Up to 71% of perimenopausal women develop joint pain — often before hot flashes even start. It is one of the most common, most dismissed, and most misdiagnosed symptoms of the hormonal transition. A landmark February 2026 clinical review from a Johns Hopkins rheumatologist calls it "an extremely common, yet frequently overlooked condition." Estrogen has receptors throughout joint tissue — in cartilage, synovium, tendons, and ligaments. When it leaves, four systems fail simult