Hello and welcome back to Making Sense of Women's Health. I’m Roberta Bass, women’s health physiotherapist, Pilates instructor, and menopause mentor. Today, we are diving into knee pain — something I see so often in women of all ages, from young athletes to postnatal mums and women going through menopause.

But why are women more prone to knee pain than men? It’s not just about wear and tear or exercise habits. Hormones, joint structure, pregnancy, and postnatal recovery all play a role.

If you’ve ever noticed your knee pain fluctuates throughout the month, found your knees feel stiffer as you’ve aged, or struggled with knee discomfort after pregnancy, this episode is for you.

We’ll break down the most common causes of knee pain in women, why we’re more at risk than men, and what you can do to manage and prevent it.

So first of all, why are women more prone to knee pain?

Women experience knee pain more frequently than men due to differences in hormones, joint alignment, and muscle function. Research has shown that hormones play a major role in knee health, particularly through their effect on ligament laxity and joint stability.

Studies assessing ACL laxity have discovered that during the late follicular phase — that’s days 10 to 14, just before ovulation — when estrogen peaks, ligament flexibility increases. While this can enhance movement, it also contributes to joint instability, increasing the risk of injuries like ACL tears.

Around ovulation, day 14, and into the luteal phase — which is days 15 to 28 — progesterone rises, which further increases ligament laxity. This makes joints more prone to excess movement and instability, which can lead to overuse injuries, pain, and inflammation. Some women also experience increased fluid retention and inflammation during this phase, further aggravating knee discomfort.

As estrogen levels drop in menopause, we see reduced collagen production — ligaments become less elastic and stiffer. We also see decreased synovial fluid — joints feel dry, achy, and inflamed. And of course, the loss of muscle mass — or sarcopenia — means weaker supporting muscles, which leads to greater stress on the knees.

This transition from high ligament laxity in reproductive years to increased stiffness post-menopause highlights why knee pain and injury risk change throughout a woman’s life.

Pregnancy and birth also have a significant impact on knee stability. Relaxin, a hormone released during pregnancy, increases ligament laxity, not just in the pelvis, but also in the knees, ankles, and other joints. This can persist for months postpartum, leading to joint instability.

If a woman is breastfeeding, low estrogen levels may contribute to symptoms similar to menopause, such as joint stiffness and increased pain sensitivity. Many postnatal women experience weakened core and glute muscles, altering pelvic and knee alignment, which increases strain on the knee joints.

This means that both postpartum and menopausal women may experience knee pain due to hormonal shifts, muscle weakness, and changes in ligament elasticity — but for different reasons.

So let’s now move on to the specific knee conditions that are most common in women and how we manage them.

First up, osteoarthritis — or OA — of the knee.

Osteoarthritis is a degenerative condition where the cartilage that cushions the knee joint gradually wears down, leading to stiffness, pain, and swelling.

Women are more prone to OA because postmenopausal estrogen decline reduces cartilage protection. Women also have greater joint laxity, which increases wear on the knee joint. And increased weight fluctuations during pregnancy and menopause can place additional stress on the knees.

Symptoms of OA include morning stiffness that improves with movement, pain with prolonged activity — especially walking or standing — and swelling and tenderness around the knee joint.

Aggravating factors can include cold, damp weather, prolonged sitting or inactivity, and high-impact activities like running or jumping.

Easing factors might include gentle movement like walking or cycling, applying heat to ease stiffness, and strengthening surrounding muscles.

Management strategies include weight management to reduce pressure on the knees, strength training — especially for the quads and glutes — to support knee stability, low-impact exercises like Pilates and swimming, and using knee supports or braces for extra stability when needed.

Next, we have anterior knee pain — also known as patellofemoral pain syndrome or runner’s knee.

This occurs when the kneecap — or patella — doesn’t track properly over the femur, leading to pain and irritation at the front of the knee.

Women are more prone to this due to a wider pelvis, which alters knee alignment, and a weaker quadriceps-to-hamstring ratio, which leads to patella instability. It’s also more common postnatally due to core and pelvic floor weakness.

Symptoms include pain at the front of the knee, especially with stairs or squatting, and discomfort after sitting for long periods — what’s known as ‘theatre knee’.

Aggravating factors include walking or running downhill, deep squatting or lunging, and weak thigh muscles.

Easing factors might include taking short walking breaks if sitting for long periods, and strengthening quads and glutes to improve patella tracking.

Management strategies include physiotherapy for strengthening and improving movement patterns, taping or bracing to support kneecap alignment, and correcting foot posture with proper footwear.

Next, ligament injuries — including ACL, MCL, and LCL tears.

These involve tears or sprains in the stabilising ligaments of the knee, most commonly the anterior cruciate ligament or ACL.

Women are more prone to these because higher estrogen levels pre-ovulation increase ligament laxity, and women tend to have delayed neuromuscular reaction times compared to men.

Symptoms might include sudden pain and swelling after an injury, a feeling of instability or "giving way", or a popping sensation at the time of injury.

Aggravating factors include sudden stopping or changing direction — common in sports injuries — and weak hip and core muscles.

Easing factors immediately after injury include RICE — rest, ice, compression, and elevation — and knee bracing if needed for support.

Management strategies include physiotherapy for rehab exercises, strengthening surrounding muscles to improve knee stability, and in severe cases, surgery may be needed.

Next, iliotibial band — or ITB — syndrome.

This occurs when a tight IT band rubs against the knee, causing pain on the outer knee.

Women are more prone due to wider hips, which put more strain on the IT band, and weaker glutes and hip stabilisers.

Symptoms include sharp or burning pain on the outer knee, and it tends to worsen with repetitive movement, like running or cycling.

Aggravating factors include running long distances and weak hip muscles.

Easing factors might include foam rolling the IT band and glutes, and strengthening hip stabilisers.

Management strategies include physio-guided rehab to balance muscle activation, adjusting running technique, and using orthotics if necessary.

Finally, meniscus tears or degeneration.

This involves a tear or gradual wear of the menisci, which cushion the knee joint.

Women are more prone due to joint hypermobility and collagen loss post-menopause.

Symptoms include sharp pain inside or outside the knee, swelling, stiffness, and a locking sensation.

Aggravating factors include twisting movements and deep squatting.

Easing factors might include avoiding twisting motions, and using compression and elevation.

Management strategies include strengthening quads and glutes for stability, and physio-led rehab to improve movement mechanics.

Knee pain doesn’t have to control your life. Whether it’s linked to hormonal changes, pregnancy, or menopause, understanding the cause is the first step toward relief. With the right approach — strengthening, alignment work, and movement — you can protect your knees and stay active.

If you found this episode helpful, share it with a friend who might be dealing with knee pain too. And make sure to subscribe so you don’t miss next week’s episode.