The First Ten Steps Out of Bed Take Longer Than They Did
Body · The Reading Room, Vol. 47 · 9 min read · What an orthopedic surgeon’s 2024 paper named, and why 40% of scans come back clean
Based on the published research of
Vonda J. Wright, MD, MS, FAOA — orthopedic surgeon, UCF College of Medicine, and lead author of the paper that named this syndrome
Faculty page, UCF College of Medicine · Wright et al., 2024, Climacteric · her site · LinkedIn
Joint pain in perimenopause is estrogen, not age, and 40% have nothing on a scan. What a 2024 orthopedic paper named it, and the morning test to take to a doctor.
The first ten steps out of bed take longer than they used to. Not pain exactly, at least not at first. Stiffness, in the hands and the hips and somewhere in the lower back, that loosens after about twenty minutes of moving around and is gone by the time anyone else is up to see it.
So you have not mentioned it. And when you did, once, the answer was that you are in your fifties now.
The short answer: joint pain in perimenopause is driven by falling estrogen rather than by age, and it now has a clinical name. A 2024 paper in Climacteric, written by an orthopedic surgeon rather than a wellness brand, proposed the musculoskeletal syndrome of menopause for the whole cluster. It reports that more than 70% of women experience musculoskeletal symptoms through the transition and 25% are disabled by them. The number worth writing down: 40% have no structural findings on imaging.¹
The skim version
- The musculoskeletal syndrome of menopause was named in a 2024 paper in Climacteric, the journal of the International Menopause Society, by orthopedic surgeon Vonda J. Wright and colleagues.¹
- More than 70% of women have musculoskeletal symptoms through the transition; 25% are disabled by them.¹
- 40% have nothing visible on a scan. A normal image does not mean nothing is happening.¹
- Estrogen receptors sit in cartilage, tendon, muscle and bone. When estrogen falls, all of them change at roughly the same time.
- Morning stiffness that eases within about half an hour is the expected pattern. Stiffness lasting well over an hour is a different question, and one worth raising with a doctor.
In this article: Why it starts now · The normal scan · What else it could be · When to call a doctor · The morning test · Questions
Why did my joints start hurting in perimenopause?
Because estrogen was doing more than most women are told. It keeps cartilage hydrated, limits inflammatory activity inside joint tissue, and helps maintain muscle mass and bone density. Estrogen receptors are present throughout the musculoskeletal system, so when levels fall the change is not confined to one joint. It happens everywhere those receptors sit, at close to the same time.
That is why the pattern is so often described as diffuse. Hands and hips and shoulders and the base of the spine, none of them injured, none of them the obvious result of anything you did.
Wright’s 2024 paper pulled these separate complaints together deliberately. Joint pain, loss of muscle mass, falling bone density and the acceleration of osteoarthritis had been treated for years as unrelated problems that happen to arrive in the same decade. Named as one syndrome with one hormonal driver, they stop looking like a run of bad luck and start looking like a single, testable mechanism.¹
Definition: the musculoskeletal syndrome of menopause is the collective term for the musculoskeletal signs and symptoms — joint pain, muscle loss, bone loss, and accelerated osteoarthritis — associated with the drop in estrogen during the menopause transition.¹
If you have been waiting for it to be bad enough to mention, the Quiet Audit is ten minutes on everything else on that list. Start here.
My scan was normal. What does that actually mean?
It means you are one of the 40%.
Wright’s paper found that 40% of women reporting these symptoms have no structural findings on imaging.¹ Nothing torn, nothing worn through, nothing to point at. And because a normal scan is usually delivered as good news, most women leave the appointment with the impression that the problem has been ruled out.
It has not been ruled out. It has been ruled out of one category. Imaging shows structure. It does not show the state of the tissue chemistry, the low-grade inflammatory activity, or the cartilage hydration lost along with the hormone that maintained it.
What the research found
Study: Wright, Schwartzman, Itinoche & Wittstein, Climacteric, 2024. A review proposing a unified clinical definition for menopause-related musculoskeletal symptoms.¹
Finding: Over 70% of women report musculoskeletal symptoms during the menopause transition; 25% report symptoms severe enough to be disabling. 40% of affected women have normal imaging.¹
Limitation: This is a narrative review synthesizing existing prevalence data, not a single new clinical trial, and the authors note more prospective research is needed to establish treatment protocols specific to this syndrome.¹
This matters practically, because a normal scan is often where the investigation stops. Knowing that four in ten women look exactly like you do on paper is what lets you go back and ask a different question, rather than concluding you imagined it.
| Hormonal, menopause-related | Worth a different conversation | |
|---|---|---|
| Morning stiffness | Eases within about 30 minutes of moving | Lasts well over an hour |
| Pattern | Diffuse, several areas, shifting | Fixed to one or two joints, worsening |
| Swelling | Little or none visible | Visible, warm, persistent |
| Timing | Arrived alongside other menopause changes | Arrived alone, unrelated to anything else |
| Imaging | Often normal | Shows a finding that fits the symptoms |
The right column is not a diagnosis. It is a description of when to press for more testing rather than accept the age explanation.
Is this arthritis, or is it hormones? What else could it be?
Frequently both, and the framing of the question is where women get stuck.
Osteoarthritis is real and it does progress in this decade. But Wright’s paper places the acceleration of osteoarthritis inside the syndrome rather than beside it, because estrogen loss appears to speed the process along.¹ So the choice is rarely between arthritis and menopause. The transition can be doing both at once.
“A normal scan rules out one category of explanation. It does not rule out the one that is actually happening.”
What else produces joint pain and stiffness like this
- Rheumatoid arthritis — usually symmetric, small joints of the hands and feet, morning stiffness typically lasting well over an hour, sometimes visible swelling. Confirmed or ruled out with blood tests (RF, anti-CCP) rather than imaging alone.
- Hypothyroidism — joint aches, fatigue and muscle stiffness are common early signs and overlap almost completely with this syndrome. A simple TSH blood test distinguishes the two.
- Vitamin D deficiency — widespread aching and muscle weakness, common in midlife women and easily corrected once identified. Checked with a blood test.
- Fibromyalgia — widespread pain with specific tender points and often disrupted sleep; a clinical diagnosis made after other causes are excluded.
- Osteoarthritis on its own — usually confined to one or two joints that have taken the most mechanical load over the years (knees, hips, the base of the thumb), and it does show up on imaging.
None of these are mutually exclusive with the musculoskeletal syndrome of menopause. A woman can have hormone-driven joint pain and a vitamin D deficiency at the same time, which is exactly why blood work is worth asking for rather than skipping.
When does this need a doctor’s appointment rather than patience?
See a doctor this week, not eventually, if you notice:
- A joint that is visibly swollen, red, or warm to the touch
- Morning stiffness lasting more than an hour, most days
- Fever alongside joint pain
- Pain concentrated in one joint that is steadily getting worse rather than shifting around
- Pain that wakes you at night, separate from general stiffness
None of these rule out a hormonal cause. They rule out treating it as hormonal without first checking.
The advice that quietly makes it worse
The instinct is to rest the joint that hurts, and for an injury that instinct is correct. This is usually not an injury.
Loss of muscle mass is part of the same syndrome, and muscle is what takes load off a joint. Rest reduces pain in the short term and reduces the muscle supporting the joint over the medium term, which is part of why the pattern so often widens over a couple of years rather than settling on its own.
The uncomfortable implication is that resistance training is more useful here than rest, and it is the thing least often suggested to a woman in her fifties presenting with sore hands. Not because anyone doubts the evidence. Because the conversation usually ends at the normal scan.
The morning test, and the sentence for the appointment
For one week, note two things when you wake. What time you got up, and what time the stiffness had gone. Two numbers, nothing else.
That gap is one of the most useful pieces of information you can hand a clinician, because the duration of morning stiffness is one of the first things a diagnosis is sorted on. Under about thirty minutes points toward the hormonal pattern. Well over an hour points somewhere that deserves blood tests rather than reassurance.
Take it in with one sentence.
Say this: “I’ve had joint pain and morning stiffness since my periods changed, and it eases after about twenty minutes. I’d like blood work to rule out thyroid and rheumatoid causes, and I’d like to know whether this is the musculoskeletal syndrome of menopause.”
Two notes on that sentence. It puts a specific, published clinical term on the table, which moves the conversation past age. And it is new enough — named in 2024 — that your doctor may not have encountered it yet. That is not a reason to avoid saying it. It is the reason to say it precisely, with the citation at the foot of this page ready if you need to point at it.
If it arrived alongside other changes you have been managing quietly, the pattern is the same one. The same hormonal shift shows up in the bathroom you locate before taking your coat off, and in the arithmetic you run in a meeting. Different tissue, one underlying change, and one appointment can reasonably cover more than one of them.
Questions women actually ask about this
Will it go away on its own?
For some women it settles as hormone levels stabilize after the transition. For others it does not, particularly where osteoarthritis is progressing underneath it. What reliably helps in both cases is maintaining muscle, which is within your control in a way the hormone timeline is not.
Should I take collagen or a joint supplement?
The evidence for most joint supplements is thin and is frequently funded by the companies selling them. That is not proof they do nothing, but it is a long way from established, and the same effort is better spent on something with a stronger evidence base: resistance training, twice a week.
Is exercise safe if it already hurts?
Generally yes, and loading the joint is the point rather than a risk to manage around. If you are unsure where to start, or something is acutely painful rather than stiff, a physiotherapist is the right first appointment.
Does hormone therapy fix it?
It is not a treatment prescribed for joint pain on its own, and it should not be started for that reason alone. The 2025 review of HRT and musculoskeletal pain found some benefit in pooled data, but the studies varied enough in design that the authors stopped short of a blanket recommendation.² If you are already weighing hormone therapy for other symptoms, this belongs in the same conversation — worth understanding what it actually treats and what it does not before that appointment rather than after.
Why has my doctor never mentioned this term?
The paper is from 2024, and menopause education in general medical training has been thin for decades. This is not a reflection on your doctor. It does mean you may be the one introducing the term, which is unfair and also useful to know going in.
Informational, not medical advice. Hot, swollen or red joints, fever, or stiffness lasting more than an hour need your own clinician promptly rather than at your convenience.
Where this evidence thins out
Wright’s 2024 paper is a narrative synthesis of existing research rather than a new clinical trial, and it names a syndrome more precisely than it prescribes a treatment for it. There is not yet a large randomized trial testing resistance training specifically against this syndrome, though the exercise-and-muscle mechanism it rests on is well established in other contexts. The HRT-and-pain evidence is genuinely mixed: some pooled studies show benefit, others do not, and individual response likely depends on factors this research has not yet sorted out.¹²
About the researcher
Vonda J. Wright, MD, MS, FAOA, is an orthopedic surgeon and sports medicine specialist based in Orlando, Florida, and a faculty member at the UCF College of Medicine. Her research and clinical practice focus on musculoskeletal aging and performance in midlife women, and she was lead author on the 2024 paper that formally proposed the musculoskeletal syndrome of menopause as a clinical term.
Disclosure
- This article is informational and is not a substitute for individual medical advice.
- Blue Leaf Journal is not a clinic and does not employ clinicians or researchers.
- Named researchers have no affiliation with or endorsement relationship with Blue Leaf Journal.
- Blue Leaf Journal has no commercial relationship with any study, researcher, or institution named above.
- This article was fact-checked against the cited sources on September 6, 2026. Spot an error? Email norawhitfield@blueleafjournal.com.
References
- Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472.
- Overton, R., Amini, P., Chew, A., Babatunde, O., Mason, K. J., Rathod, S., Welsh, V., & Burton, C. (2025). The effect of hormone replacement therapy on musculoskeletal pain in menopausal women: A systematic review and meta-analysis.
Written by Nora Whitfield for Blue Leaf Journal. Updated: September 6, 2026.
Joints are not the only tissue running on estrogen you cannot see on a scan. The brain draws on the same hormonal supply, worth knowing the next time a word goes missing along with your knees. What the imaging actually found.
The one move: run the morning-stiffness test for one week — wake time, and the time the stiffness clears. Take those two numbers to your next appointment, alongside the term musculoskeletal syndrome of menopause.
If it is the rest of what you have been quietly carrying that needs a name too, the Quiet Audit takes about ten minutes. Start here.
Most women reading this have had the symptom for a while and have already run the calculation about whether it is worth an appointment. Not dramatic enough. Probably just age. Someone else needs the slot more. It is not just age, and the slot is yours.
