Menopausal arthralgia and longitudinal changes in sex hormones and climacteric symptoms

Musculoskeletal discomfort (menopausal arthralgia) is the most prevalent and debilitating complaint during the menopausal transition. Despite its high prevalence, menopausal arthralgia has historically been overlooked, and establishing a direct association with menopause remains challenging. We aimed to study the relationship of menopausal arthralgia with respect to changes in estradiol, follicle-stimulating hormone (FSH) levels, and climacteric symptoms during the menopausal transition.

Participants from a longitudinal community-based cohort in Beijing, China recruited since 2005 were studied. Women in the menopausal transition (within 5 years before or after the final menstrual period) with ≥ 2 assessment visits were included. Menopausal arthralgia was defined as the presence of moderate or severe muscle and/or joint pain affecting multiple sites, with onset or worsening during the menopausal transition, our reference condition being arthralgia symptoms reported by breast cancer patients undergoing estrogen suppression with aromatase inhibitor therapy. Participants with any history of rheumatoid arthritis or other autoimmune diseases were excluded. Menopausal symptoms and serum levels of FSH and estradiol were evaluated at each annual visit. Multivariable binary logistic regression assessed associations.

Among 327 women (mean age 48.48±3.65), 212 (64.83%) experienced menopausal arthralgia. Lower initial FSH levels [aOR 0.71 (95% CI 0.53, 0.96)], and a more rapid rise of FSH during the menopausal transition [aOR 2.97 (95% CI 1.02, 8.68)], increased risks for menopausal arthralgia after adjustment for age, BMI, and menopausal status. Concomitantly, higher initial estradiol levels were associated with increased risk [aOR 1.34 (95% CI 1.05, 1.71)]. The presence of hot flashes [aOR 3.58 (95% CI 2.10, 6.07)], night sweats [aOR 3.33 (95% CI 1.92, 5.76)], and vulvo-vaginal discomfort [aOR 3.19 (95% CI 1.86, 5.46)] was also associated with menopausal arthralgia after covariate adjustment.

Menopausal arthralgia was associated with rapid hormonal fluctuations, characterized by a higher longitudinal rate of FSH change and lower initial FSH levels, alongside higher initial estradiol levels. Given its strong association with classic climacteric symptoms, menopausal arthralgia should be recognized as an integral component of the menopausal syndrome.