If you’re in your 40s or 50s and wondering, “What is happening to my body?” you’re not alone—and you’re definitely not imagining it. The changes that come with perimenopause and menopause can feel like a slow-motion ambush. One day you’re sprinting through your to-do list, and the next you’re lying awake at 2 a.m., wondering why your joints ache, your jeans don’t fit, and your brain feels foggy.
Recently, I joined a Polestar Pilates Hour Zoom session hosted by Dr Brent Anderson and featuring the amazing Dr Diedra Manns. The conversation centred around something more of us need to discuss: the Musculoskeletal Syndrome of Menopause.
Yes, it’s a thing—and once you hear what it is, you’ll likely realise you’ve already met it.
What Is the Musculoskeletal Syndrome of Menopause?
As estrogen declines in midlife, women experience more than hot flashes and mood swings. Our muscles, bones, joints, and connective tissues all take a hit—often silently at first.
According to Dr. Manns, this estrogen drop:
- Decreases muscle mass and strength
- Impacts joint mobility and tissue elasticity
- Increases risk of falls, fractures, and pain
- Alters metabolism, contributing to belly fat, insulin resistance, and fatigue
But here’s the kicker: These changes often get brushed off as just getting older. They’re not. They’re hormone-driven shifts—and they can be supported, strengthened, and even reversed with the right approach.
A Real Story: More Common Than You Think
Dr. Manns shared the story of a 55-year-old woman recovering from a horse-riding fall. She had a sacral fracture and was lean and active yet already showing signs of osteopenia. Despite being under the typical age for a bone density scan, Dr. Manns pushed for one—and was right.
The patient also experienced:
- Low back pain
- Migraines
- Hand numbness
- Vertigo
- Muscle instability
- And a return of her menstrual cycle (surprise—she wasn’t postmenopausal after all)
Sound familiar? You’re not alone.
Enter Pilates: The Gentle Powerhouse
Dr. Manns used gentle Pilates-based rehab to help her client build strength, restore balance, and gain control. Simple movements like heel slides, bent-knee openings, and arm arcs laid the foundation. But it wasn’t just about movement—it was about meeting the body where it was.
Pilates during menopause isn’t just about toning your core (though that’s a nice bonus). It’s about:
- Supporting your pelvic floor
- Improving balance and coordination
- Reconnecting with your breath and nervous system
- Building bone density through controlled load-bearing movement
In fact, studies show that Pilates can reduce menopausal symptoms, enhance posture, and prevent osteoporosis by improving muscle function and mobility (source).
Hormones, Sleep & the “Tired But Wired” Phenomenon
One of the biggest takeaways from the session? Many women in midlife live in sympathetic overdrive—aka chronic stress mode. We’re wired, anxious, overwhelmed… and utterly exhausted.
Estrogen helps regulate our stress response. Without it, our cortisol spikes, which can cause mood swings, sugar cravings, brain fog, and insomnia.
This is why breathwork, restorative movement, and nervous system regulation are not optional. Even 15 minutes a day of parasympathetic activation (breath-focused movement, gentle stretching, meditation) can make a massive difference.
One of the biggest takeaways from the session? Many women in midlife live in sympathetic overdrive—aka chronic stress mode. We’re wired, anxious, overwhelmed… and utterly exhausted.
Estrogen helps regulate our stress response. Without it, our cortisol spikes, which can cause mood swings, sugar cravings, brain fog, and insomnia.
This is why breathwork, restorative movement, and nervous system regulation are not optional. Even 15 minutes a day of parasympathetic activation (breath-focused movement, gentle stretching, meditation) can make a massive difference.
A Lifestyle-Centered Approach
What really resonated with me was how holistic the conversation was. Movement isn’t isolated. It’s part of a larger picture that includes:
- Exercise (especially strength and functional training)
- Nutrition (especially protein intake and micronutrients)
- Sleep (the true MVP of hormonal balance)
- Stress reduction (breathwork, mindfulness, nature)
- Avoiding harmful habits
- Community connection (because loneliness is inflammatory, too)
This approach, called Lifestyle Medicine, is your best ally in navigating menopause with grace and grit.
What This Means for You
If you’re:
- Waking up stiff and sore
- Feeling weaker than you used to
- Frustrated by weight changes
- Experiencing mystery aches or foggy thinking
- Or I’m just curious how to feel more like you again…
…know that you’re not broken. You’re evolving. And with the right tools—movement, education, advocacy, and support—you can thrive in midlife and beyond.
As Dr. Manns put it: “Pilates is a brilliant preparation for life, but it’s not the end of the story.” Let’s keep moving—stronger, wiser, and more empowered than ever.
I’d love to hear from you:
Have you noticed physical or emotional changes as you move through menopause? What role has movement played in your experience? Let’s start the conversation.