Menopause and tendonitis – Why it happens and what to do about it
- Maryke Louw
- 7 days ago
- 8 min read
Women are more likely to develop tendonitis during the perimenopause and beyond. Learn why this is, what the most effective treatments are, and how to prevent it from happening or recurring.
Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles. Read more (opens in new window).
In this article:
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Why menopause increases your risk of tendonitis
Tendonitis (also called tendinopathy) is irritation or injury to a tendon – the tough, rope-like tissue that connects your muscles to your bones. It most commonly develops through overuse – ramping up your activity levels too quickly or not allowing enough recovery time between bouts of activity.
But during the perimenopause, something else comes into play that makes tendonitis more likely, even if you haven't changed anything about how active you are.
What oestrogen has to do with it
The menopause – and the perimenopause stage leading up to it – causes a significant drop in oestrogen levels. This matters more than most people realise, because oestrogen plays an important role in keeping your tendons healthy.
Healthy tendons are mainly made up of collagen fibres running in tight, parallel bundles – this structure is what makes them so strong and resilient.
Physical activity naturally causes tiny amounts of micro-damage to tendons, and this is completely normal. Given enough recovery time, your body repairs this micro-damage and replaces it with new, stronger collagen fibres.
💡 When oestrogen levels drop, this repair process slows down.
Research shows that when oestrogen levels fall, the cells inside your tendons multiply less effectively and get injured more quickly – meaning there are fewer "workers" available to maintain and repair the tissue. Tendons also appear to produce less collagen in response to lower oestrogen levels.
The result is tendons that:
aren't quite as strong as before,
might sustain more micro-damage during activity,
and may need a little longer to recover afterwards.
It doesn't take much to tip the balance
This is why women going through the menopause often develop tendonitis without doing anything dramatically different. It might be:
keeping up the same exercise routine as before, without adjusting recovery time
a burst of unusually intense activity – like several days of heavy gardening, a long walking holiday, or getting back into sport after time off
increasing training load as normal (before you entered perimenopause) without realising the tendons aren't keeping up as well anymore.
The most effective treatments for menopause-related tendonitis
The good news is that the main treatment approach for tendonitis works well during the menopause too – you may just need to adjust the pace and be a little more patient with progression.
There are three elements worth highlighting (see section below), but you can find our detailed discussions on the complete treatment strategies for the various types of tendinopathy/tendonitis here:
Pelvis and Hip
Knee
Ankle
Arm
1️⃣ Strength training
Strength training is the most effective treatment for tendonitis, and this doesn't change during the menopause. Loading the tendons through resistance exercises stimulates them to produce new, healthy collagen fibres and gradually restores their strength and capacity.
That said, it’s very important that the exercises you do are pitched at the correct intensity for what your tendon can currently tolerate – it must match your tendon’s current strength and pain levels. These exercises must also be adapted and progressed as your tendonitis recovers, until you’ve built the strength needed for the type of activity you want to do.
💡 During the menopause, you might need more recovery time between rehab sessions and a more gradual progression than someone who is not in the menopause.
We teach our patients to monitor their 24-hour pain and symptom response and use that to guide the right exercise intensity:
A small increase in discomfort during exercise or while doing a specific activity is usually OK (just being a bit more aware of the area) and can be ignored.
And it is usually also OK to experience a small increase in discomfort in the hours after a workout or activity.
But the extra discomfort should settle down to your normal pain or stiffness levels within 24 hours of that activity.
It's also important to be specific about which tendon is affected, because each area of the body has its own set of rehab exercises, including ones that are best to avoid. You can find detailed guides on this at the links we shared above.
2️⃣ Supplements
Research has shown that hydrolysed collagen and vitamin C-enriched gelatine, taken before strength exercises, can increase the gains from those exercises for injured tendons.
The idea is that these supplements give your body the building blocks it needs to produce more collagen during the window when your tendons are most receptive to repair – i.e. straight after loading them.
This might make them a particularly useful addition during the menopause, when collagen production is already compromised. Read our detailed article on tendon repair supplements for guidance on how to use them effectively.
It's less clear whether supplements also help prevent tendon injuries, but there is some emerging evidence to suggest they might.
3️⃣ Hormone replacement therapy (HRT)
HRT is worth mentioning because it is sometimes overlooked as part of a broader tendon recovery strategy.
Very few studies have looked specifically at HRT and tendonitis recovery, so we can't make definitive claims. However, the available evidence offers some useful pointers.
One study that scanned the Achilles tendons of 53 active women found that those on HRT had less tendon abnormality than those who weren't on HRT.
A randomised controlled trial looking at HRT as part of treatment for gluteal tendinopathy (hip tendon pain) found that women with a BMI under 25 had significantly better outcomes when using HRT compared with those who didn't. This benefit wasn't seen in women with a higher BMI – a reminder of how complex our bodies are.
💡 HRT might benefit some women, but it is not right for everyone – and you can absolutely recover without it by following a sensible rehab plan. Discuss it with your doctor to understand whether it is an option worth considering for you.
How to prevent tendonitis during and after the menopause
Prevention is something we always discuss with our online patients once they've recovered from a tendon injury – because without making some adjustments, the same problem often comes back.
💡 It's not that exercise becomes dangerous during the menopause or that you need to stop doing the things you love. Your tendons simply need a little more recovery time and a more gradual increase in load than they used to need.
The principles below apply whether you are a regular gym-goer, a keen walker, a runner, or someone who just wants to get through daily life without pain.
👂Listen to your body and adjust your load
Start paying attention to how your body responds to activity – not just during it, but in the 24 hours after. If you're still sore or fatigued from the previous day, that's your body telling you it hasn't fully recovered yet.
Some practical examples of what this might look like:
When redecorating, not trying to finish a whole room in one day – breaking it into shorter sessions spread over the week or getting someone to help you.
Starting a new exercise class or returning to one after a break – ease in gradually rather than throwing yourself into a full session on day one, even if you feel fine at the time.
A weekend of DIY or helping someone move house – break up the heavy lifting and stair climbing with regular rest breaks, and don't push through if your tendons start complaining.
After a tough training session, allowing a full rest day – or at least an easier day – before loading the same tendons again.
When planning an active holiday, build up your activity levels gradually in the months leading up to it rather than going from your normal routine to a much higher load overnight.
💪 Build a foundation of regular strength training
This is probably the single most important habit you can develop.
Tendons respond especially well to heavy, slow resistance training – and the stronger your tendons are to begin with, the better they handle unexpected spikes in load (like that last-minute decision to join a 10k or spend a weekend moving house).
Once again, easing into things, starting light, and building up gradually over several months is the best way to approach this.
💡 We're concentrating on the physical factors in this article, but it's worth noting that nutrition, sleep, and stress management also play an important role in tendon health during the menopause.
How we can help
Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
