The Impacts of Estrogen on Fascia and How Myofascial Release and Massage can Help
Updated: Sep 17
If you're in your mid 30s to mid 60s and you may have noticed that your body feels different than it used to—perhaps you're stiffer when you get out of bed, you wake up one morning and your shoulder feels tight and painful, your hip hurts when you try to fall asleep, or your foot has a sharp pain when you take your first steps in the morning—you are not imagining it.
During perimenopause and menopause, the body undergoes significant hormonal changes that can affect more than reproductive health. Muscle and joint pain are increasingly recognized as common symptoms during the menopause transition. In 2024 it was officially named the Musculoskeletal Syndrome of Menopause (MSM). More than 70% of women will experience musculoskeletal symptoms and 25% will be disabled by them through the transition from perimenopause to postmenopause. This often-unrecognized collective of musculoskeletal symptoms, largely influenced by estrogen flux, includes arthralgia, loss of muscle mass, loss of bone density and progression of osteoarthritis, among others. [8]
One possible piece of this puzzle is estrogen and its relationship with connective tissue like fascia.
What is fascia?
Fascia is a continuous network of connective tissue that surrounds, supports, and separates muscles, bones, nerves, blood vessels, and organs. Rather than being a collection of isolated pieces, it forms an interconnected system throughout the body.
Healthy fascia needs to be able to adapt and allow tissues to glide and move relative to one another. Its properties are influenced by factors including movement, loading, injury, inflammation, aging, and hormones.
Importantly, fascia is not simply passive "wrapping." Fascial tissue contains fibroblasts and sensory nerve endings and participates in the remodeling of the extracellular matrix—the structural environment surrounding the cells.
Research has also identified estrogen receptors in fascial fibroblasts, suggesting that hormones can directly influence fascial tissue. [2,3]
What happens to fascia when estrogen declines?
Estrogen plays a role in connective-tissue remodeling. When estrogen levels change during perimenopause and ultimately decline after menopause, the balance of collagen and other components of the extracellular matrix can change.
Research examining human fascial tissue has found that lower estradiol levels are associated with changes in collagen composition and elastic fibers. Research has shown that lower estrogen was associated with a decrease in production of collagen which changes the tissue to become less elastic and more rigid. [2]
Estrogen also appears to influence processes involved in fibrosis and inflammation. Reviews of the scientific literature suggest that long-term estrogen deficiency may be associated with increased fibrotic changes in connective tissue. [3]
This does not mean that declining estrogen automatically causes fascia to "stick together" or that every woman will develop fascial restriction. The human body is considerably more complex than that.
But it does provide a possible biological explanation for why some women notice changes in stiffness, tissue sensitivity, mobility, and musculoskeletal comfort during the menopause transition.
Why Can Your Whole Body Feel Different?
The fascia forms an interconnected network throughout the body. Changes in one region can influence how you move and load other areas.
For example, if your hips become painful, you may unconsciously change the way you walk. That altered movement can change the demands placed on your thighs, calves, feet, low back, and even upper body.
Likewise, tension around the chest and shoulders may influence how freely the upper back and neck move.
This is one reason a whole-body approach can be valuable when working with midlife stiffness and discomfort.
Rather than focusing only on the location where you feel pain, a customized massage session can consider surrounding muscles and connective tissues that contribute to movement and comfort.
Want to hear more about my own experience with perimenopause and the changes I noticed in my body? I share my personal story and what I learned along the way in my video, How Perimenopause Changed My Body — And What I Learned.
So, Where Does Myofascial Release Fit In?
Myofascial release is a hands-on approach that uses sustained, gentle, or specific pressure and movement to work with muscles and surrounding connective tissues.
You may hear descriptions of massage "breaking up adhesions" or "releasing stuck fascia." Those phrases can be useful metaphors, but they oversimplify what is actually happening in the body.
The effects of manual therapy are more complex and may involve changes in sensory input, pain sensitivity, muscle tone, tissue movement, and nervous-system responses.
Myofascial release is one tool within a customized massage session that can provide improvement to range of motion and reduction in pain and stiffness. Stretching, muscle energy techniques and cupping are also complementary to addressing restricted fascia.
For a massage therapist, practical goals for their clients are:
Can I help you feel more comfortable? Can I help you move more freely? Can I reduce the sensation of tension and give your body an opportunity to relax?
Those are meaningful goals without promising that massage can reverse hormonal changes or cure a medical condition.
A Whole-Body Approach to Midlife Massage
When your body changes during perimenopause and menopause, the discomfort you experience may not always have a single source.
You may experience:
Shoulder pain and limited range of motion
Upper-back and neck stiffness
Low-back discomfort
Hip or gluteal pain
Thigh or calf tightness
Foot or heel discomfort
A general feeling of stiffness or reduced mobility
These symptoms don't necessarily mean that something is wrong with your fascia. And they shouldn't automatically be attributed to menopause.
But understanding the relationship between hormones, connective tissue, muscles, and the nervous system gives us another perspective on the changes many women experience during midlife.
A customized massage can take a whole-body approach, considering how different regions work together rather than treating each area as if it exists in isolation.
Supporting Your Body Through Change
Perimenopause and menopause are normal stages of life—but that doesn't mean you have to simply accept feeling uncomfortable in your body.
If you've noticed that you don't move quite as easily as you once did, that your shoulders seem to stay tense, that your hips feel tight, or that your feet are bothering you more often, there may be several factors contributing to those changes.
Massage therapy and myofascial techniques may be one supportive component of a broader approach to maintaining comfort, relaxation, body awareness, and ease of movement during midlife.
The goal is to help you feel more comfortable in your body, move with greater ease, and better understand the changes you're experiencing.
Your body isn't failing you—it's adapting
Perimenopause and menopause bring significant physiological changes, and musculoskeletal symptoms are recognized as part of that transition.
If your body feels different than it did a few years ago, that doesn't necessarily mean you're simply "getting older" or that stiffness is something you have to accept.
Understanding the role that hormones may play in connective tissue can provide another perspective—and personalized massage therapy may be one supportive option for helping you feel more comfortable and move with greater ease.
If you're experiencing persistent or significant pain, loss of function, or a new change in mobility, it's important to speak with an appropriate healthcare professional for evaluation. Massage therapy is complementary care and is not a substitute for medical diagnosis or treatment.
If you’re looking for support as your body changes through midlife, explore my massage services to learn how I can tailor a session to your individual needs.
Now is the time to prioritize your well-being and give yourself the self-care your body needs during this transition.
References
[1] Kruse, C., McKechnie, T., Dworsky-Fried, J., et al. (2026). Musculoskeletal Manifestations of Perimenopause: A Systematic Review and Meta-Analysis of 93,021 Women. JBJS Open Access, 11(1), e25.00254.PubMed reference
[2] Fede, C., Albertin, G., Petrelli, L., et al. (2016). Hormone receptor expression in human fascial tissue. European Journal of Histochemistry, 60(4), 2710.Full-text article (PMC)
[3] Fede, C., et al. (2019). Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production. PLOS ONE, 14(10), e0223195.Full-text article (PMC)
[4] Guo, Y., Lv, X., Zhou, Y., et al. (2023). Myofascial release for the treatment of pain and dysfunction in patients with chronic mechanical neck pain: Systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation, 37(4), 478–493.PubMed reference
[5] Ożóg, P., Weber-Rajek, M., & Radzimińska, A. (2023). Effects of Isolated Myofascial Release Therapy in Patients with Chronic Low Back Pain—A Systematic Review. Journal of Clinical Medicine, 12(19), 6143.PubMed reference
[6] Ajimsha, M. S., Binsu, D., & Chithra, S. (2014). Effectiveness of myofascial release in the management of plantar heel pain: A randomized controlled trial. The Foot, 24(2), 66–71.PubMed reference
[7] Laimi, K., Mäkilä, A., Bärlund, E., et al. (2018). Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: A systematic review. Clinical Rehabilitation, 32(4), 440–450.PubMed reference
[8] The musculoskeletal syndrome of menopause Vonda J Wright 1, Jonathan D Schwartzman 1, Rafael Itinoche 1, Jocelyn Wittstein 2 https://pubmed.ncbi.nlm.nih.gov/39077777/
Educational Disclaimer: This article is intended for educational and informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease or medical condition and is not a substitute for professional medical advice, diagnosis, or treatment.
