Your knees ache when you go up the stairs. Your hands feel stiff before your coffee even kicks in. You might wonder whether menopause is behind these symptoms or whether something else, like rheumatoid arthritis (RA), could be causing them.

RA is a type of inflammatory arthritis, a condition in which the immune system mistakenly attacks the joints, causing swelling, stiffness, and pain. Menopause marks the end of menstrual periods and is reached after 12 consecutive months without a period, when there is no other medical cause.

It’s not always easy to identify the cause of joint pain. Here’s what research says about menopause and RA symptoms, RA risk, hormone replacement therapy (HRT), and steps you can take to feel better.

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Can You Develop RA After Menopause?

Yes. Research links postmenopausal status with higher odds of developing RA. Researchers think declining estrogen levels may play a role, although the exact reasons are still being studied.

Here’s what the numbers show and what to know about new joint pain that shows up around menopause.

Early Menopause and RA Risk

A recent review that pooled data from thousands of women found that postmenopausal women had about 35 percent higher odds of developing RA than premenopausal women. The difference was even greater with early menopause. Women who went through menopause before age 45 had roughly three times the odds of developing RA compared with those who reached menopause later.

Early menopause may also affect women who already have RA. A five-year study found that participants with early menopause had higher disease activity, plus worse fatigue, sleep problems, and quality of life, than those who reached menopause later.

Researchers aren’t certain why early menopause is linked to greater risk, but one theory is that having lower estrogen levels for more years may affect how the immune system regulates inflammation. Still, early menopause is only one possible risk factor and doesn’t mean you’ll develop or have more severe RA.

Telling Menopause Joint Pain From RA Joint Pain

Menopause and autoimmune conditions such as RA, lupus, and Sjögren’s disease share several symptoms, including fatigue, joint pain, stiffness, and dryness, which makes it hard to tell one condition from another. Joint symptoms can also be caused by osteoarthritis, a wear-and-tear condition that becomes more common with age.

Blood work and other tests can help your healthcare provider determine whether an autoimmune condition or another health issue may be causing your symptoms. If your joint pain is new, persists, or comes with swelling, talk with your healthcare provider rather than assuming it’s caused by menopause.

Can You Use Hormone Therapy if You Have RA?

For many women with RA, hormone therapy may be an option, but it isn’t right for everyone. Here’s what current guidance says about using HRT with RA treatment, as well as nonhormonal alternatives.

Hormone Therapy and RA Treatment

According to the American College of Rheumatology, HRT can be considered for postmenopausal people with RA who have menopause symptoms and no health reason to avoid it. Studies haven’t linked HRT to more RA flares, and some research suggests it may ease disease activity.

Hormone therapy is generally not recommended for people with certain health conditions, such as a history of blood clots, stroke, heart attack, certain hormone-sensitive cancers, or liver disease. Hormone therapy requires special consideration for people with lupus, particularly those with antiphospholipid antibodies, which raise the risk of blood clots.

If hormone therapy is right for you, how you take it may also matter. Estrogen taken through the skin, such as with a patch, may carry a lower risk of blood clots than estrogen taken by mouth.

Whether to use hormone therapy is a decision to make with your rheumatologist and your menopause care provider. Together, you can consider your symptoms, health history, and the potential benefits and risks.

Nonhormonal Options for Menopause Symptoms

If HRT isn’t an option for you or you prefer not to use it, other treatments are available. Both cognitive behavioral therapy and clinical hypnosis have evidence showing they can help with hot flashes and night sweats, also called vasomotor symptoms.

Fezolinetant is a nonhormonal medication approved to treat moderate to severe hot flashes caused by menopause. It targets a brain pathway involved in temperature regulation, and studies show that it can reduce hot flash frequency. Talk with your provider about which nonhormonal approach may be best for your symptoms and health history.

Managing Menopause and RA Together

Menopause may influence RA in several ways. Shifting hormone levels may affect inflammation and RA disease activity, while menopause and RA share some of the same symptoms. Treatment options may include hormone therapy, nonhormonal treatments, and everyday habits that support joint and overall health.

A good place to start today is by keeping a simple log of your symptoms. Note when symptoms like joint pain, hot flashes, or fatigue occur so you and your healthcare providers can spot patterns.

Talk with your rheumatologist and your menopause care provider about what you’re experiencing. Working together can help them create a treatment plan that considers both RA and menopause.