How Hormones Affect Joint Hypermobility

This article focuses primarily on female hormones and hypermobility. That said, people of all sexes on the hypermobility spectrum can experience hormonal and urogenital complications throughout their lifespan.

Hormones as Messengers

Hormones are chemical messengers produced by glands that travel through the bloodstream to tissues and organs. They regulate growth, metabolism, mood, reproduction, collagen integrity, vascular tone, and nervous system function.

In individuals with hypermobility, connective tissue is already more elastic or less structurally stable. When hormones fluctuate (especially estrogen, progesterone, and relaxin) they can further influence ligament laxity, blood vessel tone, mast cell activity, and nervous system sensitivity.

For someone on the hypermobility spectrum, hormonal shifts often feel amplified.

Puberty and Hypermobility

Puberty is often the first major hormonal shift that changes joint stability.

In females, rising estrogen and relaxin can soften collagen and increase ligament laxity.

Studies show that after age 12, females experience higher rates of ligament sprains compared to males. Up to 52% report worsening hypermobility symptoms during puberty.

In contrast, testosterone increases during male puberty often improve muscle mass and dynamic stability, which may reduce symptoms.

Supportive strategies

• Begin strength and motor control training early.

• Emphasize control of joints through full available range of motion.

• Address posture and balance changes during growth spurts.

• Educate adolescents on pacing and injury prevention.

The Menstrual Cycle and Symptom Fluctuation

The menstrual cycle typically spans ~28 days and includes four phases. Hormone levels shift significantly across the cycle, which can affect joint stability, vascular tone, mast cells, and nervous system regulation.

Menstruation (Days 1–5)

• Estrogen and progesterone lowest

• Blood volume lower (POTS/dysautonomia may flare)

Common experiences:

• Increased heart rate

• Lightheadedness

• Fatigue

Helpful considerations

• Increase hydration and electrolytes.

• Reduce intensity of workouts if needed.

• Use compression garments if orthostatic symptoms flare.

Follicular Phase (Days 6–14)

• Estrogen rising

• Histamine activity may increase

Common experiences:

• Headaches

• Insomnia

• Increased allergies or skin reactivity

Helpful considerations

• Support blood sugar stability.

• Moderate high-histamine foods if sensitive.

• Keep exercise consistent but controlled.

Ovulation (~Day 14)

• Peak estrogen

• Mast cell activation may flare

Common experiences:

• Headaches

• Flushing

• Anxiety

• Increased joint laxity in some

Helpful considerations

• Prioritize joint stability work.

• Stay hydrated

• Avoid pushing end ranges aggressively.

• Emphasize controlled strength rather than mobility work.

Luteal Phase (Days 15–28)

• Progesterone highest

• Mast cell activity may calm, but joint laxity may increase

Common experiences:

• Joint instability

• Increased injury risk

• PMS/PMDD symptoms

• GI changes

• Sleep disruption

• Migraines

Helpful considerations

• Reduce high-impact activities if joints feel unstable.

• Increase feedback during exercise (bands, walls, mirrors).

• Support sleep hygiene and stress regulation.

Tracking your cycle alongside symptoms often reveals predictable patterns, which can allow you to prepare and adjust.

Pregnancy and Postpartum

Pregnancy increases joint laxity, even in the general population. In hypermobile individuals, these changes can be more pronounced.

Studies report:

• 60–79% increased joint laxity during pregnancy in EDS populations

• Over 70% report pelvic pain or instability in EDS population

• Pelvic girdle pain increases from ~7% (general population) to ~26% in hEDS/HSD

• Symptoms may begin earlier and last longer postpartum

• Women in second pregnancies often demonstrate even greater laxity.

Common Challenges

Vascular changes

• Vein swelling

• Edema

• Increased orthostatic symptoms

What may help:

• Compression wear

• Gentle daily movement

• Avoid prolonged static standing

GI changes

• Constipation

• Hemorrhoids

• Heartburn/GERD

What may help:

• Small, frequent meals

• Blood sugar regulation

• Upright posture after eating

• OB or midwife-guided supplementation

Headaches, migraine, and neck pain

• Increased sensitivity to hormone fluctuations

• Decreased neck and jaw motor control

What may help:

• Physical therapy for cervical stability

• Neck, jaw, and scapular stabilization work

• Nervous system work

Congestion and breathing difficulty

• Hormonal swelling

• Narrow/high palate tendencies in hypermobility

• Increased reflux affecting airway

• Possible vocal cord dysfunction

What may help:

• Nasal saline or rinses

• Nasal dilators

• Speech/respiratory therapy can help strengthen breathing patterns and vocal cord function

Sleep disruption

• Increased joint laxity

• Difficulty finding stable positions

• Hormonal insomnia

What may help:

• Multiple pillows for support

• Consistent bedtime routine

• Nervous system down-regulation before sleep

Musculoskeletal strain

For many hypermobile women, pregnancy is the first major pain event.

Drivers:

• Increased load

• Greater ligament laxity

• Reduced proprioception

• Pelvic floor weakness

What may help:

• If possible, check in with a physical therapist starting in first trimester to identify and address issues early on. Periodic check-ins can keep you feeling well.

• Using soft braces like Sacroiliac belts may decrease strain and help with pain management.

• Regular prenatal strength training and motor control work like pilates can help you optimize core stability and joint stability.

• Warm baths, manual therapy, and massage can help decrease muscle tension and pain.

Proprioceptive changes

Hypermobility already reduces joint position and body awareness. Pregnancy hormonal shift and rapid changes in center of mass can worsen spatial awareness.

What may help:

• Add balance training

• Joint mobility training can improve body mapping

• Slow down transitions

• Reduce multitasking during mobility tasks

Mental health considerations

Anxiety and depression are more prevalent in hypermobility populations. Hormonal shifts may amplify symptoms.

What may help:

• Structured routine

• Outdoor time

• Community support

• Professional mental health support when needed

Labor and postpartum

People with hEDS/HSD are more prone to:

• Pelvic girdle instability

• Prolapse

• Tearing

• Positioning challenges

• Breastfeeding strain due to joint pain

What may help:

• Prenatal Physical therapy for pushing mechanics and positioning

• Early postpartum pelvic floor rehab

• Ergonomic feeding positions

• Progressive return-to-strength programming

Perimenopause and Menopause

Perimenopause is often unpredictable. Estrogen fluctuations may heighten pain sensitivity and connective tissue fragility.

In studies of people with hEDS/HSD that included post-menopausal women:

• 60.9% reported worsening symptoms

• 22% in another study reported improvement

Unfortunately, research is limited in this population. Clinically, we see hypermobile women report an increase in joint pain, migraines, and instability during perimenopause.

Hormone replacement therapy (HRT) is often used in this population and can lead to varied individual response. Some people report improved joint pain and energy from HRT, but some people experience increased joint laxity. It often requires working closely with your medical provider to find what works best for you.

Supportive strategies

• Maintain consistent resistance training.

• Emphasize nervous system regulation.

• Prioritize a whole-food high protein, low sugar diet.

• Continue balance and bone-loading exercises for density and stability.

Navigating Hormonal Transitions with Hypermobility

Across puberty, menstrual cycles, pregnancy, postpartum, and menopause, one theme remains consistent:

Hormonal shifts can amplify instability and symptoms. But understanding what your body needs and having tools to support yourself can give you back a sense of predictability and control over your symptoms.

Protective habits include:

1. Track symptoms alongside hormonal changes.

2. Prioritize sleep and rest when you can. Healing, symptom management, and regulation are optimal when you get consistently good sleep. Aim to go to bed earlier and turn off all blue lights 2 hours before bed.

3. Optimize eating. High protein, low sugar whole foods are best.

4. Breathwork and other regulation strategies

5. Mindfulness and presence practices

6. Focus on core strength, joint stability, and optimal movement patterns.

7. Give your body more tactile feedback during exercise. Use resistance bands, balls, walls, and your own hand(s) for better feedback to feel grounded in your body and build an better internal map. Mirrors are also very helpful for visual feedback.

8. Weightlifting and weightbearing through your body is important to continue throughout your lifespan. It improves bone density and exercise in general is neuroplasticity to create safety and connection between your body and brain. If you have any bone density issues, you may need to work with a physical therapist to safely increase weightbearing.

9. Balance work. Hormone fluctuations may change your balance and perception of where you are in space. Performing targeting balance work and vestibular system work can help keep you safe and moving well.

10. Work with a professional to help you understand your body and learn what it needs to feel and move better.

Please keep in mind that the information presented are for education only. If you are interested in working with House of Balance, please book a free consultation.

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References:

1. Castori M, Morlino S, Pascolini G, et al. Gynecologic and obstetric implications of the joint hypermobility syndrome (Ehlers–Danlos syndrome hypermobility type). Am J Med Genet A. 2012;158A(9):2176-2182. doi:10.1002/ajmg.a.35472

   
   

2. Volkov N, Nisenblat V, Ohel G, et al. Joint laxity and pregnancy: a review of the literature. Int J Gynaecol Obstet. 2007;97(2):115-118. doi:10.1016/j.ijgo.2007.01.020

   
   

3. Karthikeyan A, Venkat-Raman N. Pelvic girdle pain in women with hypermobility disorders during pregnancy. J Obstet Gynaecol. 2018;38(2):222-226.

   
   

4. Bjelland EK, Stuge B, Vangen S, Stray-Pedersen B, Eberhard-Gran M. Pelvic girdle pain during pregnancy and risk factors in a Norwegian population study. Acta Obstet Gynecol Scand. 2010;89(3):364-370. doi:10.3109/00016340903473908

   
   

5. Rombaut L, Malfait F, De Paepe A, et al. Joint position sense and vibratory perception sense in patients with Ehlers–Danlos syndrome type III (hypermobility type). Clin Rheumatol. 2010;29(3):289-295. doi:10.1007/s10067-009-1320-4

   
   

6. Celletti C, Camerota F. The multifactorial and complex hypermobility syndrome (a.k.a. Ehlers–Danlos syndrome hypermobility type): evaluation and management through a rehabilitative approach. Clin Ter. 2013;164(4):e325-e335.

   
   

7. Hakim AJ, Grahame R. Joint hypermobility. Best Pract Res Clin Rheumatol. 2003;17(6):989-1004. doi:10.1016/j.berh.2003.08.001

   
   

8. Deane JA, O’Sullivan P, Briffa NK, Smith AJ. The influence of the menstrual cycle on knee joint laxity and neuromuscular control. Med Sci Sports Exerc. 2008;40(4):604-610. doi:10.1249/MSS.0b013e3181621345

   
   

9. Smith MD, Russell A, Hodges PW. Disorders of breathing and motor control in connective tissue disorders. J Appl Physiol. 2006;101(2):557-566. doi:10.1152/japplphysiol.01581.2005

   
   

10. The Ehlers-Danlos Society. Pregnancy, birth, feeding and hypermobile Ehlers–Danlos syndrome / hypermobility spectrum disorders. Published guidance document. Accessed 2026. https://www.ehlers-danlos.org/information/pregnancy-birth-feeding-and-hypermobile-ehlers-danlos-syndrome-hypermobility-spectrum-disorders/

Dr. Stephanie House has over 15 years of experience in the health and wellness field and currently owns her own practice as a mind-body physical therapist in Charlottesville, VA.

She holds post doctoral certifications in vestibular therapy, dry needling, yoga therapy, and pregnancy and postpartum. With extensive continued study on topics such as mind-body medicine, integrative health, breathwork, and somatic therapy, Dr. House's extensive knowledge and comprehensive approach gets to the root of movement dysfunction and pain.

If you are ready to change the way you move and feel, work directly with Dr. House or join the House of Balance Newsletter.

"I don't heal or fix people. What I do is get your body and mind to an optimal place so you can start to heal yourself. We all have a greater capacity to heal than we are led to believe. With the appropriate input and support, our bodies can do amazing things." Stephanie House, PT, Founder

For specific questions or inquiries, reach out to Dr. House directly: info@houseofbalancept.com or visit her website: www.houseofbalancept.com