Hormonal Changes in Menopause and Musculoskeletal Health: Evidence from a Systematic Review

Abstract

Introduction: Menopause is a physiological stage of female aging characterized by a decline in estrogen levels, leading to systemic changes that significantly affect musculoskeletal health. These hormonal alterations are associated with increased risk of osteoporosis, sarcopenia, musculoskeletal pain, and functional decline, representing an important public health concern in aging female populations. Objective: This review aims to systematically synthesize current scientific evidence on the effects of menopausal hormonal changes on musculoskeletal health, focusing on bone, muscle, pain, and functional outcomes in postmenopausal women. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A literature search was performed in PubMed/MEDLINE, SciELO, and the Virtual Health Library databases, including full-text studies involving human subjects published within the last five years. Controlled descriptors from MeSH and DeCS were combined using Boolean operators. Observational studies and clinical trials were included. After removal of duplicates and screening based on eligibility criteria, 25 studies were included in the qualitative synthesis. Results: The included studies consistently demonstrated that estrogen deficiency during and after menopause is associated with accelerated bone loss, reduced bone mineral density, and increased risk of osteoporosis and fractures. In addition, menopause was linked to progressive decline in muscle mass and strength, higher prevalence of sarcopenia, and increased occurrence of musculoskeletal pain and functional impairment. Several studies highlighted the coexistence of bone and muscle deterioration, supporting the concept of integrated musculoskeletal decline. Menopausal hormone therapy showed potential protective effects on bone density and, to a lesser extent, on muscle outcomes, although results were heterogeneous. Lifestyle and metabolic factors, including physical inactivity and changes in body composition, were also identified as relevant modifiers of musculoskeletal health. Conclusion: Menopausal hormonal changes play a central role in musculoskeletal deterioration, contributing to bone loss, sarcopenia, pain, and functional decline. An integrated approach that considers hormonal, structural, and functional aspects is essential for the clinical management of postmenopausal women. Further longitudinal and interventional studies are needed to clarify optimal strategies for prevention and treatment.