The Link Between Midlife Hormone Shifts and Inflammation
Part I: Body Pain
I often hear otherwise healthy women describe new or worsening aches and pains during perimenopause and menopause. It’s frequently brushed off as, “I guess I’m just getting older,” as though pain is an unavoidable part of aging.
While aging and pain can be related, they’re not the same thing — and understanding why this happens can be empowering and help guide decisions to minimize the impact.
A helpful concept here is “inflammaging” — the intersection of inflammation and aging. Much of this shift is driven by changes in hormones:
Lower estrogen = higher inflammation
Lower progesterone = reduced immune tolerance
Estrogen is naturally anti-inflammatory. It helps regulate the immune system, supports the nervous system, and protects joints and connective tissue.
When a woman is cycling normally, her hormones are not static; they fluctuate throughout the day. During perimenopause and menopause, rather than a steady decline of hormones, the fluctuations are more pronounced – higher highs and lower lows, which can trigger the immune system, leading to increased inflammation.
Clinically, estrogen fluctuations can present as hot flashes and night sweats, migratory joint or muscle pain, tendinitis (including plantar fasciitis and frozen shoulder), headaches, digestive flares such as IBS, fatigue, and increased morning stiffness.
Sound familiar?
Progesterone plays a different but equally important role. It has calming modulatory effects on the immune and nervous systems. As progesterone levels fall, mast cells (immune cells involved in inflammation and histamine release) become more reactive.
This can lead to higher histamine levels, reduced calming neurotransmitter activity (like GABA), increased pain sensitivity, and poorer sleep — further fueling inflammation.
The result isn’t “just aging”.
It’s a predictable, biologically driven shift that explains why so many women feel achier, more inflamed, and less resilient during this phase of life.
This Is Where Metabolic Health Comes In
One of the reasons I love Dr. Mary Claire Haver’s work (and why I recommended her book The New Menopause for our current book club selection) is that she connects hormone shifts with whole-body inflammation and metabolic health — including joint pain, muscle loss, and chronic aches that women are often told to simply “accept”.
This lens helps us move out of resignation and into understanding:
Inflammation during midlife is not random —
It’s biologically influenced, modifiable, and responsive to the way we support our hormones, nervous system, and metabolism.
Pain is often the first signal women notice, but it’s rarely the only one. Inflammation during midlife can also affect mood, anxiety levels, sleep, and even headaches and migraines.
In upcoming newsletters, we’ll explore why anxiety often feels more physical during this transition, how hormone-driven inflammation affects the brain, and what can help calm an overactivated nervous system.
Your Move: WHEAT = PAIN
Talking about the inflammatory effects of wheat is probably the least popular thing I discuss with patients. Due to its hybridized and genetically modified history, modern U.S. wheat is one of the most inflammatory foods we can eat.
It has been shown to contribute to gut permeability, activate immune cells, and amplify joint pain, headaches, and fatigue — even in people without celiac disease. This doesn’t even scratch the surface of wheat’s glycemic index being among the highest of all foods, even higher than table sugar.
That’s why I often write on treatment plans: WHEAT = PAIN
If you’re feeling inflamed, achy, or flared, try this experiment:
1. Make a list of all your aches and pains, rating each on a scale of 1–10.
2. Record it on your phone or paper and set it aside — don’t refer to it during the experiment.
3. Remove all wheat for 2–3 weeks.
4. Focus on whole foods: vegetables, protein, healthy fats, and naturally gluten-free carbohydrates.
5. After 2–3 weeks, re-rate your symptoms and compare. Did anything shift?
The Whole30 is a helpful framework to use.
If bread feels non-negotiable, batch-bake sweet potatoes for meals, or choose higher-quality gluten-free options like Happy Camper or Pacha (many GF breads are starchy and high-glycemic; these tend to be better balanced with more fiber and protein).
This isn’t about restriction forever.
It’s about turning down the volume on inflammation to give your immune system a break so you can better understand what your body needs during this important transition.
Warmly,
Dr. Krista
Olive Says
I don’t know what inflammaging is, but I do know this: when my joints feel creaky, I nap more. When I’m well-fed and warm, I feel spry.
Maybe you humans should listen to your bodies as well as you listen to your podcasts.
Also, if wheat equals pain, I’ve been right all along to steal only the meat from the table.