What is menopause and perimenopause?

Menopause

Menopause typically occurs between the ages of 45 and 55 and can be clinically diagnosed when a woman’s periods have been absent for a year. The symptoms of menopause are often varied and can include anything from feelings of depression and anxiety to changes in muscle strength and tone.

The main feature of menopause is a steep decline in oestrogen. Oestrogen is used in the body to maintain:

• Bone health
• Cholesterol levels
• Immune system function
• Heart health
• Body temperature
• Brain function
• Collagen elasticity
• Tendon health

During menopause, your oestrogen levels drop by up to 98%. Considering the pivotal role that oestrogen plays in a woman’s body, it’s no wonder that a considerable drop in this hormone has a significant impact on a woman’s health, both physical and mental.

Massage and menopause are becoming increasingly linked as more women look for ways to manage musculoskeletal pain, improve recovery, reduce stress and support their wellbeing during perimenopause and menopause.

Perimenopause

Peri-menopause is defined as the period of time up to 10 years before the menopause when a woman can experience menopausal-type symptoms. During peri-menopause, oestrogen levels fluctuate, which can lead to more severe symptoms than the menopause. Women can feel like they’re on a hormonal rollercoaster, with hormone levels being low one week and high the next. Feelings of anxiety, depression, irritability, fatigue and joint pain are some of the first symptoms women may experience.

Perimenopause is difficult to diagnose and is not dependent on hormone testing or periods. Women can still experience regular periods and normal blood hormone levels and be perimenopausal. A diagnosis of perimenopause is made by reviewing symptoms and, in many cases, trialling different hormone treatments (hormone replacement therapy) to help regulate hormones and symptoms.

As a massage therapist, it’s important to be mindful of the symptoms associated with menopause. If you’re working with female clients from the ages of 35 – 55, you will be seeing women who are affected by perimenopause and menopause. As trusted professionals, clients may offload their concerns to you, and you may even be one of the first people to prompt someone to see their GP.

Menopause and musculoskeletal health

Menopause has a significant impact on the musculoskeletal system. These symptoms are sometimes overlooked and are regarded as a typical part of the ageing process.

Tendons

Depleted oestrogen levels affect collagen synthesis in the tissue, which has a direct impact on tendon and ligament health. Rates of tendinopathy increase during menopause, mainly driven by an increase in tendon stiffness and micro-trauma. The tendons most commonly affected are the gluteal, Achilles, rotator cuff and patellar tendon.

Cartilage

Oestrogen acts as a protective agent for cartilage, helping to manage inflammation within the joint and maintain cartilage health. The loss of oestrogen accelerates osteoarthritic change, which can lead to pain and joint stiffness.

Muscle

Low oestrogen levels accelerate sarcopenia (the age-related decline in muscle strength). The rate of muscle mass loss during the menopause period almost doubles compared to the standard rate of loss post menopause.

Bone

Bone mineral density decreases at an accelerated rate. In the first 5-7 years post menopause, women can lose up to 20% of their bone density, increasing the risk of fractures.

How menopause impacts recovery

There is now greater awareness of the impact of the menopause on overall health. Some healthcare providers are actively encouraging women to start exercising, particularly weight training, as a way of managing the impact of sarcopenia and bone density loss during the menopause.

Prevention is always better than cure, and we’re starting to see an increase in women engaging in weight training and strength-based exercise. This can have significant health benefits, and will undoubtedly mitigate the impact of the menopause.

Post-exercise recovery

One of the issues that can arise is the body’s ability to recover from exercise. During menopause, levels of systemic inflammation increase, meaning that the usual inflammatory response post-exercise is delayed, and the body is left in a low-grade inflammatory state. Muscle tissue repair post-exercise is less effective, and a drop in mitochondrial function (the cells that help to power the recovery process) means the recovery process is less efficient and takes longer.

If women are starting weight training or more intense exercise for the first time, it’s recommended to start with a maximum of two sessions per week, allowing for a 2-3 day recovery period in between. This gives the body adequate time to recover and reduces the risk of injury. It is not uncommon for women to attend physiotherapy either for the first time with an overload injury, or from an exacerbation of an existing tendinopathy or episode of arthritic pain. Gradually introducing load and intensity at a much slower rate is essential to avoid this happening.

Sleep disruption and recovery

Sleep disruption during the menopause is common and is often the symptom that affects women the most. Lack of sleep exaggerates the other symptoms of menopause, and can greatly affect mental health and capacity to function. With sleep disrupted, the body’s ability to recover post-exercise is significantly depleted. At a time when women need to exercise and challenge their body, they are at their most vulnerable to injury and delayed recovery.

Whilst this feels like a catch-22 situation, exercise has been consistently shown to help with all symptoms of menopause (Tayade, 2025, Trujillo-Munoz et al, 2025 ), and should form an essential part of any menopause management programme. This is where massage could potentially help most.

Sports Massage for recovery

Research on massage and menopause, specifically for menopause-related recovery, is limited. For professionals working in women’s health, this is not a surprise. Women’s health issues are generally under-funded, and when working in this area, professionals often have to use data from other sources to understand the best strategy to enhance women’s health and understand how to support women effectively.

With this in mind, it’s important to consider the evidence for massage in assisting recovery post exercise. With the increased risk of overload injuries, tendinopathy, exacerbation of arthritic pain and elevated levels of systemic inflammation, massage could play a key role in managing musculoskeletal health during the menopause and reducing injury risk. Without robust evidence in this area, one must proceed with caution. However, it is fair to say that massage could play a role in aiding tissue recovery during menopause and perimenopause.

Enhancing blood flow to muscles and assists with the dispersion of lactic acid. Reducing tension in the muscles and breaking down soft tissue adhesions to restore mobility and reduce post-exercise stiffness can significantly improve muscle recovery. Massage has also been shown to improve sleep quality in women experiencing menopausal-related sleep disturbances. (Oliveira et al, 2011, 2015), further enhancing recovery capacity.

Massage for psychological symptoms

The strongest evidence base for massage and menopause lies in massage’s ability to down-regulate the nervous system to improve both mood and stress levels. Massage can reduce cortisol levels and enhance serotonin and dopamine, working as a natural intervention to stabilise mood, and even improve depression scores when used weekly (Zamanian et al, 2017).

Large-scale systematic reviews have shown that weekly massage over a 4 to 8 week period leads to substantial reductions in anxiety, irritability and mental fatigue (Listiana et al, 2022). Interestingly, when scented oils are used, such as lavender or geranium essence, people report greater improvement in symptoms than when massage alone is used (Hur et al 2008; Taavoni et al 2012).

From clinical experience, I’ve noticed that women around menopause and perimenopause age are often juggling multiple tasks and often don’t have much time for themselves. Massage gives them one hour per week or per month to tune into their bodies, relax and do something positive for themselves. Women are often managing childcare, careers and caring for elderly parents. The responsibility and lack of time can be overwhelming. Massage’s ability to improve mental and physical health for women at this stage in their lives should not be underestimated.

Key takeaways

Managing menopause symptoms effectively requires a holistic approach that supports both physical and mental wellbeing. While every woman’s experience is different, combining lifestyle strategies with appropriate healthcare can significantly improve quality of life. Effective management may include:

• Good quality nutrition
• Adequate sleep hygiene
• Stress management strategies
• Regular cardiovascular exercise
• Strength training
• Balance and mobility training

For many women, hormone replacement therapy (HRT) is an important part of symptom management. Alongside these strategies, massage and menopause are increasingly being discussed together, as sports massage may help support recovery, reduce muscle tension, improve sleep quality and promote relaxation as part of a wider management plan.

As awareness of menopause continues to grow, sports massage therapists have an important opportunity to support women through the physical and psychological changes that occur during this stage of life. Understanding how menopause affects the musculoskeletal system allows therapists to adapt treatment, educate clients and provide evidence-informed care that complements other management strategies.

If you’d like to deepen your understanding of women’s health, our Menopause Course explores the latest evidence surrounding menopause, symptom management and best practice for supporting clients during this life stage. To build your practical assessment and treatment skills, our Sports Massage Course provides the clinical knowledge and hands-on techniques needed to treat a wide range of musculoskeletal conditions, including those commonly experienced during perimenopause and menopause.

Author

Leanne O’Brien

Leanne is a Specialist Pelvic Health and Musculoskeletal Physiotherapist with over 17 years of experience. She has worked in the NHS and in private practices across London. She was the Service Lead for a large private company before moving to Bangkok to focus on physiotherapy education.