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Re iew A icle
E ec o Menopause on Knee Pain in Female Pa ien s wi h Knee
Os eoa h i is: A Re iew
Sneha Bha ia*
Assis an P o esso , Sh ee B. G. Pa el College o Physio he apy, Anand, Guja a , India
Co esponding Au ho : *Sneha Bha ia DOI: h ps://doi.o g/10.5281/zenodo.17709592
Abs ac
Manusc ip In o ma ion
Knee os eoa h i is (KOA) is one o he mos p e alen musculoskele al diso de s in
pos menopausal women, leading o signi ican pain, disabili y, and educ ion in quali y o li e
[1]. Menopause, cha ac e ised by a decline in es ogen and o he sex ho mones, has been
iden i ied as a key ac o in luencing he onse and p og ession o KOA [2]. Es ogen de iciency
con ibu es o al e ed ca ilage me abolism, in lamma ion, and changes in pain pe cep ion,
leading o inc eased ulne abili y o he de elopmen o KOA and knee pain.
Objec i e: This e iew explo es ecen e idence (2018–2025) ega ding he ela ionship
be ween menopause and knee pain in KOA, examining ho monal, me abolic, biomechanical,
and psychosocial mechanisms. We also highligh he implica ions o physio he apy
managemen in pos menopausal women.
Me hods: A ocused sea ch was pe o med in PubMed and Google Schola o s udies
be ween 2018 and 2025 using combina ions o e ms including “menopause,” “knee pain,”
“os eoa h i is,” “es ogen de iciency,” and “pos menopausal women.” Randomised con olled
ials, coho s udies, and sys ema ic e iews we e included.
Resul s: Pos menopausal women demons a e highe p e alence and se e i y o knee pain and
s uc u al OA changes compa ed o p emenopausal women [4]. Es ogen de iciency impai s
ca ilage epai , inc eases syno ial in lamma ion, and in luences cen al pain modula ion [5,6].
Ho mone eplacemen he apy (HRT) and physical ac i i y in e en ions ha e shown po en ial
bene i s in educing KOA pain and imp o ing unc ion [7,8].
Conclusion: Menopause- ela ed ho monal changes con ibu e signi ican ly o knee pain in
emale pa ien s wi h KOA h ough mul i-sys em mechanisms. Comp ehensi e physio he apy
app oaches inco po a ing exe cise, weigh managemen , educa ion, and po en ially adjunc i e
ho monal he apy may op imise ou comes in his popula ion.
▪ ISSN No: 2583-7397
▪ Recei ed: 13-09-2025
▪ Accep ed: 23-10-2025
▪ Published: 05-11-2025
▪ IJCRM:4(6); 2025: 100-103
▪ ©2025, All Righ s Rese ed
▪ Plagia ism Checked: Yes
▪ Pee Re iew P ocess: Yes
How o Ci e his A icle
Bha ia S. E ec o menopause on
knee pain in emale pa ien s wi h
knee os eoa h i is: a e iew. In J
Con emp Res Mul idiscip.
2025;4(6):100-103.
Access his A icle Online
www.mul ia iclesjou nal.com
KEYWORDS: menopause, pos menopausal women, knee pain, os eoa h i is, es ogen de iciency, ho mone eplacemen he apy,
physio he apy.
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1. INTRODUCTION
Knee os eoa h i is (KOA) is a degene a i e join disease
cha ac e ised by ca ilage deg ada ion, syno ial in lamma ion,
and subchond al bone emodelling, leading o pain, s i ness,
and unc ional limi a ions [1]. The global p e alence o KOA
has inc eased signi ican ly, pa icula ly among women a e
menopause [2]. Epidemiological s udies e eal ha women o e
50 yea s ha e nea ly wice he isk o de eloping symp oma ic
KOA compa ed o men [3].
The menopausal ansi ion is accompanied by a apid decline in
es ogen and p oges e one le els, bo h o which in luence
musculoskele al homeos asis. Es ogen has p o ec i e oles in
ca ilage me abolism, bone u no e , and neu omodula ion o
pain [4]. The e o e, menopause- ela ed es ogen de iciency may
accele a e join degene a ion and modula e pain pe cep ion,
explaining he gende dispa i y in KOA [5].
Beyond ho monal ac o s, menopause is associa ed wi h
inc eased body weigh , al e ed a dis ibu ion, and changes in
in lamma o y cy okines, all con ibu ing o knee join s ess [6,7].
Cen al sensi isa ion and psychosocial ac o s, including sleep
dis u bance and mood changes, u he exace ba e pain
expe ience [8].
Gi en he mul i ac o ial na u e o KOA in pos menopausal
women, unde s anding he in e sec ion be ween menopause and
knee pain is c ucial o physio he apis s and ehabili a ion
specialis s o design holis ic managemen s a egies ha
in eg a e physical, ho monal, and psychosocial aspec s.
Epidemiology: menopause and knee pain
La ge popula ion analyses and na ional coho s udies indica e
ha he p e alence and impac o KOA inc ease ma kedly a e
menopause. Global es ima es show ising OA bu den in women
a e midli e and iden i y pos -menopausal women as a high-
isk g oup o symp oma ic OA [1]. C oss-sec ional
in es iga ions ha e ound associa ions be ween cu en MHT
use and knee OA p e alence, al hough hese indings a y by
s udy and con ounde s [2]. Rep oduc i e his o y s udies indica e
ha he iming o menopause, pa i y and o he ep oduc i e
ac o s may modula e la e KOA isk and unc ional ou comes,
hough indings emain inconsis en ac oss popula ions [9].
Toge he , epidemiologic da a es ablish menopause as a
empo al in lexion poin o knee pain and he onse o
p og ession o symp oma ic KOA in many women [1–3].
Biological mechanisms linking menopause o knee pain
Es ogen e ec s on join issues and in lamma ion
Es ogens in luence join homeos asis h ough ecep o s
exp essed on chond ocy es, syno iocy es and subchond al bone
cells. Expe imen al and ansla ional esea ch demons a es ha
es ogen de iciency p omo es ca ilage ma ix b eakdown,
impai s anabolic chond ocy e ac i i y, and modula es
subchond al bone emodelling and syno ial in lamma ion —
p ocesses ha accele a e OA pa hology and can inc ease
nocicep i e inpu om he knee join [3,4]. T ansc ip omic and
molecula ageing s udies highligh es ogen-sensi i e pa hways
(e.g., ma ix me allop o einases, p o-in lamma o y cy okines,
and senescence-associa ed sec e o y pheno ype ac o s) ha a e
up egula ed wi h ageing and menopause, p omo ing issue
deg ada ion and local in lamma ion [3].
Sys emic me abolic and in lamma o y changes
Menopause is associa ed wi h changes in body composi ion
(inc eased cen al adiposi y), insulin esis ance and low-g ade
sys emic in lamma ion — all ecognised con ibu o s o OA
pa hogenesis and pain [8]. Me abolomic and bioma ke esea ch
sugges s dis inc sex-speci ic me abolic signa u es in KOA ha
may be ampli ied du ing he menopausal ansi ion, linking
sys emic me abolic de angemen wi h join symp oms and
p og ession [9].
Neu oendoc ine modula ion o pain sensi i i y
Sex ho mones modula e cen al pain p ocessing and descending
pain modula o y sys ems. Declining es ogen le els can al e
neu o ansmi e sys ems, neu oin lamma ion, and pain- ela ed
b ain ci cui y, po en ially lowe ing pain h esholds and
inc easing pain ca as ophizing and a ec i e componen s o
pain [7]. These cen al changes may explain why some women
epo disp opo iona e pain ela i e o join imaging se e i y
ollowing menopause [3,7].
Timing and “window” hypo heses
Clinical and ansla ional e idence sugges s ha iming o
es ogen exposu e ma e s: ini ia ing es ogen eplacemen nea
he menopausal ansi ion may ha e di e en e ec s han
s a ing he apy la e in li e ( he “ iming hypo hesis”), simila o
ca dio ascula li e a u e. A ew longi udinal s udies sugges
ea ly pos -menopausal es ogen he apy could be associa ed
wi h lowe OA incidence o slowe p og ession in some
subg oups, bu esul s a e inconsis en and dependen on
he apy composi ion and du a ion [5,6].
Menopausal ho mone he apy (MHT) — e ec s on knee
symp oms and OA isk
The ole o MHT in KOA is complex and con es ed. Ea lie
andomised and obse a ional wo k epo ed mixed indings:
la ge ials such as analyses om he Women’s Heal h Ini ia i e
did no show obus educ ions in knee a h oplas y o
consis en symp om bene i s ac oss all o mula ions, while
some coho s udies epo ed modes symp oma ic o s uc u al
ad an ages when es ogen (wi hou p oges in) was used and
when he apy was s a ed ea lie [6]. Mo e ecen pooled
analyses and me a-analyses h ough 2024–2025 accen ua e he
he e ogenei y: some me a-analy ic syn heses epo an ele a ed
isk o documen ed OA diagnosis among use s o MHT
(possibly e lec ing su eillance bias o con ounding by
indica ion), while o he analyses and subg oup da a indica e
po en ial symp oma ic bene i o join pain in ce ain imelines
o o mula ions [5,6]. O e all, cu en e idence does no suppo
ou ine use o MHT solely o p e en o ea KOA pain;
decisions abou MHT mus weigh sys emic isks and bene i s
and conside indi idual pa ien p io i ies, iming, and
ca dio ascula /b eas cance isk p o ile [5–7].
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Clinical implica ions o physio he apis s and ea ing
clinicians
Assessmen and his o y aking
Clinicians should ou inely ask abou menopausal s a us, age a
menopause, and any cu en o pas use o MHT when assessing
women wi h KOA. Tempo al links be ween he onse o
wo sening o knee pain and menopausal ansi ion can help
a ge managemen s a egies and iden i y pa ien s who may
bene i om a en ion o sleep, mood, o me abolic isk ac o s.
Rep oduc i e his o y (pa i y, age a mena che/menopause) can
be collec ed as pa o comp ehensi e isk p o iling [2,9].
Non-pha macologic managemen conside a ions
Gi en he mul i ac o ial in luence o menopause on pain,
mul imodal conse a i e ca e emains essen ial. Exe cise
(ae obic, s eng hening, neu omuscula aining), weigh
managemen , cogni i e-beha iou al me hods and sleep
op imisa ion a e i s -line. Physio he apis s should app ecia e
ha menopausal women may ha e heigh ened pain sensi i i y
and sleep dis u bance; in eg a ing pain neu oscience educa ion,
g aded ac i i y, and s a egies o manage sleep and mood can
imp o e engagemen and ou comes [1,7].
Ho mone he apy and sha ed decision-making
MHT is no p ima ily a musculoskele al he apy, bu
discussions abou MHT may a ise. Clinicians should be amilia
wi h he e idence nuances: MHT may o e symp om elie o
sys emic menopausal symp oms and, in some analyses, modes
join symp om bene i in pa icula con ex s, bu i ca ies non-
i ial sys emic isks and inconsis en OA bene i s. Sha ed
decision-making wi h p ima y ca e o gynaecology colleagues
is ecommended when pa ien s eques MHT o join pain [5,6].
2. METHODS
A ocused na a i e e iew was conduc ed using PubMed,
Scopus, and Google Schola da abases o s udies published
be ween Janua y 2018 and Oc obe 2025. The sea ch e ms
included: “menopause,” “pos menopausal women,” “knee
pain,” “os eoa h i is,” “es ogen de iciency,” “ho mone
eplacemen he apy,” and “physio he apy.” Boolean ope a o s
(“AND,” “OR”) we e used o e ine sea ches. S udies we e
included i hey examined associa ions be ween menopause o
ho monal ac o s and KOA.
3. RESULT
A o al o 135 a icles we e iden i ied; a e sc eening i les,
abs ac s, and ull ex s, 41 s udies me he inclusion c i e ia.
E idence was syn hesised na a i ely acco ding o ho monal,
biomechanical, and psychosocial dimensions.
Resea ch gaps and p io i ies (2018–2025)
1. P ospec i e coho s udies ha cap u e ep oduc i e
ageing, se ial ho mone le els, and de ailed knee pain and
s uc u e ou comes a e needed o cla i y empo ali y and
causal pa hways.
2. Randomised ials es ing he e ec o iming, dose and
o mula ion o es ogen (and es ogen-only s combined
he apy) on knee pain, unc ion, and s uc u al p og ession
in ea ly pos -menopausal women would add ess c i ical
he apeu ic ques ions. Exis ing ials a e unde powe ed o
ha e di e gen popula ions.
3. Mechanis ic s udies linking endoc ine changes wi h
syno ial bioma ke s, ca ilage deg ada ion ma ke s,
neu oimaging o pain p ocessing, and pain sensi i i y
es ing would help b idge he bench- o-bedside gap [3,4].
4. Subg oup analyses o iden i y which women de i e he
mos bene i (e.g., hose wi h high in lamma o y
pheno ype, poo sleep, o cen al sensi isa ion) would
suppo p ecision app oaches.
5. Implemen a ion esea ch on in eg a ed ca e bundles
(exe cise + psychosocial ca e + a ge ed sleep and
me abolic in e en ions) ailo ed o pos -menopausal
women wi h KOA may yield p agma ic managemen
s a egies.
4. DISCUSSION
Recen e idence ein o ces ha menopause is a c i ical pe iod
in luencing he onse and p og ession o knee os eoa h i is [2,3].
Es ogen de iciency has been shown o al e ca ilage
homeos asis h ough supp ession o p o eoglycan syn hesis and
up egula ion o in lamma o y media o s such as IL-1β and
TNF-α [5]. These molecula changes accele a e ca ilage
deg ada ion and pain sensi isa ion.
Ho monal mechanisms: Es ogen ecep o s (ER-α and ER-β)
a e exp essed in a icula ca ilage, syno ium, and subchond al
bone. S udies demons a e ha pos menopausal es ogen loss
leads o inc eased ca ilage ma ix b eakdown and os eophy e
o ma ion [6,7]. Ho mone eplacemen he apy (HRT) appea s o
mi iga e some o hese e ec s; a 2023 me a-analysis epo ed
ha women ecei ing HRT had lowe KOA incidence and
educed pain se e i y [8]. Howe e , e idence emains mixed due
o he e ogenei y in dosing and du a ion ac oss s udies.
Me abolic and biomechanical ac o s: Menopause is
accompanied by me abolic synd ome componen s, including
inc eased adiposi y, insulin esis ance, and dyslipidemia, which
p omo e low-g ade sys emic in lamma ion [9]. Adipokines such
as lep in and esis in ha e been associa ed wi h g ea e knee
pain and s uc u al p og ession [10]. Weigh gain du ing
menopause also ele a es mechanical loading on he knee join ,
compounding ho monal e ec s [11].
Pain modula ion and cen al sensi isa ion: Declining es ogen
impac s cen al ne ous sys em p ocessing o pain. Func ional
MRI s udies indica e al e ed ac i a ion o limbic and senso y
co ices in pos menopausal women wi h KOA [12]. Mo eo e ,
sleep dis u bance, anxie y, and dep essi e symp oms—common
in menopause—may ampli y pain pe cep ion and con ibu e o
ch onici y [13].
Physio he apy implica ions: Physio he apis s should ecognise
ha knee pain in pos menopausal women is in luenced by bo h
biomechanical and ho monal mechanisms. Exe cise emains
i s -line he apy, bu in eg a ing mind-body app oaches,
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elaxa ion echniques, and educa ion abou ho monal in luences
may enhance adhe ence and ou comes [14]. S eng hening and
ae obic p og ams ha e shown imp o ed knee unc ion, while
weigh managemen educes mechanical s ess [15].
In e disciplina y ca e wi h endoc inologis s may be bene icial
in complex cases.
Eme ging in e en ions: Resea ch sugges s combining exe cise
he apy wi h mind ulness o yoga may imp o e bo h
musculoskele al and psychological symp oms [16]. Addi ionally,
die a y phy oes ogens and i amin D op imisa ion a e being
explo ed as adjunc i e s a egies [17]. Fu u e RCTs should
e alua e mul imodal app oaches combining physio he apy,
HRT, and li es yle modi ica ion o op imal ou comes in
pos menopausal KOA.
Limi a ions o he cu en e idence base
In e p e a ion o he li e a u e is limi ed by he e ogenei y in
exposu e de ini ions (e.g., how menopause is asce ained),
a iabili y in MHT o mula ions and iming, he p edominance
o c oss-sec ional designs, po en ial con ounding (e.g., body
composi ion, heal hca e-seeking beha iou ), and inconsis ency
in ou come measu es (sel - epo ed pain s objec i e s uc u al
change). Mo eo e , much o he mechanis ic e idence is
p eclinical o anecdo al and equi es alida ion in longi udinal
human s udies.
5. CONCLUSION
Menopause signi ican ly in luences he de elopmen and
expe ience o knee pain in emale pa ien s wi h knee
os eoa h i is. Es ogen de iciency a ec s ca ilage me abolism,
pain modula ion, and sys emic in lamma ion, while me abolic
and psychosocial ac o s compound symp oms. Physio he apy
in e en ions should add ess hese mul idimensional
mechanisms h ough indi idualised exe cise, educa ion, and
mind-body app oaches. In eg a ion o ho monal conside a ions
in o ehabili a ion may enhance he ea men ou comes. Fu he
longi udinal s udies and clinical ials a e essen ial o cla i y
and guide e idence-based physio he apy managemen o
pos menopausal women wi h KOA.
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Abou he co esponding au ho
Sneha Bha ia is an Assis an P o esso a Sh ee B. G. Pa el
College o Physio he apy, Anand, Guja a , India. He esea ch
in e es s include musculoskele al physio he apy, pain
neu oscience educa ion, and ehabili a ion science. She is
dedica ed o ad ancing e idence-based physio he apy p ac ices
and imp o ing pa ien ou comes h ough inno a i e clinical
and academic app oaches.
