If you are between 40 and 60 and noticing more joint stiffness, tendon pain, or slower recovery from workouts, you are not alone. Many adults in Westerville, Ohio, begin experiencing musculoskeletal changes during this stage of life. In this article, Hormones and Joint Pain After 40 we will examine exactly how it might be a major cause of your pain.
While activity levels, stress, and old injuries play a role, research increasingly suggests that declining estrogen and testosterone levels may influence joint structure, tendon resilience, muscle mass, and pain perception.
At Central Ohio Spine and Joint, we frequently evaluate patients in this age group who say:
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“I haven’t changed anything, but my joints ache more.”
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“My knees feel stiffer than they used to.”
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“My recovery time is slower.”
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“My tendons seem more irritated.”
Let’s break down what the research currently tells us.
The Role of Estrogen in Joint and Tendon Health
Cartilage and Joint Structure
Research shows that postmenopausal women tend to have thinner articular cartilage compared to premenopausal women. Studies also suggest that women using exogenous estrogen may have thicker cartilage and intervertebral discs (Gulati et al., 2023).
In women with symptomatic knee osteoarthritis, lower estradiol levels were associated with increased bone marrow lesions and effusion-synovitis volume on MRI (Jin et al., 2017). These structural changes often correlate with increased pain and stiffness.
Tendons and Muscle
Estrogen loss may:
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Reduce tendon collagen synthesis capacity
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Contribute to muscle atrophy
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Decrease tissue resilience
Tendons rely on collagen turnover to maintain strength and elasticity. If collagen production declines, tendons may become more vulnerable to irritation and overload.
Rate of Decline Matters
Interestingly, research suggests that the rate of estrogen decline may be more important than the absolute level. Women who experience abrupt estrogen loss, such as those treated with aromatase inhibitors, often report increased joint symptoms (Sestak et al., 2008).
Some populations report improvement in symptoms with hormone replacement therapy, though causality is not definitively established.
Pain, Sleep, and Inflammation
Estrogen also plays a role in:
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Modulating inflammation
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Influencing pain pathways
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Regulating sleep and mood
These factors indirectly affect how pain is experienced and tolerated.
Testosterone and Musculoskeletal Health
Bone and Cartilage
Testosterone deficiency in men is associated with:
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Lower bone mineral density
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Thinner cartilage
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Increased risk of muscle loss
These changes can increase joint stress over time.
Tendon Strength and Collagen
Testosterone appears to enhance tendon stiffness by increasing collagen turnover and content (Hansen & Kjaer, 2016). Tendon stiffness is not a negative trait. It helps transmit force effectively and maintain joint stability.
Pain Protection
Testosterone also has antinociceptive properties, meaning it may reduce pain sensitivity. In women, longitudinal research suggests that higher testosterone levels may be protective against knee pain and effusion-synovitis (Jin et al., 2017).
Is Hormonal Decline the Sole Cause of Joint Pain?
The short answer is no.
The current evidence linking sex hormone changes to joint pathology is strong but largely circumstantial (Gulati et al., 2023). We cannot yet say declining estrogen or testosterone directly causes osteoarthritis.
Other important contributors include:
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Changes in body composition
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Increased inflammatory markers (often called “inflammaging”)
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Reduced muscle mass
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Sleep disruption
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Stress and mood changes
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Reduced movement variability
Hormones likely interact with these factors rather than act alone.
What Does This Mean for Adults in Westerville, Ohio?
At Central Ohio Spine and Joint, we see many patients in their 40s and 50s who are active professionals, parents, and golfers. They are not sedentary. Yet they feel different than they did at 30.
This is where our 3-step process: Repair → Retrain → Reinforce becomes essential.
Step 1: Repair
We reduce irritation and calm inflamed tissue using:
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Chiropractic care
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Soft tissue therapy
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Focused shockwave therapy
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Dry needling
The goal is to create a window for adaptation.
Step 2: Retrain
Hormonal changes can alter movement control. We use:
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3D motion capture
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Movement analysis
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Motor control retraining
This helps correct compensation patterns that overload vulnerable joints.
Step 3: Reinforce
This is the most important phase.
Declining estrogen and testosterone can reduce muscle mass and tendon resilience. The most evidence-supported intervention to counter this is progressive strength training.
Strength training:
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Improves tendon stiffness
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Stimulates collagen production
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Preserves muscle mass
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Supports bone density
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Improves insulin sensitivity
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Reduces systemic inflammation
You cannot out-adjust hormonal decline. You must train through it strategically.
Should You Consider Hormone Replacement Therapy?
Some studies suggest potential benefits of hormone therapy on joint symptoms. However:
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Causality is not fully established
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Long-term disease modification is uncertain
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Risks and benefits vary individually
This decision should always involve discussion with your primary care physician or specialist.
Our role is to optimize the mechanical and neuromuscular side of the equation regardless of hormonal status.
When to Seek Evaluation
If you are between 40 and 60 and experiencing:
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Persistent joint stiffness
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Tendon pain that lingers
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Slower recovery
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Recurrent flare-ups
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New knee, hip, or shoulder discomfort
It may be time for a comprehensive evaluation.
Understanding how hormonal changes interact with movement patterns, tissue tolerance, and load capacity is key to long-term resilience.
Take the Next Step
If you live in Westerville, New Albany, Gahanna, Worthington, Dublin, or the surrounding Central Ohio area, and you want a clear plan to stay strong through midlife, we can help.
Our team at Central Ohio Spine and Joint combines advanced diagnostics with evidence-based rehab and progressive strength training to help you move better and stay better.
Schedule your comprehensive movement evaluation today:
👉 https://centralohiospineandjoint.com/schedule
References
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Jin X, Wang BH, Wang X, et al. Associations between endogenous sex hormones and MRI structural changes in symptomatic knee osteoarthritis. Osteoarthritis and Cartilage. 2017.
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Hansen M, Kjaer M. Sex hormones and tendon. Advances in Experimental Medicine and Biology. 2016.
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Sestak I, Cuzick J, Sapunar F, et al. Risk factors for joint symptoms in patients enrolled in the ATAC trial. The Lancet Oncology. 2008.
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Williams JAE, Chester-Jones M, Minns Lowe C, et al. Hormone replacement therapy for post-menopausal women with symptomatic hand osteoarthritis. The Lancet Rheumatology. 2022.
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