Hormones, Movement & Midlife: Why Your Body Feels Different (AndWhat To Do About It)

By Osteopath Carien Boshoff

I recently had the privilege of spending an hour on a Zoom call with Tania Dalton, an experienced health coach who is deeply passionate about supporting and energising women through the many stages of life. Our conversation explored the complexities of women’s health, particularly the transitions that can often feel confusing, overwhelming, or underdiscussed.

Tania brings a wealth of knowledge and a refreshing perspective, focusing not just on managing symptoms, but on empowering women to feel informed, supported, and connected to their bodies. This discussion offered valuable insights into how we can better understand these changes and approach them with confidence, rather than uncertainty. This blog is inspired by that conversation, unpacking key themes, sharing reflections, and opening up a space for more honest dialogue around women’s health and wellbeing.

Tania Dalton - Energised Aging

Hormones influence far more than reproduction. They affect energy levels, recovery, injury risk and

how the body adapts to movement and training across the lifespan.

In the final part of this series, we explore how hormonal transitions impact performance, recovery

and overall wellbeing. One important and often overlooked stage in this conversation is

perimenopause and menopause, a time where many women experience significant changes in

how their body feels and responds.

Have you, your mum, grandmother or wife ever told you they are experiencing persistent joint

pain, reduced recovery, fatigue or injuries that don’t quite follow the “usual” pattern? Sometimes

these presentations are not purely mechanical. They may reflect a deeper shift occurring within

the body.

Understanding Perimenopause and Menopause

Perimenopause refers to the years leading up to menopause, where hormonal fluctuations begin

to occur. This phase can last anywhere from 4 to 10 years and is often where symptoms are most

noticeable. Menopause itself is defined as 12 months after the final menstrual period, with

everything after that considered postmenopause. From an osteopathic perspective, this transition

highlights the importance of understanding the body as an integrated system, where hormonal,

musculoskeletal, neurological and lifestyle factors all interact.

Why This Matters in Clinical Practice

In a recent discussion with women’s health coach Tania Dalton, one key theme stood out:

“Women often say, ‘I just don’t feel like myself anymore.’”

This feeling can present in many ways within an osteopathic setting:

• Persistent joint pain with no clear structural pathology

• Reduced tolerance to exercise or rehabilitation

• Increased injury frequency

• Slower recovery despite appropriate treatment

These changes are not imagined; they are often driven by hormonal fluctuations affecting tissue

quality, recovery capacity and nervous system regulation.

Common Symptoms That May Present in Clinic

Perimenopause and menopause are often associated with hot flushes and night sweats. However,

many symptoms are less recognised and frequently present in musculoskeletal care:

Musculoskeletal

• Joint stiffness and pain (often unexplained)

• Tendinopathies (e.g. elbow, shoulder)

• Reduced tissue resilience

• Increased injury risk

Systemic

• Fatigue and reduced energy

• Poor sleep or insomnia

• Brain fog and reduced concentration

• Increased anxiety or mood changes

Other indicators

• Changes in menstrual cycle

• Feeling “off” or not like themselves

• Reduced motivation or exercise tolerance

As highlighted in the discussion, there are dozens of recognised symptoms, and not every woman will experience the same presentation.

Why Hormones Affect the Musculoskeletal System

Hormones such as oestrogen and progesterone play a significant role in: collagen production,

joint lubrication, bone density and muscle recovery.

As these hormone levels fluctuate and decline, joints may feel stiffer or more irritable, tendons

and ligaments may tolerate load less effectively, and recovery between sessions may slow. This helps explain why some patients do not respond as expected to treatment, experience recurring injuries, or feel worse despite “doing all the right things”.

Movement, Training and Load: Finding the Balance

A key insight from Tania’s experience is that women often respond in one of two ways during this

stage:

1. Overdoing it

• Increasing training to “fight” body changes

• Pushing through fatigue

• Higher risk of injury and burnout

2. Withdrawing from movement

• Due to fatigue, pain, or reduced confidence

• Leading to deconditioning and further decline

Neither extreme supports long-term health. Instead, the goal is to work with the body, not against it.

Osteopathic Approach to Management

Osteopathy offers a holistic framework to support women through this transition.

Assessment considerations

• Hormonal stage and menstrual history

• Sleep quality and recovery

• Stress and lifestyle factors

• Load tolerance and training patterns

Management strategies

• Individualised load modification

• Supporting joint and tissue health

• Encouraging sustainable movement patterns

• Addressing contributing factors beyond structure alone

Importantly, treatment is not just about “fixing pain” but understanding why the body is

responding differently.

Practical Strategies for Patients

1. Track symptoms

Patterns often emerge over time and help guide care.

2. Prioritise recovery

Sleep, nutrition and stress management become increasingly important.

3. Adjust training

• Reduce intensity during high fatigue periods

• Focus on consistency over extremes

4. Build strength gradually

Strength training remains essential for:

• Bone health

• Muscle mass

• Long-term function

5. Seek support

A multidisciplinary approach may include:

• GP or menopause informed practitioner

• Osteopath

• Nutrition or health coaching support

Reframing the Narrative

Menopause is often viewed negatively, but it can also be reframed as a transition, not a decline.

As Tania shared:

“It’s not a downward spiral. It’s a new stage of life, and it can be empowering.”

With the right support, education and approach, women can continue to:

• Train effectively

• Stay active

• Maintain strength and independence

Why This Matters

As osteopaths, we often spend more time with patients than many other healthcare providers.

This creates an opportunity to:

• Listen beyond the primary complaint

• Recognise patterns that may indicate hormonal influence

• Guide patients toward appropriate support

Understanding hormonal transitions allows us to provide care that is:

• More individualised

• More holistic

• More effective long-term

Important Notes

Not all musculoskeletal pain or fatigue is related to hormonal changes. Many factors including stress, sleep disruption, training errors or underlying pathology, can present similarly.

Persistent or concerning symptoms should always be discussed with a qualified healthcare

professional. This information is general in nature and not a substitute for personalised medical

advice.

The Takeaway

If your body feels different, it probably is, and that’s not something to ignore. Hormonal

transitions can influence how you move, recover and respond to treatment. Recognising these changes early allows for better support, smarter training and improved long-term health outcomes.

References

Elliott-Sale, K. J., Tenforde, A. S., Parziale, A. L., Holtzman, B., & Ackerman, K. E. (2018).

Endocrine effects of relative energy deficiency in sport. International Journal of Sport Nutrition

and Exercise Metabolism, 28(4), 335–349. https://doi.org/10.1123/ijsnem.2018-0127

Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., & Kaunitz, A. M. (2022).

Global consensus position statement on the use of testosterone therapy for women. Climacteric,

25(2), 1–16.

Santoro, N., & Randolph, J. F. (2016). Reproductive hormones and the menopause transition.

Obstetrics and Gynecology Clinics of North America, 43(3), 455–466.

The North American Menopause Society. (2023). The 2023 hormone therapy position statement.

Menopause, 30(4), 573–590.