Knee Pain During Perimenopause: Causes, Relief Strategies, and When to Act

The Hormonal Connection to Knee Pain

Estrogen receptors exist in cartilage, ligaments, tendons, and synovial fluid throughout the body, including in the knees. When estrogen falls during perimenopause, joint lubrication can decrease and cartilage becomes less resilient. This makes the knees more susceptible to friction, inflammation, and wear. Women are already at higher risk of knee osteoarthritis than men, and the perimenopause transition appears to accelerate the process in those with an existing tendency toward joint changes.

Common Symptoms to Recognise

Perimenopausal knee pain often presents as stiffness after sitting or sleeping, a creaky or crunchy sensation during movement, aching after stairs or prolonged standing, and swelling around the joint. Pain that fluctuates with your cycle is a clue that hormones are involved. Many women notice symptoms are worse in the mornings and ease once the joint warms up. Bilateral knee discomfort (affecting both knees at once) without a history of injury is a strong indicator of a systemic hormonal cause rather than a local structural one.

When to See a Doctor

Exercise: The Best Medicine for Knee Health

Strengthening the muscles that surround the knee, particularly the quadriceps, hamstrings, and glutes, is the most important thing you can do for long-term knee health. Leg press, squats to a comfortable depth, step-ups, and clamshells all load the right muscles without excessive joint strain. Low-impact cardio such as swimming, cycling, and walking is much kinder to knees than high-impact running when pain is present. Aim for at least three strength sessions per week. Tracking your workouts in PeriPlan can help you spot the connection between exercise consistency and symptom severity.

Self-Management at Home

Applying ice wrapped in a cloth for 10 to 15 minutes after activity helps reduce acute inflammation and swelling. Heat is more useful for chronic stiffness and is best applied before movement. Collagen peptides (10 g daily) have early evidence for supporting joint cartilage integrity. Omega-3 fatty acids and curcumin both have anti-inflammatory properties worth discussing with your healthcare provider. Maintaining a healthy body weight significantly reduces load on the knee joints; even modest weight loss makes a measurable difference to pain scores in research studies.

Medical and Therapeutic Options

Physiotherapy is highly effective for knee pain and should be a first-line treatment before considering injections or surgery. A physio can assess alignment issues, prescribe targeted exercises, and offer manual therapy. HRT is increasingly recognised as beneficial for joint health, and many women report meaningful knee pain improvement after starting it. For more advanced cartilage damage, options include intra-articular hyaluronic acid injections or corticosteroid injections for short-term relief. Surgical options like arthroscopy are only appropriate in specific structural cases and are not routinely recommended for osteoarthritic knee pain.