2 Nov 2026 · @Ivana
Why does everything hurt?
Stiff mornings. Aching joints. Shoulders that won't release, a back that won't settle, and pain that seems to move around the body without a clear reason. Many women in perimenopause tell me they suddenly feel decades older, often after scans and blood tests have come back "normal".
This is not in your head, although your brain is very much involved, and we'll come to that.
Pain is one of the most common and least discussed experiences of the Menopause transition. It is rarely on the checklist next to hot flushes and sleep. Yet for many women it is the symptom that most affects how they move, work, rest and connect.
This month I want to take you through why pain changes in midlife, the tissue that connects it all (fascia), how the nervous system shapes what we feel, and what the body needs to come out of protection mode. At the end, I'll show you why all of this leads us towards December's topic: libido.
Oestrogen and pain: more connected than we were taught
Oestrogen does far more than regulate periods. It has receptors throughout the body, including in muscles, joints, tendons, ligaments, connective tissue and the nervous system.
Among other roles, oestrogen helps to:
maintain collagen, the protein that gives tissues strength and elasticity
keep tissues hydrated and supple
regulate inflammation
influence how the brain and spinal cord process pain signals
As oestrogen fluctuates and then falls, many women notice they become more sensitive to pain and slower to recover from strain or injury. Joint aches, stiffness, frozen shoulder, tendon problems and widespread muscle pain all become more common through the transition.
Researchers have only recently started describing this as a pattern of its own, sometimes called the musculoskeletal syndrome of Menopause. Naming it matters. A symptom with a name is more likely to be asked about, studied, and taken seriously.
We still have significant gaps in research on women's midlife health, and much of what we know about pain was learned from studies that did not look at hormonal change at all. What we can say is that midlife pain is real, common and worth investigating properly.
Fascia: the body's living web
Under your skin, a continuous web of connective tissue called fascia wraps and connects every muscle, organ, nerve, and blood vessel. Think of the thin, silvery layer you see on a cut of meat, then imagine it running through your whole body in one connected system.
For a long time, people treated fascia as passive packing material and cut it away in anatomy dissections to get to the "important" structures. We now understand it as a living, responsive tissue:
It is richly supplied with nerves. Many of them sense pressure, stretch and pain, so fascia plays a part in how the body feels, not only how it holds together.
It depends on water and movement. Healthy fascia glides. Without regular movement and hydration, its layers stiffen and become less able to slide over each other.
It responds to hormones. Oestrogen influences collagen and hydration in connective tissue, which may help explain why many women feel stiffer and less elastic in midlife.
It responds to stress. A body held in tension for long periods tends to stay in tension.
A word of honesty: fascia research is still developing, and some popular claims run well ahead of the evidence. Be cautious of anyone promising to "release" or "reset" your fascia in a session.
What is well supported is that regular, varied movement, good sleep and managing stress all help connective tissue stay healthy. When a woman says she feels "tight all over" or "stuck in her body", fascia is often part of the picture, together with the nervous system it is wired into.
Pain is a protector
One of the most important shifts in modern pain science is this: pain is not a direct measure of tissue damage. Much of this work has been led by the Neuro Orthopaedic Institute (NOI) in Adelaide and by pain scientists such as Lorimer Moseley and David Butler.
Pain is produced by the brain as a protective response. It is the brain's best judgement, in that moment, about whether the body is in danger. To reach that judgement, the brain weighs signals from the tissues, but also:
how well you have slept
your stress levels
past experiences of pain and injury
fear and expectation
mood
hormones
nutrients
social connections
In acute injury, this system works beautifully. You sprain an ankle, it hurts, you protect it, it heals, the pain settles.
In chronic pain, the alarm system often becomes sensitised. Like a smoke alarm that goes off every time you make toast, it fires sooner, louder and for longer than the situation calls for. The pain is completely real, but it no longer accurately reflects harm in the tissues.
Midlife can turn that alarm up. Falling oestrogen, broken sleep, chronic stress and years of carrying a heavy mental and physical load all push the nervous system towards protection.
Understanding pain is part of treating it
The NOI approach puts understanding pain at the centre of care. Learning how pain works, often in a group with others going through the same thing, is a recognised part of evidence-based chronic pain management.
When we understand the alarm, we fear it less. That matters, because fear is one of the things that turns the alarm up. Understanding also makes it easier to return to movement, which the body needs to recover.
The way back: top-down and bottom-up
Two broad routes can help a sensitised nervous system settle, and they work best together.
Top-down approaches work through thoughts, knowledge and meaning. Pain education is one. Cognitive approaches such as CBT are another: noticing the thoughts that come with pain, checking them, and changing the ones that keep the alarm on high.
Bottom-up approaches work through the body itself: movement, breath and the senses. Rather than reasoning with the nervous system, they show it directly, through experience, that it is safe.
Yoga as a bottom-up practice
Yoga is one of the best-studied bottom-up approaches for chronic pain. It brings together three things a sensitised system needs:
gentle, graded loading of muscles, joints and fascia
slow breathing, which calms the stress response
attention to body sensations without alarm, learning to notice what you feel without immediately bracing against it
Research supports yoga for conditions such as chronic low back pain, and it can be adapted to almost any body, age and level of fitness. It does not need to look like the pictures on social media. A few minutes of slow, supported movement and breathing at home counts.
Other bottom-up tools
walking, ideally outdoors
gentle stretching and mobility work
warmth: a bath, a heat pack, a warm shower
touch and massage
rhythm: music, dancing, swimming
rest that actually restores you, not just stopping
The aim is not to push through pain, and not to avoid all movement either. It is to give the nervous system repeated, gentle experiences of safety in the body.
From protection to pleasure
There is a bigger reason all of this matters. Pain and pleasure share much of the same neural wiring. The same brain systems that decide how much something hurts also help decide how much we want, enjoy and reach for things.
A nervous system stuck in protection doesn't only amplify pain. It can push appetite up or down, which often distorts our relationship with food. It turns down curiosity, playfulness and desire.
A body braced against discomfort, including pelvic pain or painful sex, finds it hard to open to pleasure. Many women quietly withdraw from intimacy not because they have stopped caring, but because their body has learned to expect discomfort and is protecting them.
This is where pain and libido meet. Coming out of protection mode is not only about hurting less. It is about making room to feel more: more energy, more interest and more connection, first with yourself and then with others.
That is where we are heading in December, when I'll be writing about libido in perimenopause and Menopause, the life force that so often goes quiet in midlife, and how women reconnect with it.
Bringing it together
If your body has started to ache in ways it never used to, you are not imagining it, and you are not simply "getting old". Hormonal change, connective tissue, sleep, stress and the nervous system are all part of the picture. We can understand and work with each of them.
In my Mastering Menopause program, we explore both top-down and bottom-up tools for working with the nervous system, including how pain, stress and sleep connect. Understanding the mechanisms behind your pain, and using that understanding to guide how you move your body and observe your mind, is the path back towards a body that feels safe, at ease and free to move
I am Dr Ivana — GP, Lifestyle Physician, and a woman. 🌿
📍 Maxwell Medical Group Braybrook 📞 03 7036 2450 🔗 doctorivana.com.au
Further reading
Butler D, Moseley GL. Explain Pain. 2nd ed. Adelaide: Noigroup Publications; 2013.
Moseley GL, Butler DS. Explain Pain Supercharged. Adelaide: Noigroup Publications; 2017.
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024.
Fede C, et al. Hormone receptor expression in human fascial tissue. European Journal of Histochemistry. 2016.
Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiotherapy Theory and Practice. 2016.
Wieland LS, et al. Yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews. 2022.
