You are not imagining it. And you are not alone.
Has your body started hurting in ways you cannot quite explain? A hip that wakes you in the night. A shoulder that has been grumbling for months. Headaches that seem to come out of nowhere. A general sense of being more inflamed, more reactive, more tired than the life you are leading would seem to warrant?
If you are in your 40s or 50s and this sounds familiar, there is a very good chance that perimenopause or menopause is playing a significant role — not just in the pain itself, but in why it arrived when it did, why it is not settling on its own, and why what you have tried so far may not have helped as much as you hoped.
This is not weakness. It is not bad luck. And it is not simply what getting older feels like.
There are real, well-understood reasons your body is responding this way right now — and understanding them is the first step toward actually getting on top of it.
The question most practitioners are not asking
When women in this stage of life come to us at Whittlesea Physiotherapy and Clinical Pilates, they often arrive having already seen several other practitioners. They have tried massage, a cortisone injection, a personal trainer. Some things helped for a short while. Nothing held.
The reason, in most cases, is not that those treatments were wrong in themselves — it is that they were treating a single symptom in a picture that has multiple, overlapping drivers. When you address one thing in isolation, you get isolated relief. When you address the whole picture, you get lasting change.
So what is the whole picture? For most women in perimenopause and menopause, it comes down to three things working together.
Driver 1: What declining oestrogen is doing to your joints and tendons
Oestrogen does far more in the body than most people realise. Yes, it plays a central role in reproductive health — but it also supports the health and resilience of your tendons and joint tissues, regulates the body’s inflammatory response, influences how well you sleep, and plays a significant part in how your nervous system processes pain.
As oestrogen levels decline during perimenopause and menopause, the tissues that oestrogen was supporting become more reactive. Tendons that were previously tolerating load without complaint become more sensitive. Joints that were recovering well between exercise sessions start to take longer. Movement patterns and activities that felt perfectly comfortable before can start to provoke symptoms — not because you have done anything wrong, but because the hormonal environment underpinning your tissues has changed.
This is why hip pain, shoulder pain and tendon-related complaints are so much more common in women over 50 than in any other group. It is not coincidence. It is biology — and it is well documented in the research.
Hip pain from gluteal tendinopathy, for example, affects approximately 1 in 4 women over the age of 50. It is the most common cause of pain on the outside of the hip. It is also the condition most often explained away, misdiagnosed, or treated without addressing the hormonal driver — which is why so many women go around in circles with it for years.
Driver 2: The role of chronic inflammation
This is the piece that most people have not been told about, and it is one of the most important.
Chronic low-grade inflammation is extremely common in this group — and it significantly lowers the body’s threshold for pain, slows tissue repair, and makes recovery from any physical complaint much harder.
Several factors that tend to converge during perimenopause and menopause drive this inflammatory state. Elevated stress and cortisol maintain a background level of inflammation in the body. Disrupted sleep — whether from pain, hot flushes, or a racing mind — is itself a significant driver of systemic inflammation, and poor sleep and pain feed each other in a cycle that can be very difficult to break without addressing both.
Reduced activity because of pain removes the natural anti-inflammatory benefits of movement. Dietary patterns that lean toward processed foods or alcohol contribute. And one that is rarely mentioned: shallow, upper-chest breathing — which is far more common in this group than most people realise — keeps the nervous system in a low-level stress state that sustains cortisol output and the inflammatory response that follows.
When these factors stack, as they often do, pain becomes more persistent, recovery becomes slower, and treatments that target only the physical structure — the tendon, the joint, the muscle — consistently fail to provide lasting relief.
Reducing inflammation is not a lifestyle add-on to the clinical work. For this group, it is central to it.
Driver 3: Deconditioning and the load problem
The third piece of the picture is mechanical — and it is closely connected to the first two.
When pain reduces activity, the muscles that support the affected joints gradually lose strength and capacity. When oestrogen declines, tendons already have a reduced ability to handle load. When inflammation is elevated, the body’s capacity to repair between episodes of activity is lower. The result is a system that is absorbing more load than it should with less muscular support than it needs — in a hormonal and inflammatory environment that makes the whole thing harder to manage.
This is why rest does not fix the problem. Rest reduces load temporarily — but it also accelerates the deconditioning that is part of the problem in the first place. The body needs load, the right load, applied gradually and progressively, to rebuild the strength and capacity needed for lasting relief.
Getting exercise back in — specifically and carefully — is one of the most important things women in this group can do. Not just for pain, but for bone density, energy, mood, sleep quality and long-term independence.
What actually helps
When all three of these drivers are addressed together, the results are genuinely meaningful.
Pain that has been present for months or years settles. Sleep improves. Energy returns. Women find themselves moving more freely, doing things they had quietly stopped doing — reaching their feet, sitting through a full meal, walking without planning the route around the stairs.
The approach that achieves this combines hands-on physiotherapy treatment with a specific, progressive exercise program; practical load management for everyday life; and education and support around the lifestyle factors driving inflammation. For many women, nervous system regulation through breathwork, yoga or mindfulness is also a meaningful part of recovery — not as a soft add-on, but as a genuine clinical tool that changes the body’s resting inflammatory state and improves pain management.
None of this is a quick fix. For tendon-related pain, meaningful improvement typically begins within 2 to 4 weeks of starting the right program, with deeper, more consistent gains continuing over several months. The timeline varies depending on how long the condition has been present, how deconditioned the body has become, and how well the lifestyle factors are addressed alongside the physical work. What does not vary is the pattern: a whole-person approach produces whole-person outcomes in a way that single-symptom treatment simply cannot.
The team best placed to help you
At Whittlesea Physiotherapy and Clinical Pilates, three members of our team work closely with women navigating perimenopause and menopause.
Samantha Heyfron is our director and lead physiotherapist, with over 30 years of clinical experience. Sam also teaches yoga and breathwork, and brings a uniquely integrated approach to this group — addressing the physical, hormonal, inflammatory and nervous system picture together rather than in isolation.
Tanvi Tiwari has a focused clinical interest in headache and neck pain management, including the Watson Approach — one of the most well-researched physiotherapy approaches for cervicogenic headache. If persistent headaches or neck pain are part of your picture, Tanvi’s input can make a significant difference to outcomes.
Casey Trevenna is our women’s health physiotherapist, available Wednesdays and Saturdays. Casey works specifically with the hormonal and pelvic health side of this transition — including pelvic floor function, pelvic pain, bladder and bowel concerns, and the broader changes that perimenopause and menopause bring to women’s bodies. Her work sits alongside the musculoskeletal picture and is often a meaningful part of the whole-person approach.
Claire Barbosa leads our Bone Strength program and brings a focused clinical interest in bone density and strength-based exercise. For women in perimenopause and menopause, building and protecting bone density is one of the most important long-term investments you can make — and Claire’s work in this area is a core part of how we support this group over the long term.
Between them, Sam, Tanvi, Casey and Claire cover the full breadth of what this group of women needs — and they work together where your picture overlaps across their areas.
a note from sam
I have been a physiotherapist for over 30 years, and I also teach yoga and breathwork. The women I see in this stage of life are often the most determined, self-aware and motivated people I work with — and also the most frustrated, because they have tried hard to address their pain and not been given the full picture.
What I want you to know is this: there is a clear explanation for what is happening in your body. There is a well-evidenced path through it. And you do not have to keep trying things in isolation and wondering why they are not working.
We have been helping women through exactly this kind of picture at our clinic for many years. We are simply getting better at talking about it.
If any of what I have written here resonates, I would love to hear from you.
Samantha Heyfron Physiotherapist, Yoga Teacher, Director Whittlesea Physiotherapy and Clinical Pilates
Ready to understand what is driving your pain and start getting on top of it?
We offer a thorough initial assessment where we take the time to understand your full picture — not just where it hurts, but why, and what it will take to get lasting relief.
Book online or call us on 03 9716 2250. We are here Monday to Friday from 8:00am – 6:30pm, and Saturdays from 8am – 12 noon.