Perimenopause, Insulin Resistance, and Persistent Muscle & Joint Pain: A Functional Medicine Framework: Nutritionist Leyla Muedin discusses perimenopausal musculoskeletal symptoms—new or persistent joint pain, muscle aches, and tendon problems—and highlights a Clinician’s Journal article by physical therapist Tara Moore proposing insulin resistance screening in perimenopausal musculoskeletal care. She explains that declining estradiol during the menopausal transition can worsen insulin signaling, increase visceral fat, and reduce insulin sensitivity, affecting skeletal muscle recovery and potentially contributing to tendinopathies and poor or short-lived responses to localized treatments like PT. The framework emphasizes assessing systemic metabolic contributors (e.g., sedentary behavior, high-carbohydrate nutrition patterns, PCOS, central weight gain, stress, sleep disruption) and addressing mediators such as inflammation and impaired glucose utilization. She suggests integrating metabolic risk assessment, sleep and stress strategies, resistance training, and interdisciplinary referrals, arguing that nutrition and supplementation—especially a low-carb approach—may improve recovery and pain outcomes.