Weight, muscles, joints, bones and heart

Part 7 of 12 · All topics on the menopause

When your body shape changes

You are not eating much differently from before, you are moving about as much as ever, and yet you notice that your waistband is getting tighter. Perhaps the scales show hardly any change, even though your body feels different. Or you are losing strength, even though you believe you are just as active as before. Experiences like these can occur in midlife. But they cannot be traced back to a single cause.

Body weight depends on many things, among them energy intake, everyday movement, sleep, genetic factors, medicines, illnesses and the age-related change in muscle mass. The menopause can also influence how fat is distributed, above all the tendency to store more fat in the abdomen. That does not mean that every weight gain is caused directly by falling oestrogen levels. It does explain why looking at body composition is sometimes more helpful than looking at the number on the scales. [1] [2]

Health does not begin with a particular clothes size. What matters, for example, is blood pressure, blood fats, blood sugar, muscle strength, fitness, sleep and your own quality of life. A woman whose weight is stable can have risk factors that matter for her health; another woman with a higher body weight can be well trained and metabolically in good shape. Weight alone is too crude to describe a person’s condition.

Muscles: important, but unseen

Muscle tissue helps with climbing stairs, getting up, carrying shopping bags and stabilising the joints. It also plays a part in metabolism. As you get older, muscle mass can be lost, especially if regular loading is missing. That is exactly why the question of strength and function matters more than fear of every change in the body.

A simple form of self-observation could be: is something harder for me now that I used to manage without difficulty? This is not a medical measurement, but it can be a reason to look more closely at your training and health. There are good reasons for regular strength training in midlife. It can help to keep muscle strength and physical independence over the long term. It does not follow that a particular exercise will directly ease every hot flush; these are different health goals. We discuss the practical side of exercise on the page What you can do yourself. [3]

The menopause years can also be a chance to get to know your own body anew. Not as a repair project, but as something that can keep and build abilities. Starting with light training can make more sense than an over-ambitious plan that ends after two weeks. What matters is a load that suits your age, existing illnesses and starting fitness.

Joint pain: common, but not automatically hormonal

Many women report joint stiffness, diffuse pain or a feeling of having to “warm up” first in the morning during and after the menopausal transition. This deserves attention. A meta-analysis published in 2026 pooled 37 observational studies with more than 93,000 women in total and found musculoskeletal complaints more often in perimenopausal and postmenopausal groups than in premenopausal ones. However, the studies differed greatly; they could not prove a simple causal link. [4]

Why this caution? Because joint pain can have many causes. Osteoarthritis, inflammatory rheumatic diseases, overuse, injuries, certain medicines and other illnesses can all play a part. New swelling, redness, marked morning stiffness, fever or lasting loss of function should be checked by a doctor. This applies especially if individual joints are severely affected or symptoms increase quickly.

Here too, a precise description protects you: “My hands have been stiff in the morning for a few weeks, and it gets better after half an hour” is more helpful for a medical assessment than “I think it’s my hormones”. The second suspicion is welcome in the conversation; the first gives concrete clues.

Bones often become an issue only late

Bone is living tissue that is constantly being built up and remodelled. Oestrogen plays an important part in this. After the menopause, bone loss can speed up. Unlike hot flushes, you usually do not feel reduced bone density straight away. Osteoporosis is therefore often recognised only through an examination or after a fracture.

Risk factors for broken bones include older age, earlier fractures after minor trauma, certain medicines such as glucocorticoids used for longer periods, a family history, low body weight, smoking and other illnesses. The question for you as an individual is not: “Does every woman have osteoporosis after the menopause?” but: “Do I have factors that make a risk assessment or a bone density measurement worthwhile?” For young women with premature ovarian insufficiency, special considerations apply, because the hormone deficiency can affect bones and other systems much earlier. [5]

The decision about screening depends on age, risk profile and regional recommendations. A bone density measurement by DXA can, in suitable situations, help to judge the fracture risk more precisely; it is not automatically necessary for every 42-year-old. Likewise, simply taking calcium tablets is not enough to treat all causes of an increased fracture risk. Nutrition, muscle strength, the risk of falling and, where appropriate, specific medicines belong in an overall view.

Heart and metabolism: not everything begins with the last period

The risk of cardiovascular disease rises over the years of life. In midlife, blood pressure, blood fats, insulin sensitivity and body composition can change. The menopause and ageing overlap in time, which makes it scientifically demanding to separate their individual contributions. For your own health, though, it matters less what percentage of a change is caused by hormones. It matters more to recognise risk factors that can be treated.

A regular look at blood pressure, lipids and, where appropriate, blood sugar can make sense, depending on your risk profile. If you smoke, you gain a great deal in health terms from stopping. Exercise, a balanced diet and treatment of raised blood pressure are not special menopause tricks, but central measures of general prevention. The international IMS recommendation of 2026 therefore treats heart, metabolism and bone health as part of comprehensive women’s health in midlife. [2]

Most importantly: systemic hormone therapy should not be started solely to prevent heart attacks or strokes. Even though the age at starting and the time since the menopause influence the balance of benefit and risk, a blanket indication for protecting the heart is not justified by the clinical studies. The large WHI data are put in context on the page Hormone therapy. [6]

Skin, hair and other visible changes

Drier skin, changed hair fullness or a different hair texture can become noticeable in midlife. Here too, ageing, predisposition, illnesses and hormonal changes are intertwined. With clearly increasing hair loss, bald patches, marked itching or new skin changes, other causes such as iron deficiency, thyroid disease or dermatological conditions can be relevant. A guide may mention such complaints without declaring every cosmetic change to be an illness.

The market for “hormonal skin care” is large; the scientific evidence for specific product claims is much smaller. Be particularly alert to offers that immediately derive a supposedly measurable “hormone deficiency” from a vague symptom and then want to sell you an expensive product. How to check such claims is explained on the page Supplements and myths.

Which tests are really worthwhile?

Not everyone needs the same tests. A good work-up depends on symptoms, physical findings, existing illnesses and risk factors. With persistent exhaustion, for example, a blood count, thyroid values or iron status may be relevant; with cardiovascular risks, other tests make sense. If joint pain is the main problem, you may need a rheumatological or orthopaedic assessment. A list of twenty laboratory values without a clinical question, by contrast, is rarely a good route to more certainty.

Women with an early menopause, premature ovarian insufficiency, chemotherapy in their history or removal of both ovaries need different planning from women with a natural transition around the typical age of the menopause. For these groups in particular, advice on bone health, cardiovascular risks and individual treatments is important. [1] [5]

Weight is a number, health is the whole picture

Many women notice in midlife that the distribution of fat changes. Clothes fit differently, even though body weight hardly fluctuates. Others do actually gain weight. It is tempting to put all of this down to “the oestrogen deficiency”. But body weight and composition change under the influence of age, sleep, activity level, diet, medicines, health conditions and individual circumstances. The menopausal transition can accompany or contribute to some of these developments. A simple cause-and-effect formula would shortchange the state of the research.

More important than a single measured value is the question of what is changing in terms of health. Have blood pressure or blood sugar gone up? Has physical fitness declined? Have eating and exercise habits changed under stress? Abdominal fat in particular can increase relative to other fat deposits. This is relevant because metabolic risks do not follow from a body mass index alone. At the same time, women with a higher weight can have different metabolic starting points. Blanket blame achieves nothing medically.

A realistic goal is not to make your body look at 47 as it did at 27. Goals that improve something functional make more sense: climbing stairs more easily, less breathlessness in everyday life, more strength, better blood pressure values, less exhaustion. If weight changes happen quickly, are unexplained or come with other symptoms, medical causes should be considered. On the page What you can do yourself, nutrition and physical activity are explained in practical terms. Here the focus is on the health assessment.

Why muscle strength is so valuable at this stage of life

As you get older, keeping muscle mass and strength becomes more important. Muscles help not only in sport, but also with getting up, carrying, climbing stairs and keeping the body stable. If there is less movement in everyday life, a gradual loss can go unnoticed for years. The menopause years fall in a phase in which this process gains in importance; it would be wrong, however, to trace every change in the muscles back to the last cycle.

Strength is also a matter of independence. A person who regularly lifts weights or does exercises against resistance is not training only for an outward ideal. She builds reserves for daily life and later years. Starting does not have to mean signing a gym contract. For some women, supervised physiotherapy makes sense, especially with pain, injuries or other illnesses. Others can start with simple strength exercises and build up slowly.

The phrase “metabolism slows down” should also be used with care. People move different amounts in everyday life, sleep differently well and have an individual energy requirement. The idea that a particular supplement can reliably restart a hormonally “sleeping metabolism” is not scientifically convincing. If a guide takes health seriously, it must also explain the unglamorous but solid basics: load, recovery, nutrition and sustainable routines.

Taking joint pain seriously without inventing a diagnosis

The systematic review of 2026 found that muscle and joint complaints are reported more often in perimenopausal and postmenopausal groups than before the perimenopause. Observational data cannot, however, prove what share is caused directly by hormonal changes. In addition, the studies differ in definitions, measurement and the selection of participants. [4]

This has a practical meaning: pain in the hands, shoulders, knees or hips deserves a proper assessment. Inflammatory rheumatic diseases, osteoarthritis, tendon problems, overuse or earlier injuries can cause similar symptoms. Stiff joints after getting up, swelling, fever or suddenly severe pain should be examined accordingly. Not everyone needs extensive tests, but a blanket answer of “That’s just the menopause” is as unhelpful as unnecessary alarm.

To ease the pain, depending on the cause, adjustments to movement, physiotherapy, adapted strength building and targeted medical treatment can contribute. Systemic hormone therapy is not automatically the treatment for an unclear joint condition. This also applies when women report subjectively that pain improved under a particular therapy. Individual experiences are to be taken seriously, but on their own they do not prove a general treatment effect.

Bones: a risk you cannot feel

Osteoporosis differs from many acute complaints on these pages. Low bone density does not usually cause a hot flush, tingling or any clear early warning feeling. The problem sometimes becomes visible only when a bone breaks in a comparatively minor fall. This is exactly why risk-based prevention makes sense. Age, earlier broken bones, certain medicines, family history, smoking and other illnesses play a part. An early menopause can add to the risk.

The change in oestrogen action is well established as a factor in bone remodelling. It does not follow, though, that every woman needs a bone density measurement immediately at 50, or that hormone therapy alone would be the best solution for general prevention in every woman. Whether a measurement, a risk calculator or a treatment makes sense depends on your personal risk factors and on national recommendations. [7] [6]

Bones are also not solely a matter of calcium. Regular weight-bearing exercise, enough nutrients, avoiding smoking and appropriate treatment of specific risk factors all belong here. A supplement is not automatically better than a well-planned diet and should be guided by individual need. Very high doses without a medical indication can also have disadvantages.

Heart and blood vessels: the right question at the right time

In midlife it is worth looking at blood pressure, blood fats, diabetes risk, smoking, exercise and family history. These factors often influence cardiovascular risk more strongly than the question of whether the last period has already happened. The menopause is thus a good occasion for prevention, but not a sufficient explanation for every change.

The historical WHI debate has led to misunderstandings. Some people took from it that hormone therapy always harms the heart; others later claimed that hormone therapy started early protects the heart as a rule. Both simplifications are problematic. The randomised studies tested specific regimens in particular age groups and starting risks. For a decision about hot flushes these results are important, but they do not lead to a general recommendation to take hormones solely to prevent heart attacks. [6]

A good conversation about prevention often consists of quite simple measurements and an assessment of your personal history. If you have raised blood pressure, you benefit from targeted treatment regardless of how marked your hot flushes are. If you have chest pain on exertion, new severe breathlessness or neurological deficits, you need medical help straight away. These are not typical complaints that should be put off for years of hormonal transition.

Hair and skin: visible changes, many causes

Dry skin, changed hair texture or increased hair loss can become noticeable in midlife. Hormones play a part, but so do genetic factors, nutrition, medicines, the thyroid, inflammation and other illnesses. A single symptom does not allow a diagnosis. With severe, patchy or rapidly increasing hair loss, a dermatological work-up can make sense. Dry skin, too, does not have to be treated “from within” with expensive products.

Appropriate skin care can be simple: cleanse gently, moisturise as needed and use sun protection. Expensive “menopause creams” are not an active-ingredient class of their own. What matters is what the product actually contains and which problem it is meant to solve. The transition to a new stage of life does not mean that every visible change has to be corrected.

Prevention without compulsive checking

The aim of this page is not a complete checklist of risks. It is about sensible prioritising. In your case, perhaps checking your blood pressure and taking up strength training again is enough. For another woman, bone density, diabetes or a long-standing joint inflammation come first. Good prevention cannot be derived from a general “hormone age”. It combines age, personal medical history and concrete findings.

At your next check-up, ask: Which test would be especially worthwhile for me? What benefit does it have? Are there also disadvantages through false alarms or over-diagnosis? How often does it need to be repeated? A carefully answered question is often worth more than a long list of non-specific values.

A conversation about bone health in five questions

If you want to know whether a bone density measurement makes sense, the question “How old am I?” alone helps only to a limited extent. Other points are earlier broken bones after minor stress, certain medicines such as glucocorticoids used long term, a family history, marked weight loss and illnesses that affect bone metabolism. With a very early menopause, a longer-lasting oestrogen deficiency can have additional significance.

At your check-up, ask: What is my personal fracture risk? Is there a reason for a DXA measurement? Would a result change my treatment? What should I bear in mind regarding exercise and nutrition? When would it make sense to assess me again? These questions prevent measurements from being done for their own sake and help to prioritise effective prevention.

Heart health is a lifelong task, not a hormone value

Cardiovascular risk, too, cannot be read from a single number. Blood pressure, blood fats, diabetes, smoking, exercise and family history all influence the assessment. In midlife, regular checks can be especially useful, because risk factors that can be treated may be found. The menopause is part of the overall picture, but it does not replace usual prevention.

Systemic hormone therapy should not be started solely with the aim of preventing heart attacks or strokes in a person who otherwise has no symptoms. The 2024 WHI reassessment is important precisely because it distinguishes between treating symptoms and preventing disease. [6]

Not just knowing, but acting

Long-term health is easier to improve if you choose a goal that fits your situation. Perhaps your blood pressure is already being treated and you would like to add exercise. Perhaps your back needs targeted training rather than more painkillers. Perhaps checking recurring joint swelling comes first. Large general health programmes can be helpful, but sometimes seem so comprehensive that it is unclear where to begin.

If you have done little sport for years, a small start can make more sense, both medically and practically, than an abrupt plan with five intensive training days. If you are already active, a shift towards more muscle strengthening may be relevant. If pain limits you, its cause should be examined first. In all cases: physical health is more than an aesthetic ideal.

Why the body sometimes feels strange

Many women describe midlife with the sentence: “I’m not doing anything differently, and yet my body is changing.” Such experiences are to be taken seriously. A change in body shape can be noticeable even though the scales show hardly anything. Conversely, weight can rise while muscle mass falls. Sleep problems, less movement because of pain, different working conditions and the biological changes of ageing can all play a part at the same time. It would be too simple to blame a single hormonal mechanism for everything.

Whether a change is a problem for your health cannot be answered from appearance alone. Waist circumference, blood pressure, blood sugar, blood fats and your personal medical history can provide important information, depending on the situation. At the same time, not every measurable change needs to be treated. A guide that addresses women from 40 should not confuse health with a narrow ideal of beauty. A woman who feels strong and resilient has different needs from someone with marked exhaustion, pain and newly developed high blood pressure.

Changes in weight also often relate to energy use in everyday life. A person who used to cycle to work but now has a long commute and cares for relatives in the evening lives under different conditions. The resulting change is not necessarily a “failing metabolism”. Biology and living conditions act together. Good health advice tries to understand both, rather than looking for someone to blame.

The invisible change in body composition

Muscle mass and fatty tissue influence body functions in different ways. Scales cannot reliably show these differences. That is why a fixation on weight alone often leads to misunderstandings. A woman can become stronger through training, move more easily and improve medically relevant values without her weight falling markedly. Another loses weight but feels weaker, because she is taking in too little energy or protein.

Keeping muscle strength matters well beyond midlife. Muscles support everyday movements, stability and energy balance. Strength training can be adapted to different fitness levels. Someone who has trained little so far needs a slower start than a person with sporting experience. Existing illnesses, pain or an increased risk of falling may call for professional guidance. The basic idea is, however, relevant for many women: strength is a functional resource, not just an aesthetic goal.

Exercise programmes should therefore not be aimed solely at weight loss. If after a few months you can climb stairs better, are less afraid of carrying heavy objects or feel steadier in everyday life, these are valuable changes. Some of them say much more about your quality of life than a single number.

Joints, tendons and muscles – a complex picture of complaints

Muscle and joint complaints are frequently reported in the perimenopause. The meta-analysis of 37 observational studies and more than 93,000 women found higher rates of complaints during and after the menopausal transition than before. The authors, however, expressly point to the large heterogeneity and the limited strength of the findings as to causes. A common complaint is not automatically a specific syndrome that could be treated by oestrogen alone. [4]

In practice, the place, duration and pattern of the pain are important. Pain after exertion can have different causes from marked morning stiffness with swelling. Suddenly appearing, severe joint pain should be judged differently from complaints known for many years. The transition to the menopause is not a sufficient reason to ignore new signs of inflammation or neurological symptoms.

Treatment also depends on the diagnosis. In osteoarthritis, adapted exercise and strength building can make sense. In inflammatory diseases, specific medical therapy is often needed. Some women benefit from physiotherapy that makes everyday movements easier. A popular guide should not promise a universal exercise here that solves all joint problems.

What bone formation and bone loss mean

Bone is living tissue. Even in adulthood, remodelling goes on all the time: old bone tissue is broken down and new tissue is built up. If this balance shifts, bone density can fall over the long term. The decline in oestrogen action around the menopause contributes to this change. It often runs its course without pain and without early signs that you can notice yourself.

This sets the risk of osteoporosis apart from hot flushes. With hot flushes, a woman often notices the reason to consider treatment straight away. With bones, by contrast, the personal risk decides. Age, fractures, certain medicines, illnesses and the timing of the menopause are important building blocks. A bone density measurement can help if its result changes a decision. But it is not automatically worthwhile for every woman from 40. [7]

An early menopause calls for particular attention, because the time with reduced hormone action can be longer. A woman with premature ovarian insufficiency before the age of 40 is in a medically different situation from a woman with a natural menopause at around 51. The international guidelines take this into account in counselling and long-term preventive care. [5]

Why prevention is not a list of compulsory purchases

On the market, numerous products and tests are devoted to bone health. Calcium, vitamin D and other nutrients are biologically relevant; it does not follow, though, that high-dose supplements are suitable for every woman. What matters is whether there is a deficiency or a particular risk situation. Sometimes the need can be met through diet, sometimes a targeted supplement makes sense. Doses that are too high, or an uncritical combination of several products, can have disadvantages.

Weight-bearing exercise and muscle strength also play a part for bones. If you move regularly, you can benefit over the long term from better function and stability. However, with a high fracture risk, exercise does not replace every drug treatment. The individual risk and any existing fractures must be taken into account. Good professional advice explains what can be achieved with diet and training and when additional medical measures are needed.

Not reducing cardiovascular health to hormones

Midlife is an occasion to talk about heart and blood vessels. Blood pressure and blood fats can change, and some women develop diabetes or other risk factors for the first time at this stage. The menopause is part of the stage of life in which these developments become visible. But it is not identical to biological ageing and does not explain all changes. For individual prevention, known risk factors and your personal family history are often decisive.

Hormone therapy must not be promoted as a general treatment to protect the heart. The WHI results have in particular shown the limits of such a prevention strategy. The reassessment of 2024 expressly distinguishes between treating distressing menopausal symptoms and preventing chronic illnesses. For a woman with severe hot flushes, hormone therapy can make sense after individual weighing up; this gives rise to no recommendation to treat women without symptoms routinely with hormones because of their age. [6]

Cholesterol, blood pressure and blood sugar: three different numbers

Blood pressure describes the pressure in the vessels, blood fats give information about various lipoproteins, and blood sugar values help to assess glucose metabolism. They answer different questions. An abnormal value is not automatically a diagnosis and has to be seen in the context of age, existing illnesses and other risk factors. Conversely, repeatedly raised values should not be ignored with a reference to the menopause.

When several risk factors come together, a structured assessment of cardiovascular risk can make sense. Which measurements, thresholds and intervals are recommended depends on the health system concerned and on individual circumstances. It is not the job of these pages to derive an individual prescription from general numbers. The important message is: there are known risk factors, often easy to influence, that you can take care of regardless of hot flushes.

What lies behind body image and shame

Physical changes are not judged only in medical terms. Many women have learned over decades to watch their figure closely. When the waist gets wider or the skin changes, this can trigger feelings of losing control. These feelings do not have to be treated as a disorder, but they deserve respectful handling. A guide should not create a new duty to look at 50 as much like 30 as possible.

A realistic, health-focused view asks about function, well-being and medically relevant risks. Someone who is less active because of symptoms may need support that makes exercise possible again. Someone who suffers from an eating disorder or has a troubled relationship with her own body needs particular caution with restrictive diet and weight programmes. Well-being does not get better by marking every change as a problem.

Which complaints can occur together

Lack of sleep can make exhaustion worse, exhaustion can reduce activity, and less activity can affect physical fitness. Joint pain, in turn, can make training harder. In this way cycles arise in which several complaints accompany one another without having the same cause. Good treatment therefore looks for a reachable starting point. Perhaps it is treating the insomnia, perhaps an examination of the joints, perhaps targeted pain therapy or a well-supervised start to training.

Such cycles can equally be set off by illnesses unrelated to the menopause. Diabetes, thyroid disorders, inflammatory diseases and medicine effects may belong in the differential diagnosis. A guide can name these possibilities; it cannot decide which one applies to a particular person.

Prevention as a partnership with the health system

You do not have to pay out of your own pocket for every available laboratory profile. Risk-based prevention with questions you can follow makes more sense. Which test is recommended and why? Is there a treatment option that depends on its result? Which known risk factors can I influence? When does a repeat test make sense? In this way, measurements become aids to decisions.

The same principle applies to treatment. A decision about medicine for high blood pressure does not have to be put off until the menopause years are over. A joint-specific illness deserves its own therapy. And hormone treatment for hot flushes has to be judged by its benefits and risks, not by whether it could prevent every long-term illness.

Three women, three different priorities

Nora, 46, notices a larger waist but feels fit and has no symptoms. Her priority is a realistic look at exercise and medical prevention, not necessarily hormone treatment. Tina, 54, develops joint swelling and morning stiffness. She needs a targeted examination, rather than having the symptom put down to age alone. Eva, 49, had an early, abrupt loss of hormones after an operation. In her case, long-term bone and heart health belong especially carefully in specialist counselling. These examples are invented and do not replace a diagnosis.

A good guide allows for these differences. It explains why the same health tips do not answer every question. The greatest gain lies in being able to distinguish deliberately between treating symptoms, prevention and checking for other illnesses.

What you can take away from this page in practice

If you have so far thought little about bones and heart, you do not have to change everything at once. First check which check-ups and values are really relevant in your case. Then consider how physical activity can be adapted to your current health. With unusual pain, rapid changes or new warning signs, a medical check is more important than an online programme.

The menopause years can change the way you look at your own health. That does not have to lead to more fear. It can be an occasion to know the most important risks and to act where good evidence exists. That is exactly the difference between sensible prevention and an endless search for the perfect body.

Your own health stocktake without perfectionism

It can be useful to get an overview of your health at regular intervals. This is not about constantly monitoring every value or every bodily feeling. Rather, you can check which known risks exist, which preventive services are recommended at your age and which complaints should be assessed by a doctor. Such a stocktake is the more helpful the more closely it follows your personal circumstances.

Imagine three areas: What do I feel? This includes symptoms such as sleep problems, pain or exhaustion. What do I already know? Here come known illnesses, medicines and earlier tests. What do I want to clarify? Perhaps it is a new joint swelling, blood pressure values or the question of whether bones should be given more attention after an early menopause. This division stops subjective complaints and long-term risk factors from being mixed up without order.

In a conversation with your GP practice, suitable steps can then be agreed. Some are simple: a blood pressure check, a risk assessment or an adjustment to existing treatment. Others require a specific gynaecological or internal medicine examination. If a chronic illness already exists, your care should stay coordinated with it. The menopause does not replace usual health prevention.

Medicines that can affect the body

In midlife, some women start medicines for the first time for blood pressure, mental health problems or chronic pain. Others have taken medicines for years that can affect sleep, weight or sexual function. This is why the list of medicines belongs in a good work-up of symptoms. New tiredness after a dose increase can have a different explanation from tiredness that begins together with severe night-time hot flushes.

Medicines used to treat menopausal symptoms can also interact with others. This is especially relevant when several products and supplements are combined. A complete overview helps the healthcare professional treating you to recognise risks and avoid unnecessary treatments. The current list of medicines is often more informative than a large collection of non-specific hormone values.

Pain and exercise: a careful start

When joints hurt, the advice to be more active seems contradictory at first. Movements can be uncomfortable, yet too little movement can impair muscles and function. The solution often lies in individual adaptation, not in the blanket demand to ignore pain. A medical examination can clarify whether inflammation, injury or other illnesses play a part. Depending on the findings, a suitable programme can be developed.

With some complaints, it helps to spread the load into smaller units or to practise certain movements first under guidance. Others need targeted medical therapy before training is possible again. The aim remains to keep function and independence. A physical change does not necessarily have to disappear completely for everyday life to become easier again.

Why the language about weight matters

If a guide keeps talking about problem areas, forbidden foods or hormonal belly fat, it can add to unnecessary worry. A health-oriented language asks instead which risks really exist and what can sensibly be influenced. Some women want to lose weight, others need better blood pressure control or more muscle strength. Still others are content with their bodies and only want to be informed.

Respectful counselling accepts these differences. It avoids the idea that a particular figure is proof of good self-care. Health is complex, and individual circumstances differ. In the menopause years especially, information should help you gain more room for action, rather than create additional demands on appearance and performance.

What marks out a good preventive measure

A sensible preventive measure should concern a relevant health problem, have a benefit you can follow and be suitable for the person concerned. Possible disadvantages belong here too: false alarms, unnecessary tests, side effects or the burden of frequent checks. Such questions are as important for bone density measurements as for blood tests or general screening programmes.

Before a test, you can therefore ask: How likely is it that it will find something important in me? Would the result change a decision? Are there alternatives? When should it be repeated? It is perfectly reasonable to ask for an explanation you can understand. Informed prevention does not mean collecting as much data as possible, but answering the right questions.

Common questions

Why am I gaining weight around my belly in the menopause years?

The menopause can influence fat distribution, above all towards more fat in the abdomen. That does not mean every weight gain comes directly from falling oestrogen. Energy intake, everyday movement, sleep, inherited tendency, medicines, illnesses and the change in muscle mass also play a part. Body composition often says more than the number on the scales.

Are joint pains in the menopause years caused by hormones?

Not necessarily. An analysis of many studies found muscle and joint symptoms more often in women in and after the transition, but could not prove a simple causal link. Osteoarthritis, inflammatory rheumatic diseases, overuse, injuries or medicines also come into question. New swelling, redness, marked morning stiffness, fever or quickly worsening symptoms should be checked by a doctor.

Do I need a bone density scan in the menopause years?

Not automatically. Whether a scan makes sense depends on age, risk profile and regional recommendations. Risk factors include earlier fractures after minor trauma, certain medicines such as glucocorticoids used for a longer time, family history, low body weight and smoking. A scan can assess fracture risk more precisely, but it is not needed for every 42-year-old.

Should I take hormones in the menopause years to protect my heart?

No, not for that reason alone. Systemic hormone therapy should not be started just to prevent heart attacks or strokes. A general indication for heart protection is not justified by the clinical trials. Blood pressure, blood fats, diabetes risk, smoking, exercise and family history often influence cardiovascular risk more than your last period.

Sources

1. European Society of Endocrinology: Clinical practice guideline for evaluation and management of menopause and the perimenopause (2025). DOI
2. International Menopause Society: Recommendations and Key Messages on Women’s Midlife Health and Menopause (2026). IMS
3. Money et al.: Physical activity and exercise interventions on symptoms for women experiencing menopause (2024). PubMed
4. Kruse et al.: Musculoskeletal manifestations of perimenopause (2026). PubMed
5. Panay et al.: Evidence-based guideline: premature ovarian insufficiency (2024). PubMed
6. Manson et al.: The Women's Health Initiative Randomized Trials and Clinical Practice: A Review (2024). PubMed
7. NICE: Menopause: identification and management (NG23). NICE