

Her message to employers is that individual women may need different forms of support.

Some may benefit from flexible working. Others may need physical changes to their working environment.

Rather than assuming, Ginny says:

“Ask women what they think and what they need.”

Her advice to organisations is:

“Listen to your women, and support them through it.”

What would Ginny say to men during menopause?

Ginny’s first message is straightforward:

“Educate yourself.”

She encourages men to attend workshops, read about menopause or find other ways to understand what the women around them may be experiencing.

Her second message is to listen.

“Listen to the women in your life.”

That includes partners, friends and colleagues.

And listening does not necessarily mean immediately trying to solve the problem.

“Just listen, be empathic.”

Ginny also suggests practical support in the background, whether that means giving a partner time for movement or stress management, helping with dinner or taking responsibility for the children.

Her emphasis is on quietly making things easier rather than expecting praise for doing so.

What does Ginny want women going through menopause to know?

Towards the end of the conversation, Ginny returns to the emotional impact menopause can have.

She describes seeing women who no longer recognise themselves and begin questioning whether what they are experiencing is real.

Her message is:

“This isn’t forever.”

She is careful not to minimise difficult experiences. She says she has seen the effect severe symptoms can have on women’s health, relationships and work.

But she also says:

“You are not imagining it. It is happening, it is real.”

Her advice is:



“Know yourself, and get the help that you deserve.”

For Ginny, that can mean speaking to a medical professional, prioritising time for yourself or reconsidering what you need from your lifestyle.

With the right support, she believes this stage can also create an opportunity to think about what you want from the rest of your life.

Alex founded Alexander Clementine manufacturer and supplier of environmentally friendly seaweed based underwear. This is Alex’s story.

What started as a sustainability project became a personal mission to drive innovation in women's health.

Underwear in one of the most disposed of items of clothing and is not bought second hand.

Experts also recommend replacing underwear every 6-12 months, so initially we simply wanted to develop something more environmentally friendly.

We soon discovered that our seaweed based underwear was having a positive impact in women's health. Women kept coming forward highlighting the support and comfort our unique fabric was providing during menopause.

During this time it hit closer to home, with my mum, Alison, experiencing breast cancer. In a time when I felt helpless, our underwear was the only thing that she could wear to comfort her during recovery.

This became the trigger to pivot the brand to focus on women's health.

Today we work with leading experts across science and medicine to drive material innovation to support women's health.

We actively engage with the growing menopause community to support meaningful change.

As a young man in this space, I feel I have an opportunity to help drive awareness for menopause.

What touches your skin matters, because sometimes the smallest layer can make the biggest difference.