Joint and bone health
Joint and bone health in perimenopause: what helps
Falling oestrogen in perimenopause speeds up bone loss and changes how joints and connective tissue feel. This guide covers the nutrients with the strongest foundation for bone and cartilage, what the research says about collagen and glucosamine, and what helps beyond supplements.
Our content is developed with input from a registered dietitian specialising in women’s health
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Why bone and joints change in perimenopause
Oestrogen does more than regulate your cycle. It helps protect bone, and it influences the connective tissue in and around your joints. As oestrogen falls through perimenopause and into menopause, bone is broken down faster than it is rebuilt, and bone density can decline more quickly than at any other time in adult life.
Many women also notice more aches, stiffness, or changes in how their joints feel during this time. The picture there is more complex and individual, but supporting the tissues involved, and the muscle around them, is a sensible foundation.
Nutrition is one part of this, alongside weight-bearing and resistance exercise, which we cover further down. Below we start with the nutrients that have the strongest, most established foundation for bone, then look at cartilage and connective tissue, and finally at two supplements people often ask about, collagen and glucosamine.
The nutrients that support normal bone
Bone is living tissue that needs a steady supply of several nutrients. For perimenopausal women the most important pairing is calcium and vitamin D, which work together, with magnesium, vitamin K and protein playing supporting roles.
Calcium and vitamin D
Calcium is needed for the maintenance of normal bones, and vitamin D contributes to the maintenance of normal bones and to normal muscle function, partly by helping your body absorb calcium, which is why the two are so often taken together. For women after the menopause this pairing matters most: calcium and vitamin D help to reduce the loss of bone mineral in post-menopausal women, an effect specifically intended for women aged 50 and over, with the benefit obtained at a daily intake of at least 1200mg of calcium and 20 micrograms of vitamin D from all sources. Food comes first here, dairy, fortified alternatives, tinned fish with bones and leafy greens, but a combined supplement is a sensible top-up. The one below pairs calcium and vitamin D with magnesium and zinc, which also contribute to the maintenance of normal bones.
Check price on Amazon →Vitamin D on its own
If your calcium intake from food is already good, you may only need vitamin D. It contributes to the maintenance of normal bones, teeth and muscle function and to a normal immune system. In the UK, supplementing through autumn and winter is widely advised. Vitamin D also helps to reduce the risk of falling associated with postural instability and muscle weakness in men and women aged 60 and over, at a daily intake of at least 20 micrograms, which matters because falls are a major cause of fractures later in life.
Check price on Amazon →Magnesium
This is the one many women quietly run low on. Magnesium contributes to the maintenance of normal bones and to normal muscle function, and a large share of the body’s store sits in the skeleton itself, so it is a reasonable everyday addition. A well-absorbed, gentle form such as magnesium glycinate (bisglycinate) is the easiest to get on with.
Check price on Amazon →Vitamin K
Often bought alongside vitamin D rather than on its own, and for good reason. Vitamin K contributes to the maintenance of normal bones, and turns up in leafy greens and some fermented foods, with supplements frequently pairing vitamin K2 with vitamin D. If you take blood-thinning medication, speak to your GP before supplementing vitamin K.
Check price on Amazon →Protein
Easy to overlook when bones are the topic, but it works on two fronts. Protein contributes to the maintenance of normal bones and to the maintenance of muscle mass, and it is the muscle around a joint that helps support and protect it. Food should come first, but a protein powder is a convenient way to top up if you find it hard to reach enough across the day, for example with a smaller appetite or a plant-based diet. Here are two clean options we rate, one dairy and one vegan.
Naked Whey, for dairy
A single-ingredient, grass-fed whey with no sweeteners, flavourings or fillers, which is about as pared-back as protein powder gets. If you tolerate dairy, it is a simple, high-protein way to top up when you fall short from food, and that short ingredient list is exactly what makes it a clean choice.
Naked Whey on Amazon →Form Pureblend, for vegan
An unflavoured, unsweetened plant protein that blends organic pea and brown rice with other plant sources. The blend is the point: combining sources gives a complete amino acid profile, which a single plant protein does not always manage on its own. No fillers, thickeners or artificial sweeteners, so a clean pick if you are dairy-free.
Form on Amazon →Zinc
A trace mineral you need only a little of, but it still counts. Zinc contributes to the maintenance of normal bones, and is usually well covered by a varied diet or a standard multivitamin, though it is available on its own if you want to top up.
Check price on Amazon →Prefer one supplement?
A bone and muscle complex
If you would rather not keep several separate bottles on the go, a Food-Grown bone and muscle complex from Wild Nutrition brings calcium, magnesium, zinc and vitamins C, D and K together in one capsule blend. Calcium, magnesium, zinc and vitamins C, D and K all contribute to the maintenance of normal bones, calcium, magnesium and vitamin D contribute to normal muscle function, and vitamin C contributes to normal collagen formation for the normal function of cartilage. Like any supplement, it works best as a top-up to a varied diet rather than a replacement for one.
Check price on Amazon →Cartilage and connective tissue
Joints rely on cartilage and the connective tissue around them. A handful of nutrients have an established role in how the body forms and maintains these tissues.
Vitamin C
Vitamin C contributes to normal collagen formation for the normal function of cartilage and bones. In other words, your body needs vitamin C to make collagen, the main structural protein in cartilage, which is why it is a genuinely useful nutrient to get right when joints are on your mind. It also contributes to the protection of cells from oxidative stress. Easy to get from fruit and vegetables, and inexpensive to supplement.
Check price on Amazon →Manganese
Manganese is a trace mineral, needed only in tiny amounts, that contributes to the normal formation of connective tissue. Your body uses it as a cofactor, a helper that lets certain enzymes work, and some of those enzymes are involved in building the cartilage and connective tissue framework that cushions and supports your joints. It turns up in wholegrains, nuts, leafy green vegetables, legumes and tea, and because the body needs so little, most people meet their requirement through food alone. A standalone manganese supplement is rarely necessary.
Copper
Copper is another trace mineral, this time one that contributes to the maintenance of normal connective tissues. It has a role in the enzymes that cross-link collagen and elastin, the two proteins that give connective tissue both its strength and its stretch, which is part of why it matters for the tissues in and around a joint. Shellfish, nuts and seeds, wholegrains and even dark chocolate are good sources. Needs are small and usually met through diet, and it is worth knowing that very high doses of zinc can interfere with copper absorption, so it is something to keep in mind if you take a high-strength zinc supplement on its own.
Collagen and glucosamine: what the research shows
These are the two supplements women ask us about most for joints, so here is an honest look at where the evidence actually stands.
Collagen peptides
Several randomised controlled trials in people with knee osteoarthritis, or with activity-related knee pain, have reported reductions in joint pain and improvements in function with collagen peptides, typically at 5 to 10g a day, or around 3g a day of low-molecular-weight peptides, taken over three to six months. A meta-analysis of four knee osteoarthritis trials found a significant reduction in pain compared with placebo.
The honest caveat is that the same meta-analysis judged those trials to carry a high risk of bias, many studies are funded by supplement manufacturers, and some use combination products that make it hard to isolate collagen’s effect. So the picture is genuinely promising, especially given collagen’s good safety profile, but it is not yet settled.
Glucosamine
Glucosamine has been studied extensively for osteoarthritis over several decades, often alongside chondroitin. Despite that, the higher-quality independent evidence is largely unsupportive. Large, well-designed trials have generally found little or no benefit over placebo for joint pain or function.
Some trials of glucosamine sulfate, several funded by manufacturers, have reported modest improvements, which is why you will still see it widely sold. But weighing the evidence as a whole, it is one of the weaker options for joints.
Beyond supplements
For bone and joints in midlife, what you do with your body matters at least as much as what you take.
Walking, jogging, dancing and similar weight-bearing activity signals bone to stay strong. Aim to make it a regular part of your week.
Resistance training a couple of times a week builds the muscle that supports your joints and loads bone in a way that helps maintain density.
A varied diet with enough calcium, protein and colourful plants covers most of the nutrients above. Supplements fill genuine gaps rather than replacing this.
Stopping smoking and keeping alcohol moderate both support bone. So does maintaining a healthy body weight, which reduces load on the joints.
When to speak to your GP
See your GP if you have persistent or worsening joint pain, swelling, or stiffness, if you have had a fracture from a minor fall, or if you have risk factors for osteoporosis such as a family history or early menopause, as a bone density scan may be appropriate. Always check with your GP or pharmacist before starting a supplement if you take regular medication, have kidney problems, or are on blood thinners.
Frequently asked questions
What is the single most important thing for bone in perimenopause?
Getting enough calcium and vitamin D, alongside regular weight-bearing and resistance exercise. These are the foundations, and supplements fill the gaps food and sunlight leave.
Should I take a vitamin D supplement?
In the UK, supplementing vitamin D through autumn and winter is widely advised, as it is hard to make enough from sunlight in those months. Vitamin D contributes to the maintenance of normal bones and muscle function.
Is collagen worth trying for joints?
The research is promising, with several trials reporting less joint pain, though the studies have limitations and many are industry-funded. It has a good safety record, so some women choose to try it. Vitamin C is worth getting right too, since your body needs it to make collagen.
What about glucosamine?
It is heavily marketed, but the better independent evidence is largely unsupportive, with large trials finding little or no benefit over placebo. We would not point you there as a first choice.
Can I take these with HRT?
There are no known interactions between these everyday nutrients and standard HRT. As always, if you take any regular medication, check with your GP or pharmacist before starting something new.
References (highest level of evidence first)
Systematic reviews and meta-analyses
- Lin CR, Tsai SHL, Huang KY, Tsai PA, Chou H, Chang SH. Analgesic efficacy of collagen peptide in knee osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2023 Sep 16;18(1):694. doi: 10.1186/s13018-023-04182-w. PMID: 37717022; PMCID: PMC10505327.
Randomised controlled trials
- Park S-Y, Lee S-H, Kim HT, Park H-J, Kim D-U, Kim SU, Heo I. Efficacy and safety of low-molecular-weight collagen peptides in knee osteoarthritis: a randomized, double-blind, placebo-controlled trial. Front Nutr. 2025;12:1644899. doi: 10.3389/fnut.2025.1644899.
- Zdzieblik D, Brame J, Oesser S, Gollhofer A, König D. The Influence of Specific Bioactive Collagen Peptides on Knee Joint Discomfort in Young Physically Active Adults: A Randomized Controlled Trial. Nutrients. 2021 Feb 5;13(2):523. doi: 10.3390/nu13020523. PMID: 33562729; PMCID: PMC7915677.
- Clegg DO, Reda DJ, Harris CL, Klein MA, O’Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808. doi: 10.1056/NEJMoa052771. PMID: 16495392.
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