Oestrogen and Your Joints.
Trail Notes | Female Athlete Health
it is not just the kms
Oestrogen And
Your Joints.
If your knees and hips feel stiffer in your forties than they used to, and you have quietly blamed the years of running, there is a piece of the story you have probably never been told. Your hormones may be part of this.
Many of us reach perimenopause and start to notice new joint signals. Knees that ache longer in the morning. Hips that take an extra kilometre to loosen. Recovery in the joints that feels slower than it did a few years ago. The easy assumption is that the mileage has finally caught up with us.
The research is starting to tell a more nuanced story. Hormones may be part of what you are feeling, alongside mechanical and other factors, and that is worth knowing as you plan your training through this window.
Oestrogen appears to help protect cartilage. Early research suggests that when it declines, that protection may decline with it.
Your joints are not failing you. They may be responding to a change in your chemistry, and that is something you can plan around.
Trail Note · 01
The pattern clinicians have seen for years
It has long been observed that women develop knee osteoarthritis at higher rates than men after the age of 50, and that the rise lines up with the menopausal transition. The pattern was clear. The mechanism behind it was not.
For a long time this left us with unsatisfying advice. Joints were treated as a wear-and-tear problem, and the recommendation was often simply to do less. For an athlete who has built a life around movement, that advice never sat right, and it turns out it was incomplete.
The rise in knee and hip symptoms after 50 may be linked, in part, to the loss of a hormone.
Trail Note · 02
What the new research actually showed
In 2025, a mouse study in Nature Aging offered new evidence that the loss of oestrogen and progesterone at menopause may contribute to cartilage breakdown, not just happen at the same time.
Working in mice with chemically induced menopause, the researchers found that the hormonal drop accelerated cartilage degeneration compared to controls. When they restored those same hormones, the cartilage was protected. Human cartilage cells from post-menopausal donors also behaved better in the lab when oestrogen and progesterone were added back, showing fewer markers of ageing and more markers of cartilage-building activity.
In plain terms: oestrogen and progesterone appear to be protective for joints, and this early research suggests their decline may remove a defence your cartilage has relied on. Human trials are still needed.
What this means for you
New joint stiffness in your forties is not proof that running has damaged you.
Hormonal change may influence how joints feel, so the same joint can sometimes feel sorer.
Cartilage may be more vulnerable in this window, which is a reason to train it well, not to abandon it.
The protective evidence for moderate running still holds. This is an added layer, not a contradiction.
Trail Note · 03
Why this matters for the trail athlete
The core cohort of trail and ultra running sits right inside this hormonal transition. If you are somewhere in the 40 to 55 range, you may be navigating a shift in oestrogen and progesterone at the same time as you are asking a lot of your body on the trails.
This is why the perimenopause window deserves proactive joint care rather than quiet worry. An athlete who has trained for years without a single joint complaint may suddenly notice changes, and assume she has done something wrong. She has not. The ground has shifted underneath her, and the response is to adjust the plan, not to stop.
Her Trails coaching cue
New joint signals in perimenopause are information, not a verdict. Treat them as a prompt to strengthen and manage load, not a reason to hang up your shoes.
Trail Note · 04
What you can actually do
The hormonal shift is not fully in your hands, but the way you support your joints through it very much is. Osteoarthritis guidelines recommend exercise and sensible load management as first-line care, and strength work in particular is a sound place to start in this window.
Strength
Make hip and glute strength non-negotiable. Strong muscle shares load that the joint would otherwise carry alone.
Load
Build recovery in. Through perimenopause the joints may want a little more time between hard impact days.
Downhill
Watch big downhill blocks for knee signals. Descents are where compressive load on the joint spikes hardest.
Conversation
Talk to your GP. The hormonal context of joint health, including the evidence on hormone therapy, is worth an honest discussion.
Trail Note · 05
The reframe
Understanding the oestrogen piece does something quietly powerful. It takes the joint changes of perimenopause out of the realm of guilt and self-blame, and puts them into the realm of things you can prepare for.
You are not paying a debt for the years you have run. You are moving through a hormonal transition that asks for a smarter, stronger, more attentive approach to the joints that carry you. The aim is not to run less. It is to keep running, well, for decades.
Declining oestrogen is a reason to train your joints with intention, never a reason to stop trusting your body.
Strength. Recovery. Load awareness. Honest conversations with your GP. The next good decision.
strong joints are built, not just inherited
Written by the Her Trails coaching team
Trail Notes are evidence-informed coaching journals written for women who train, race and run on trails. Made to be absorbed in 10 minutes and remembered for a season.
Evidence: Gilmer G, et al. Menopause-induced 17 beta-estradiol and progesterone loss increases senescence markers, matrix disassembly and degeneration in mouse cartilage. Nature Aging, 2025 (PMID 39820791). Kennard A, Saunders KT. Integrative approaches to perimenopause. American Journal of Medicine, 2026 (PMID 41520809). This note is general coaching education, not individual medical advice. Discuss your joints and any hormone therapy questions with your GP.
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