Women’s Joint Pain: What to Ask Before Accepting “Just Aging”
By Deborah Westergaard, M.D. | Regen Experts | Dallas and Plano
You still want to take the trip, play the match, and walk comfortably the next morning. But a knee, hip, or shoulder has begun making decisions for you.
When that happens in midlife, “You’re getting older” is an incomplete answer. The next question should be: What is causing the pain, and which treatment options fit the problem?
That question is central to my contribution to D Magazine’s September 2026 women’s health
feature, now available online.
Disclosure: I participated in D Magazine’s sponsored feature, “Doctor’s Orders, Women’s Health.” It is advertising content, rather than an independent editorial endorsement.
Women’s Joint Pain Deserves More Than an Age-Based Explanation
Women’s joint pain can have several contributors, including osteoarthritis, tendon problems, injury, inflammatory conditions, and changes associated with the menopause transition. Identifying the cause matters because those problems do not all call for the same treatment.
My message in the feature is that women deserve an opportunity to understand their options through a comprehensive evaluation.
In my practice, that conversation begins with what has changed. Does the knee swell after activity? Does the shoulder hurt when you reach overhead? Has walking become limited by pain, weakness, or a feeling that the joint will give way?
Those details help connect an imaging finding to the person experiencing it.
Can Declining Estrogen Contribute to Joint Pain?
Declining estrogen may contribute to musculoskeletal symptoms during perimenopause and menopause. Hormonal changes can affect tissues involved in movement, but they do not establish the diagnosis in an individual woman.
A 2024 clinical review describing the musculoskeletal syndrome of menopause discusses joint pain and other musculoskeletal changes associated with this transition. It offers a useful framework for recognizing symptoms that may otherwise receive little attention.
It does not mean every painful joint is caused by menopause. It also does not establish that hormone treatment, PRP, or bone marrow concentrate will resolve those symptoms.
If one knee repeatedly swells or one shoulder loses motion, I want to understand that particular problem. Menopause may be relevant background, while a local structural condition still requires its own evaluation.
What Does a Joint-Preservation Evaluation Look At?
A joint-preservation evaluation considers the diagnosis, remaining function, structural changes, previous treatment, and the activities the patient wants to maintain.
For a painful knee, my assessment may include the cartilage and underlying bone, menisci, ligaments, surrounding tendons, muscle support, alignment, and stability. Which structures deserve attention depends on the history and examination.
An abnormality on an MRI is a finding to interpret. It does not automatically identify the source of pain or establish that an injection is appropriate.
I explain what I believe is contributing to the symptoms, what remains uncertain, and how that affects the treatment choices. Sometimes additional imaging or another specialist’s assessment is the most useful next step.
Where Do PRP and Bone Marrow Concentrate Fit?
Platelet-rich plasma, or PRP, is prepared from a patient’s blood. Bone marrow concentrate, also called BMC or BMAC, is prepared from a sample of the patient’s bone marrow. They are different orthobiologic preparations, and their use should follow a specific diagnosis.
For knee osteoarthritis, the American Academy of Orthopaedic Surgeons guideline states that PRP may improve pain and function, while assigning the recommendation limited strength because the evidence is inconsistent.
With bone marrow concentrate, an additional question matters: Are we treating inside the joint, the underlying bone, or both?
What Hernigou’s Research Adds
Dr. Philippe Hernigou and colleagues have investigated treatment of the subchondral bone, the bone immediately beneath the cartilage. This is a different approach from placing BMC only into the joint space.
In a randomized study of 60 patients with osteoarthritis in both knees, each patient received bone marrow concentrate into the subchondral bone of one knee and into the joint space of the other. At an average follow-up of 15 years, 12 of 60 knees treated in the subchondral bone had undergone knee replacement, compared with 42 of 60 knees treated inside the joint: 20% versus 70%.
A separate study involving 140 patients compared knee replacement on one side with subchondral BMC treatment on the other. At an average follow-up of 15 years, 25 of the 140 BMC-treated knees, approximately 18%, had subsequently undergone replacement. Among those knees, replacement occurred an average of 10 years after treatment.
These are encouraging long-term findings in selected patients. They do not establish that every patient will achieve similar results, that BMC is superior to PRP, or that all BMC techniques are interchangeable. Neither study specifically tested treatment for menopause-related joint pain.
For me, this research reinforces an important clinical question: What role is the bone beneath the cartilage playing in this patient’s arthritis? It supports evaluating the osteochondral unit, meaning the cartilage and underlying bone together, rather than considering cartilage loss alone.
Matching the Treatment to the Problem
A systematic review of randomized trials of BMAC for knee osteoarthritis also examines outcomes against other injections. That evidence should be interpreted alongside the preparation, delivery location, and patient population studied. Research on an injection into the joint space does not fully answer questions about treatment directed into subchondral bone.
Results depend on the diagnosis, patient selection, preparation, and treatment approach. Findings from knee studies should not automatically be applied to the hip, shoulder, or spine.
Neither PRP nor BMC guarantees cartilage regrowth or avoidance of joint replacement. Procedures carry risks, including pain, bleeding, and infection; bone marrow collection and injection into bone add procedural considerations.
At Regen Experts, I discuss these options when the examination and imaging support considering them. Rehabilitation, strengthening, activity adjustments, medication when appropriate, and surgical consultation remain part of the broader conversation.
The goal is to understand which tissues are contributing to the problem and choose a treatment plan that fits the patient.
What Should You Ask Before Deciding on Treatment?
The most useful questions are specific:
What is the working diagnosis? Ask which findings explain your symptoms and which may be incidental.
What reasonable options remain? Discuss rehabilitation, medical treatment, appropriate procedures, and surgery.
What evidence applies to someone with my condition? A study involving a different joint or degree of arthritis may not answer your question.
What would count as success? Walking farther, sleeping more comfortably, and returning to an activity are concrete goals.
What would make you recommend surgery instead? An honest evaluation should address when further nonsurgical treatment is unlikely to be worthwhile.
Joint replacement can be the appropriate choice. An evaluation should help clarify that decision rather than create an expectation that surgery can always be postponed.
Frequently Asked Questions About Women’s Joint Pain
Is joint pain after menopause always caused by low estrogen?
No. Hormonal changes may contribute, but osteoarthritis, tendon disorders, injuries, inflammatory disease, and other conditions can cause similar symptoms. The pattern of pain and the examination help determine what needs investigation.
Can PRP treat menopause-related joint pain?
PRP is considered for certain diagnosed musculoskeletal conditions. It is not an established treatment for menopause itself or for generalized menopausal aches. Candidacy depends on the specific diagnosis.
Is bone marrow concentrate better than PRP?
Not in every situation. They are different preparations, and comparative research does not establish BMC as the better choice for every patient. The diagnosis, evidence, procedural burden, risks, and cost all matter.
Can nonsurgical treatment prevent joint replacement?
No individual outcome can be promised. Some patients obtain meaningful symptom relief with nonsurgical care, while others still need joint replacement. Treatment decisions should reflect function, symptoms, structural disease, and patient preferences.
Where can I request a joint-preservation evaluation in Dallas or Plano?
Regen Experts offers physician-led spine and joint evaluations in Dallas and Plano. An evaluation helps determine whether rehabilitation, an orthobiologic treatment, another intervention, or surgical consultation is appropriate.
Treatment Cost
The cost of orthobiologic treatment depends on the recommended procedure and treatment areas. Before proceeding, request an individualized estimate and clarification of insurance coverage or self-pay responsibility. A consultation does not obligate you to undergo a procedure.
Understand Your Options Before Making the Decision
If joint pain is changing how you exercise, travel, or manage everyday activities, an evaluation can help you understand the diagnosis and the choices available to you.
At Regen Experts in Dallas and Plano, my goal is to help you make that decision with a clear explanation of the findings, the evidence, and the limitations.
About the author: Deborah Westergaard, M.D. is Medical Director of Regen Experts and is double board-certified in Anesthesiology and Pain Medicine. Her practice focuses on image-guided spine and joint care in Dallas and Plano. She is a physician in the licensed Regenexx network.
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