Estrogen's Role in Joint Pain: Understanding the Connection
- Monica Bell
- Aug 6
- 4 min read
Almost everyone has experienced joint pain at some point, and many people experience chronic joint pain. Joint pain can occur due to injury, wear and tear, and inflammation. When inflammation becomes chronic, it can contribute to significant joint pain and damage, particularly in conditions like arthritis and rheumatoid arthritis. For many, joint pain can contribute to loss of flexibility, strength and over time, impact functioning. Although inflammation and joint pain have complex etiologies, estrogen levels have an outsized influence on joint pain. Let’s look at how you can prevent and treat joint pain.
What is Inflammation?
You are probably familiar with inflammation if you have ever had an injury. The response to sudden body damage, such as cutting your finger or undergoing surgery, is for your body to send inflammatory cells to the injury. These cells start the healing process.
But with chronic inflammation, your body continues sending inflammatory cells even when there is no outside danger. For example, in rheumatoid arthritis, inflammatory cells and substances attack joint tissues, leading to an inflammation that comes and goes and can cause severe damage to joints with pain and deformities.
Inflammation has also been implicated in Alzheimer’s disease. For example, people with Alzheimer’s have higher gut inflammation with higher levels of amyloid plaque accumulation.
Causes of Inflammation
Inflammation is a complex interplay involving multiple factors, and we don’t have all the answers, but we have some.
Overuse: Chronic overuse of muscles and joints can lead to inflammation, especially as you age.
Menopause: A decline in estrogen contributes to an increase in estrogen, which affects joints, increases the risk of heart disease, stroke, and dementia.
Autoimmune Diseases: Autoimmune diseases such as arthritis, lupus, and MS cause the immune system to mistakenly attack its own tissues and organs, leading to chronic inflammation.
Environmental Factors: Exposure to toxins and pollutants can trigger an inflammatory response.
Diet: A diet high in processed foods, refined carbohydrates, and unhealthy fats can contribute to chronic inflammation. A diet high in vegetables, fruits, and healthy fats can reduce inflammation.
Lifestyle: Smoking, alcohol consumption, stress, lack of exercise, and poor sleep increase inflammation.
The Women’s Health Initiative Study on Estrogen and Joint Pain
By now, you have heard about the debunked Women’s Health Initiative study in 2002 that led to an unnecessary decrease in providing Hormone Replacement Therapy by providers. A post hoc analysis of data in the Women’s Health Initiative examined the effects of estrogen only on women without a uterus on joint pain.
A total of almost 11,000 postmenopausal women between 50 and 79 years old who had a previous hysterectomy with no prior breast cancer were entered into the randomized, double-blind, placebo-controlled trial at 40 US clinical centers. The findings:
After 1 year, joint pain frequency was significantly “lower” in the estrogen-alone group compared with the placebo group.
Same with joint pain severity.
The difference in pain between randomization groups persisted through year 3.
How Estrogen and Joint Pain Are Connected
Joint pain affects over 30% of individuals, with arthritis being the most common cause of joint pain. About 60% of people over the age of 75 have arthritis. Joint pain can occur in the knees, hands, hips, feet, back, elbows and wrists. Estrogen fights joint pain in the following ways:
Joint Lubrication
Estrogen helps maintain fluid in the joints, which lubricates and cushions joints, reducing friction and pain.
Cartilage Maintenance
Cartilage is the connective tissue in the joints, and estrogen increases collagen production and reduces joint inflammation. Estrogen deficiency after menopause has been linked to increased rates of osteoarthritis.
Bone Density
Inflammation, particularly chronic inflammation, is significantly linked to osteoporosis. It affects bone remodeling by influencing the activity of osteoclasts (bone-resorbing cells) and osteoblasts (bone-building cells), often leading to bone loss. Also, inflammatory arthritis is associated with osteoporosis.
Estrogen plays a critical role in bone health in both sexes. Estrogen promotes the activity of osteoblasts, which are cells that synthesize and secrete bone matrix and participate in the mineralization of bone.This function suggests that estrogen may help slow the breakdown of bones and encourage bone growth and that estrogen reduction over time could compromise bone health.
Osteoarthritis Prevention and Pain
Osteoarthritis is more common in women than men, and its prevalence increases after menopause, when estrogen levels decline. Estrogen receptors are found in joint tissues and cartilage, indicating that cartilage can respond to estrogen.
Several human studies support the correlation between estrogen levels and osteoarthritis. A meta-analysis found that women tended to experience more severe knee osteoarthritis than men and that this was substantially amplified in women after menopause, when estrogen levels decline. Together with animal findings, these data highlight the potential role of low estrogen levels in accelerating osteoarthritis and osteoarthritis pain.
Risk Factors for Inflammation and What You Can Do
Some risk factors are modifiable, and others aren’t. Some of the behavioral approaches you can tackle now:
Check your inflammatory markers. At Optimal Hormone Health, we will check your C-reactive protein and homocysteine, both markers of inflammation.
Reduce body fat. Calorie restriction is the most powerful life-extension intervention in most animal models and is associated with reduced inflammatory biomarkers.
Estrogen has been shown to prevent prolonged inflammation, suggesting that decreasing estrogen production could tip the inflammatory balance toward chronic systemic inflammation. Talk with us about hormone replacement therapy for inflammation and pain.
Reduce stress since chronic stress is associated with inflammation
Exercise to build strength and flexibility.
Eat a plant-based diet. Red and processed meats contribute to inflammation
Reduce sugar intake. Excessive sugar intake is associated with an increase in inflammation.
A Holistic Approach to Joint Pain
At Optimal Hormone Health, hormone replacement is our specialty, but we consider any hormone replacement in the larger context of lifestyle, stress, diet and exercise. Estrogen replacement has numerous benefits, joint pain relief being one of them. Talk with us about your specific needs and we can create an individualized plan for improving your health and well-being.