What’s the connection between menopause and arthritis?

Changes in hormone levels during menopause may contribute to your risk of developing both osteoarthritis and rheumatoid arthritis. But scientists are still trying to understand exactly how this works.

Part of what’s puzzling is that hormone replacement therapy (HRT) doesn’t necessarily help to reduce arthritis symptoms or risk, and in some cases can actually increase them.

Symptoms can depend on the type of arthritis you have but often include aching, swollen and stiff joints. The particular joints affected, and the best treatments for your arthritis, also vary, but there are lifestyle changes and medications that can help with both types.

Certain supplements may also improve the health of your joints and reduce arthritis symptoms.

The Better Gut award-winning probiotic supplements can help with a whole range of perimenopause and menopause symptoms, from problems with bone health to hot flashes, anxiety and digestive issues.

Find out more here about what these beneficial bacteria can do for you. And for 10% off, plus regular expert tips on menopause health and nutrition, join our newsletter.

Osteoarthritis and menopause

Osteoarthritis is a common degenerative disease where the cartilage in your joints starts to break down. It can affect your hands, feet, spine, hips and knees, causing pain, stiffness and swelling.

Perimenopause and menopause increase your risk of developing osteoarthritis. Many scientists believe this is due to the natural reduction in the reproductive hormone oestrogen that happens during this time.

During perimenopause, oestrogen levels vary from one woman to another and studies have found that those with osteoarthritis have lower levels of oestrogen than those who haven't developed it.

Cartilage, which acts as a cushion between the bones in your joints, contains oestrogen receptors and there is evidence that oestrogen can help protect cartilage from deteriorating.

However, scientists still don’t fully understand the relationship between oestrogen levels, cartilage and osteoarthritis and not all research supports it.

Part of the confusion comes from studies looking at the effects of hormone replacement therapy (HRT).

Does HRT help with osteoarthritis?

HRT is a prescription treatment that uses tablets, skin patches or gels to replace the oestrogen and other hormones you lose during perimenopause and menopause.

HRT can be an effective way to treat a range of menopause symptoms, but does it help with osteoarthritis? The answer is currently unclear.

One older population study involving over 4,300 post-menopausal women, found that those using oestrogen replacement therapy had a 40% lower instance of hip osteoarthritis, which reduced even further after 10 years of using oestrogen.

A study in Italy backed this up, finding that menopausal women who used HRT were 27% less likely to be diagnosed with osteoarthritis.

In contrast, another large-scale study found that participants had a 29% greater risk of developing osteoarthritis if they had used HRT in the past, and 38% greater if they were currently using it.

Similar results came from a study involving 1,000 postmenopausal women, with participants who had been using oestrogen for over a year more likely to have osteoarthritis in their hands and hips than those who had never used it.

These conflicting results are a reminder that there’s still lots scientists don’t understand about the relationship between oestrogen levels and the risk of developing osteoarthritis.

Rheumatoid arthritis and menopause

Rheumatoid arthritis is a type of autoimmune disease where your immune system starts to attack the tissues of your joints, usually in your hands, wrists and feet. Over time, this can damage the cartilage and bone.

Although rheumatoid arthritis is more common in women than men, until recently it hasn’t been as strongly linked to menopause as osteoarthritis has.

However, one large, long-term observational study published in 2024 by the British Medical Journal (BMJ) did identify several factors relating to women’s hormonal status that might increase their risk of developing rheumatoid arthritis.

According to the study, your risk of developing rheumatoid arthritis increases if:

• you had your first period at 14 or older: 17% greater risk than at 13
• you reached menopause before the age of 45: 46% greater than at 50–51
• there were fewer than 33 years between your first period and menopause: 39% greater
• you have had 4 or more children: 18% greater risk than having 2 children
• you have had a hysterectomy (removal of the uterus and cervix): 41% greater
• you have had an oophorectomy (removal of both ovaries): 21% greater

It’s important to remember that this was an observational study, rather than a tightly controlled experimental study, so more research is needed. Nevertheless, it does strongly suggest that menopausal and hormonal factors are relevant to the development of rheumatoid arthritis.

It’s also worth being aware that earlier clinical studies have suggested that women who go through menopause before the age of 45 and develop rheumatoid arthritis may have milder symptoms.

Does HRT help rheumatoid arthritis?

The BMJ study found that women who had used HRT had a 46% greater chance of developing rheumatoid arthritis. However, older studies have shown mixed results.

The researchers running the BMJ study also noted that the negative impact of boosting oestrogen using HRT was at odds with the apparent risk-reducing effects of having naturally higher levels of oestrogen.

As with osteoarthritis, it seems there is a link between hormone levels and rheumatoid arthritis but it’s not a simple one.

Arthritis symptoms: what does it feel like and which joints are affected?

Because there are different types of arthritis, your symptoms may vary, but they could commonly include:

• a throbbing or aching pain in your joints
• stiffness and restricted movement
• swelling or inflammation around your joints
• redness and heat at the joint
• joints that feel larger or ‘knobbly’

Pain and stiffness are often worse in the morning or if you haven’t moved for a while. With osteoarthritis, this usually wears off in around half an hour. With rheumatoid arthritis, it can take longer.

Osteoarthritis often involves pain in just one or a few joints at a time. The most commonly affected areas are:

• knees
• hips
• the small joints in your hands

Rheumatoid arthritis can involve ‘flare ups’, where your symptoms suddenly get worse for a day or two, and sometimes longer. It’s most common in your:

• hands
• wrists
• feet

Treatment

If you’re diagnosed with osteoarthritis or rheumatoid arthritis, your doctor may recommend over-the-counter drugs, such as paracetamol, ibuprofen or codeine, to help with the pain. If your pain is very bad, they may also suggest steroid injections.

In some cases, surgery may be required.

When it comes to treating the cause of your arthritis, there are a number of medications and lifestyle changes you could be prescribed, which we’ll look at below. With all of these, it’s important to follow them as instructed by your doctor.

Osteoarthritis treatments

Most of the recommended treatments for osteoarthritis are lifestyle changes. These may help to prevent your symptoms from getting worse:

• Exercise: The NHS recommends targeted exercise as a way of strengthening the muscles around your joints, reducing stress, helping to maintain a healthy weight and improving your overall fitness, all of which can help to relieve symptoms. Your doctor or a physiotherapist can help to create an exercise plan that suits you.
• Losing weight: Being above a healthy weight can put extra pressure on your joints, which can make your arthritis worse. This NHS calculator can tell you if you might be overweight. Along with regular exercise, eating a healthy balanced diet can help you to lose weight in a sustainable way. Talk to a healthcare professional about the best ways to approach this.
• Hot or cold packs: Some people find that holding a hot water bottle filled with hot or cold water against their affected joints can help reduce pain. You can also buy specially designed packs to heat up in the microwave or cool in the freezer.
• Manual therapy: If your doctor refers you to a physiotherapist, they may use a technique called manual therapy where they massage and stretch the tissues around your joints to help keep them flexible.

Rheumatoid arthritis treatments

There are several treatments for rheumatoid arthritis that can help to reduce inflammation and damage to your joints, and ease your symptoms:

• Disease-modifying anti-rheumatic drugs (DMARDs): These block the damaging effects of chemicals released by your immune system when it attacks your joints. DMARDs include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine.
• Biological treatments: If DMARDs aren’t fully effective, you may also be given an injection of a biological treatment such as adalimumab, etanercept or infliximab. They stop your immune system from attacking your joints in the first place.
• Janus kinase (JAK) inhibitors: If you can’t take DMARDs or biological treatments, or if they aren’t working, you may be prescribed JAK inhibitors such as tofacitinib, baricitinib, upadacitinib or filgotinib. They work in a similar way to DMARDs but come as tablets.
• Physiotherapy and exercise: A physiotherapist can recommend exercises to help strengthen the muscles around your joints and improve your flexibility. They may also use a TENS machine, which sends electrical pulses to your joints to help relieve pain.

Supplements for joint health and arthritis

There’s some evidence that certain food supplements may help to improve joint health and reduce symptoms of arthritis, including during menopause.

For more information, read our dedicated article on supplements for menopause joint pain.

• Omega-3 fatty acids: Found in fish oil and algae supplements, omega-3s can reduce menopausal joint pain and stiffness, as well as the swelling and pain of rheumatoid arthritis.
• Collagen: Studies have found that supplements containing collagen peptides can help protect cartilage, improve joint function and reduce joint pain.
• Glucosamine: Sometimes prescribed for people with osteoarthritis, glucosamine sulphate may help to protect cartilage and reduce knee pain.
• Methylsulfonylmethane (MSM): MSM is another compound that may protect cartilage. Studies suggest it can help with joint pain and swelling in older people, and those with knee osteoarthritis.
• Curcumin: Supplements containing curcumin, the active ingredient in the spice turmeric, may help with arthritis joint pain and could even be as effective as traditional painkillers.
• Probiotics: Probiotics are gut bacteria with health benefits. Certain strains can improve symptoms related to menopause joint health, including by reducing inflammation, strengthening your immune system and increasing bone density.

The Better Gut is an award-winning probiotic supplement containing strains of bacteria chosen specifically to improve your health during perimenopause and menopause. They can help with symptoms including:

• hot flashes and night sweats
• mood and symptoms of anxiety and depression
• brain fog and mental fatigue 
• sleep quality
• bloating and constipation
• vaginal health 
• maintaining a healthy weight

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Does menopause arthritis go away?

When it comes to the connection between menopause and arthritis, it’s clear that the reduction in natural levels of oestrogen plays a part. During perimenopause, oestrogen production can fluctuate but after menopause levels remain low. It’s therefore unlikely that your arthritis will get better naturally at this point if it’s menopause-related.

Although there’s no cure for either osteoarthritis or rheumatoid arthritis, osteoarthritis doesn’t necessarily get worse over time. Treatments and lifestyle changes, including those we’ve looked at, can help to reduce symptoms and manage the progression of both these diseases.

Summary

The risk of developing both osteoarthritis and rheumatoid arthritis appears to increase with the natural reduction in oestrogen levels that takes place during perimenopause and menopause.

However, studies involving hormone replacement therapy have had conflicting results, with some suggesting that HRT can reduce risk and others that it can increase it. More research is needed before scientists fully understand the link between oestrogen and arthritis.

Treatments for arthritis vary depending on which type you have, but over-the-counter painkillers can help with both.

For osteoarthritis, exercise and maintaining a healthy weight are important, while hot or cold packs may help with faster relief.

For rheumatoid arthritis, a doctor may prescribe medications including disease-modifying anti-rheumatic drugs, biological treatments and JAK inhibitors, as well as physiotherapy and targeted exercises.

Supplements including omega-3s and glucosamine may also help some people.

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