A large number of women first notice knee pain in the years around and after menopause. It is common enough that patients assume it is simply age. The pattern is real, and some of the reasons for it are worth understanding, because several are modifiable.
What changes around menopause
Oestrogen has receptors in cartilage, bone and the joint lining, and its decline is associated with changes in cartilage metabolism and with accelerated bone loss. Women lose bone rapidly in the first years after menopause, and the bone beneath the joint surface is part of how a joint absorbs load.
Muscle mass also declines with age and with reduced oestrogen. Weaker quadriceps transfer more load directly to the joint surface with every step. Body composition commonly shifts in the same period, and additional weight multiplies through the knee several times over with each stride.
Why women are affected differently from men
Women have a wider pelvis and a greater angle between the thigh and the shin, which influences how the kneecap tracks and how load distributes across the compartments. Patellofemoral arthritis is more common in women as a result.
Severe knee osteoarthritis is more prevalent in women than in men, and women tend to present with more advanced changes, partly because symptoms are often attributed to age and tolerated for longer.
The Indian context
Deep squatting, sitting cross legged and floor sitting are part of daily life and worship for many women, and these positions load the knee heavily. Vitamin D deficiency is widespread. Both are addressable without giving up anything essential.
What is not true
Knee pain after menopause is not an inevitability to be endured, and nothing about this stage of life makes treatment less effective. Equally, there is no supplement or oil that regenerates worn cartilage, whatever the price or the claim.
What genuinely helps
Progressive strengthening of the quadriceps and hip abductors is the single most effective non-surgical treatment, and the response in this group is good. It needs to be progressive resistance, not gentle movement alone.
Weight reduction where relevant produces a dose dependent reduction in symptoms. Correcting vitamin D deficiency and maintaining calcium intake supports bone health, which matters both for the joint and for fracture risk.
Reducing deep squatting, prolonged floor sitting and cross legged sitting lowers peak loads substantially. A chair for prayer or cooking is a small change with a measurable effect.
Bone density assessment is worth discussing, since osteoporosis and osteoarthritis frequently coexist and the fracture risk is independent of the knee pain.
A detailed guide for this group is available here: https://www.mayurajcc.com/knee-arthritis-guides/knee-arthritis-women-after-menopause
When to get assessed
Get a clinical examination and a weight-bearing X-ray if knee pain has lasted more than six weeks, if it wakes you at night, if your walking distance has fallen, or if you have started avoiding stairs. Treating it at the stage where strengthening still works is considerably better than waiting until it does not.