Chiropractic May Help Women With Perimenopause: What the Evidence Supports—and What It Doesn’t

Abstract

Perimenopause is a prolonged transitional life stage characterized by fluctuating ovarian hormones and a broad symptom profile that extends beyond vasomotor complaints. Musculoskeletal pain—including back pain, neck pain, joint stiffness, and functional decline—is highly prevalent during this transition and is increasingly recognized as a meaningful contributor to disability and reduced quality of life. Evidence-based chiropractic care, when practiced as musculoskeletal healthcare (clinical assessment, manual therapy, exercise prescription, and referral when appropriate), may serve as a non-pharmacologic option for managing certain pain presentations common in perimenopause. This article reviews current evidence on musculoskeletal symptoms in perimenopause, summarizes where chiropractic care aligns with established clinical guidelines, clarifies important limitations, and outlines safety considerations relevant to midlife women.

Understanding Perimenopause

Perimenopause refers to the menopausal transition preceding the final menstrual period and is defined retrospectively once menopause—12 consecutive months without menstruation—has occurred. This transition often begins in the early to mid-40s and may last several years. During this time, estrogen levels fluctuate unpredictably, contributing to a wide range of symptoms that can include menstrual irregularity, vasomotor symptoms, sleep disturbance, mood changes, and physical discomfort.¹

While hot flashes and night sweats are the most widely discussed features, large observational studies show that musculoskeletal symptoms are also common and frequently under-recognized.²

The Burden of Musculoskeletal Pain During the Menopausal Transition

Multiple systematic reviews demonstrate that musculoskeletal pain is prevalent during perimenopause, although reported rates vary depending on symptom definitions and study design.

A 2020 systematic review and meta-analysis estimated that approximately 71% of perimenopausal women report musculoskeletal pain, including back pain, joint pain, and generalized stiffness.³ A more recent large-scale systematic review and meta-analysis (2026) involving over 93,000 women reported pooled prevalence estimates of approximately 57% for muscle and joint pain during perimenopause, compared with around 40% in premenopausal women, with similarly elevated prevalence for back pain.⁴

In 2024, researchers proposed the term “musculoskeletal syndrome of menopause” to describe a constellation of symptoms—arthralgia, loss of muscle mass and strength, bone density changes, and osteoarthritis progression—linked in part to estrogen fluctuation. The authors estimated that more than 70% of women experience musculoskeletal symptoms across the menopausal transition, with approximately 25% reporting functional disability.⁵

Taken together, these findings suggest that musculoskeletal pain is not incidental during perimenopause but represents a common and clinically relevant aspect of the transition.

Why Might Perimenopause Affect Pain and Function?

The mechanisms underlying musculoskeletal symptoms in perimenopause are multifactorial. Estrogen receptors are present in bone, cartilage, muscle, and connective tissue, and hormonal fluctuation may influence tissue remodeling, pain sensitivity, and injury tolerance.⁵,⁶

Additional contributors include sleep disruption, increased psychosocial stress, cumulative mechanical load from work and caregiving roles, and age-related declines in muscle strength when resistance training is insufficient.⁷ These interacting factors help explain why many women report new or worsening pain despite no clear injury.

Where Chiropractic Care Fits—According to Evidence and Guidelines

Chiropractic care encompasses a range of approaches. The evidence discussed below applies specifically to chiropractic practiced as musculoskeletal healthcare, emphasizing assessment, manual therapy, exercise, and referral—not as a treatment for hormonal symptoms.

Low Back Pain

Clinical guidelines consistently support non-pharmacologic approaches as first-line care for low back pain.

The American College of Physicians (ACP) recommends non-drug therapies—including spinal manipulation—for acute and subacute low back pain, and lists spinal manipulation among several options for chronic low back pain.⁸ The UK National Institute for Health and Care Excellence (NICE) recommends considering manual therapy (spinal manipulation, mobilization, soft tissue techniques) only as part of a treatment package that includes exercise, with or without psychological approaches.⁹

A 2026 Cochrane review concluded that spinal manipulation may provide small-to-modest improvements in pain and function for chronic low back pain compared with sham, no treatment, or other conservative interventions; however, certainty of evidence was rated low to very low.¹⁰

Neck Pain

Neck pain is common during midlife and often coexists with occupational strain and sleep disturbance.

A major clinical practice guideline published in the Journal of Orthopaedic & Sports Physical Therapy recommends thoracic manipulation combined with exercise for certain neck pain presentations and supports selective use of cervical manipulation or mobilization depending on classification and stage.¹¹ Multimodal care remains the standard.

Headache Considerations

Evidence varies by headache type. For migraine, a 2024 systematic review and meta-analysis found no convincing evidence that spinal manipulation improves migraine intensity, frequency, or duration, with low or very low certainty.¹²

Some guidelines allow spinal manipulation as part of multimodal care for tension-type or cervicogenic headaches, which are closely associated with neck dysfunction, but careful diagnosis and referral are essential.

What Chiropractic Care Does Not Treat in Perimenopause

Maintaining credibility requires clear boundaries.

The American College of Obstetricians and Gynecologists (ACOG) states that there is no evidence that chiropractic spinal adjustments reduce hot flashes, night sweats, insomnia, or other core menopausal symptoms.¹³

Accordingly, chiropractic care should not be presented as a treatment for hormonal imbalance, vasomotor symptoms, or menopause itself. Its role, where appropriate, is limited to musculoskeletal pain and functional support.

Safety Considerations

Most patients receiving spinal manipulation or other manual therapies experience no adverse effects or only transient soreness. However, serious adverse events—particularly cervical artery dissection associated with neck pain and headache—are the primary safety concern discussed in the literature.

A large Medicare claims analysis found no increased risk of cervical artery dissection following cervical spinal manipulation compared with other clinical encounters in older adults.¹⁴ Interpretation remains complex, as dissections may begin spontaneously and present with symptoms that prompt care seeking.

Best practice includes careful screening, recognition of red flags, informed consent, and offering lower-force alternatives (mobilization, soft tissue techniques, exercise-based care) when appropriate.

What Evidence-Based Perimenopause Chiropractic Care Looks Like

When chiropractic care is appropriate, higher-quality practice typically includes:

• Comprehensive history, including sleep, activity, injury history, and relevant medical factors
• Physical examination with functional and neurological assessment when indicated
• Active care strategies such as progressive strengthening, mobility work, and education
• Clear referral pathways to primary care, gynecology, or other specialists when symptoms suggest anemia, thyroid disease, autoimmune conditions, abnormal bleeding, or neurologic change

Conclusion

Perimenopause is a common, prolonged, and often physically disruptive life stage. Musculoskeletal pain is prevalent and can significantly impair daily function, yet it is frequently under-addressed in clinical conversations. Evidence-based chiropractic care may offer a non-drug option for managing certain musculoskeletal complaints—particularly back and neck pain—when delivered as part of a multimodal, patient-centered plan.

Importantly, chiropractic care should not be framed as a treatment for hormonal symptoms or menopause itself. When practiced with appropriate scope, humility, and collaboration, it may represent one of several supportive options for women navigating the physical challenges of perimenopause.

References

• Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop +10 (STRAW+10). Menopause. 2012.
• Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015.
• Kwon R, et al. Prevalence of musculoskeletal pain in perimenopausal women: A systematic review and meta-analysis. Maturitas. 2020.
• [Author(s)]. Muscle, joint, and back pain prevalence across the menopausal transition: A systematic review and meta-analysis. Year 2026.
• Szoeke CEI, et al. Musculoskeletal syndrome of menopause. Climacteric. 2024.
• Imai Y, et al. Estrogen signaling and musculoskeletal tissues. Bone. 2013.
• Finley CR, et al. Sleep disturbance and pain sensitivity. Pain. 2018.
• Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain. Ann Intern Med. 2017.
• NICE. Low back pain and sciatica in over 16s: assessment and management (NG59). 2016.
• Rubinstein SM, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2026.
• Blanpied PR, et al. Neck pain: Clinical practice guidelines. J Orthop Sports Phys Ther. 2017.
• Chaibi A, et al. Spinal manipulation for migraine: Systematic review and meta-analysis. Cephalalgia. 2024.
• ACOG. The Menopause Years: What to Expect. Patient FAQ.