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How the menopause can cause Achilles tendinopathy

Updated: Jun 1

For several years now I’ve been aware that the menopause is listed as one of the things that may contribute to someone developing Achilles tendinopathy or tendonitis symptoms, but I’ve never really understood why or how. Recently I’ve also noticed that my female patients who are in the perimenopause and menopause all seem to take much longer to recover and that it’s a lot trickier to increase their exercise regimes without flaring their Achilles tendons up. This spurred me on to take a good look at the research and see why this may be and what I can do to help them.

Learn how the Menopause can contribute to you developing Achilles tendinopathy or Achilles tendonitis.

In this article:

  • What makes the Achilles tendon so strong?

  • Perimenopause, menopause and postmenopause

  • Why can the menopause cause tendon injuries and/or prolong healing?

  • Top tips for tendon health during/after the menopause

I've also explained it in this video:

What makes the Achilles tendon so strong?

Tendons are mainly made up of lots of collagen fibres that are tightly packed next to each other. In healthy tendons, these collagen fibres are organised in parallel and this is one of the reasons why tendons are so strong. A single thread is easy to snap, but if you bunch a few pieces of thread together, in parallel, they become an extremely strong rope.

Perimenopause, menopause and postmenopause

Perimenopause: This is the period during which a woman is making the transition to the menopause. It can start around 10 years before the menopause and is basically the period during which your oestrogen levels start to drop. This is when you start observing symptoms like changes to your periods, sleep, mood, weight, hot flushes, decreased sex drive, painful joints etc.

Menopause: You are classed as being in the menopause when you’ve not menstruated for a full 12 month cycle. The symptoms are very similar to those of the perimenopause but usually just more severe.

Postmenopause: This refers to the years after the menopause. Most woman’s bodies will get used to the new lower levels of oestrogen and you may find that the menopause symptoms slowly decreases.

Why can the menopause cause tendon injuries and/or prolong healing?

Your oestrogen level drops dramatically during the perimenopause/menopause and then remains low afterwards. Oestrogen plays an important role in the production of new collagen fibres and as mentioned above, your tendons are mainly made up of collagen.

Exercise of any form causes micro-trauma in our muscles, bones, ligaments and tendons. This micro-trauma is normal and acts as the signal to the brain to rebuild our bodies stronger.

But if your oestrogen levels are low, your tendons will take longer to recover from a bout of exercise than when your hormone levels were normal, because it's not as effective in producing new collagen fibres. This makes it much easier to over-train, causing the micro-trauma to accumulate and cause a tendon injury.

You can consult us online for a tailored treatment plan for your Achilles tendinopathy. Follow the link to read more.

Top tips for tendon health during/after the menopause

The good news is that the menopause does not have to cause you injuries. Your body has changed and there’s nothing you can do about that. But now that you know how it affects your tendons, you can make adjustments in your training and lifestyle to accommodate this.

1. Take more notice of your body and how well you recover after training sessions. You may need longer rest periods after hard sessions like hills, speed workouts or very long runs.

2. Strength training is extremely important. Heavy, slow resistance training simulates tendon growth, but what I haven’t mentioned in this article is that oestrogen also affects the collagen in your muscles. So you will also help reduce your risk of muscle strains by adding this to your regular routine.

3. Consider Hormone Replacement Therapy. Not a lot of research has been done on this yet, but it does seem that HRT can help improve your tendon health.

Do you need help with your Achilles injury? We provide a specialist online service for treating Achilles tendon pain. All the consultations are done via video call so that we can see you move and this allows us to create a treatment plan that’s tailored to your specific needs. Let me know if you have any questions!

Best wishes


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.


  1. Leblanc D, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. The Journal of steroid biochemistry and molecular biology 2017;172:106-16.

  2. Oliva F, Piccirilli E, Berardi AC, et al. Hormones and tendinopathies: the current evidence. British medical bulletin 2016;117(1):39-58.