Biological Readiness in Midlife Rehabilitation: An Under-Recognised Clinical Consideration

In midlife, some women with musculoskeletal symptoms respond well to rehabilitation, while others experience persistent pain and fluctuating symptoms. In this editorial, we draw the menopausal transition to musculoskeletal rehabilitation clinicians’ attention and introduce the concept of biological readiness: the extent to which a person’s biology may support adaptation, recovery and responsiveness to rehabilitation. Research increasingly recognises the menopausal transition as a period of interacting biological, psychological, behavioural, and social change, distinct from but overlapping with ageing.

Musculoskeletal rehabilitation that focuses solely on symptoms may not deliver the outcomes patients and clinicians hope for. Instead, we advocate for a whole-person approach, starting with early recognition and screening of menopausal symptoms; education about how these may affect pain and recovery; discussion of treatment options with primary care clinicians; and continued rehabilitation prioritising individually progressed loading. Midlife is an important opportunity to recognise menopause-related issues, target interventions and improve rehabilitation outcomes.