Joanna Trilling speaks with orthopaedic surgeon and physiotherapist Dr Samuel Duff about how perimenopause and menopause affect joints, muscles and bones.

Dr Duff explains that almost every tissue in the body has oestrogen receptors, so when oestrogen levels fall the effects can be felt throughout the body. Tendons rely on oestrogen for strength. Without it they become weaker and less able to cope with everyday biomechanical stress, which is why conditions such as frozen shoulder and tennis elbow often flare around menopause.

Bone is affected too. Women can lose around 10 per cent of their bone mass in the five to ten years around menopause, raising the risk of wrist, hip, shoulder and spinal fractures from even a simple fall. At the same time muscles become smaller and weaker, reducing strength and balance and making falls more likely.

Dr Duff stresses the importance of a proper diagnosis. Rather than assuming pain is simply due to menopause, he recommends X-rays and other tests to rule out other causes.

When it comes to what helps, regular cardiovascular and weight-bearing exercise is essential for bone density, joint comfort and muscle strength. Exercise-based physiotherapy and structured programs such as GLA:D for arthritis are well supported by evidence. Simple pain relief such as paracetamol or anti-inflammatories may help. It's also worth asking your GP to check your calcium, vitamin D, thyroid and parathyroid levels.

Dr Duff's three key messages:

1. Get a diagnosis
2. Exercise regularly
3. Eat well, as choosing the right foods can also help reduce inflammation