Knee pain is one of the most common reasons women over 45 walk into orthopaedic clinics – and while many brush it off as simply “age catching up”, the explanation is far more precise. Beyond wear and tear, hormonal shifts and structural changes in the body begin to play a significant role, making midlife a turning point for joint health in women.
HT Lifestyle spoke with Dr Akhilesh Rathi – the Director of Robotics, Joint Replacement, Orthopaedics and Sports Injury at Sri Balaji Action Medical Institute, Paschim Vihar and the Founder of Rathi Orthopaedics and Spine Clinic in Dwarka, New Delhi – to gain expert insights on this matter.
He explains, “This age marks a biological transition in a woman’s body, especially after perimenopause and menopause, which directly affects joints and bone strength. After 45, hormonal balance begins to change, and the knee joint is often the first place where the body starts showing its wear and tear.”
The surgeon outlines the following medical reasons:
1. Hormonal changes (oestrogen decline)
According to Dr Rathi, after menopause, oestrogen levels drop significantly. Oestrogen is not only a reproductive hormone – it also protects cartilage and bones. When its level decreases, cartilage cushioning inside the knee becomes thinner and more fragile. The joint surfaces begin to rub against each other, leading to stiffness and pain.
Answer to win daily Rewards!
Please wait a moment.
He explains, “According to the World Health Organization, globally, osteoarthritis affects women more commonly than men, with around 60 percent of cases occurring in females and typically beginning in the late 40s to mid-50s. Oestrogen works like a natural lubricant protector for joints. Once it declines, cartilage degeneration accelerates.”
2. Early osteoarthritis
Dr Rathi points out that women above 45 often develop early osteoarthritis – a condition where the joint cartilage gradually wears out. He outlines the following symptoms:
- Pain while climbing stairs
- Crackling sound in knees
- Morning stiffness
- Difficulty sitting cross-legged
He explains, “Because the knee is a weight-bearing joint, even mild degeneration becomes painful quickly. Many women ignore early knee pain, thinking it is weakness or calcium deficiency, but in reality it is the beginning of arthritis.”
Calcium and vitamin D deficiency
Indian women are particularly prone to low vitamin D and calcium levels due to indoor lifestyle and nutritional gaps. The surgeon highlights that low calcium weakens bones, while Vitamin D deficiency reduces calcium absorption.
He explains, “This combination weakens the bone beneath the cartilage, increasing knee pain and fatigue while walking. I frequently see patients whose X-rays look older than their age simply because of chronic vitamin D deficiency.”
Weight gain after 40
Women tend to gain weight after the age of 40 as metabolism slows down. According to Dr Rathi, even a slight increase in weight – four to five kilos – can significantly increases pressure on the knee joint.
He explains, “The knee carries nearly three to four times the body weight during walking and stair climbing. As a result, cartilage damage accelerates every extra kilogram and acts like an additional load on the knee joint. Joints have a memory – they keep accumulating damage.”
Lifestyle and household strain
Indian women often sit on the floor, squat during household work, or climb stairs frequently. These activities put repeated stress on the knee joint over decades. Dr Rathi emphasises that the cumulative effect appears after 45.
How to prevent it?
The surgeon highlights that ignoring early symptoms can eventually lead to advanced arthritis and even the need for knee replacement. He outlines the following ways you can prevent it:
- Regular walking (30 minutes daily)
- Quadriceps strengthening exercises
- Weight control
- Sun exposure for Vitamin D
- Early orthopaedic consultation
Knee pain after 45 is not “normal ageing” – it is a treatable orthopaedic condition if addressed early. Dr Rathi concludes, “The biggest mistake women make is tolerating pain for years. Knee arthritis does not start suddenly at 60 – it quietly begins in the mid-40s. Early treatment can delay surgery by many years.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
