Frozen shoulder and menopause: is there a link?

A closer look at this painful and often frustrating condition

Frozen shoulder is a common condition that predominantly affects women aged 40 to 60
It’s poorly understood with no simple cause or cure
Advice and tips on how to manage this condition

Pain in muscles and joints are a common symptom of perimenopause and menopause. Many women experience muscle and joint stiffness too, particularly when getting out of bed in the morning.

Adhesive capsulitis (AC), known as frozen shoulder, is a common condition but one that can be self-limiting and painful. Despite the term ‘frozen shoulder’ first being described in 1934 (by Dr Codman, who was the first to describe the diagnostic criteria for it), it’s still poorly understood and there is little research into the people who tend to suffer most from it – midlife women.

Here, balance looks at what we do know about frozen shoulder, and how you can manage and treat it.

What exactly is frozen shoulder?

Frozen shoulder occurs when the tissue around your shoulder joint becomes inflamed. This tissue then gets tighter and shrinks. If you have frozen shoulder, you’ll often experience pain, which is usually worse at night, and a stiffness, which can restrict movement. It tends to first affect external rotation of your shoulder and then abduction of your shoulder (moving it out to the side) [1].

It can interfere with your daily life – you might find it difficult to reach for things, particularly overhead, such as hanging up clothes, or to the side, such as fastening your seatbelt. Some people may find it difficult to get dressed and brush their hair.

Some people also experience neck pain – this is mostly from overuse of cervical (neck) muscles to compensate the loss of shoulder motion [2].

While most people do recover from frozen shoulder, it can take some time – recovery can take 1 to 3½ years, with the average time being 2½ years [3]. For some women it can take longer though.

Who does frozen shoulder affect?

Frozen shoulder most often occurs in people between 40 and 60 years old, and women are four times more likely to experience it than men [4]. One study found that the average age was 56.4 years [5], and the condition is sometimes referred to as “the fifty-year-old shoulder”.

It affects both sides of the body equally, and rarely presents in both shoulders at the same time [6].

What causes frozen shoulder?

It’s not always clear why some people get a frozen shoulder and the risk factors aren’t fully understood. Although you can get it if you’ve had an injury or surgery that stops you from moving your arm normally, it tends to be more associated with age. It is also associated with some conditions – risk factors include diabetes, stroke and thyroid disorder.

Asian ethnicity is also a risk factor [7].

The vast majority of people who suffer from frozen shoulder are women between the ages of 40 and 60, the age that coincides with perimenopause and menopause.

The hormones oestradiol, progesterone and testosterone work to reduce inflammation, play a role in joint health and lubrication, and promote connective tissue integrity. During perimenopause and menopause, levels of these hormones fluctuate and reduce.

Researchers from Duke University School of Medicine in the US carried out a retrospective cohort study that analysed the medical records of nearly 2,000 post-menopausal women between the ages of 45 and 60 who presented with shoulder pain, stiffness and frozen shoulder.

The researchers compared shoulder symptoms in women who were taking HRT (about 8% of them) and with those who weren’t. Their results found that those women who didn’t take HRT had 99% greater chance of having frozen shoulder compared with women who took HRT [8]. This was only a small study and clearly more research needs to be done in this area.

How is frozen shoulder diagnosed?

There is no specific test to diagnose frozen shoulder – a diagnosis is made by taking your medical history and having a physical examination, which usually shows restriction of movement.

How is frozen shoulder treated?

There are two stages of frozen shoulder – the early stage, which is considered inflammatory, and the developed stage, where the painful period may have subsided but the condition has progressed to a frozen phase.

The NHS recommends three steps to treatment.

Pain relief – avoid movements that cause pain and take paracetamol for pain relief. If paracetamol isn’t effective, try ibuprofen.
Stronger pain relief – you may be prescribed stronger pain relief or be given a steroid injection in your shoulder.
Get movement back – try gentle shoulder exercises at home. If pain continues, you may be referred to a physiotherapist for stretching exercises, strength exercises and posture advice.

The movements and exercises you will be recommended will depend on the stage of your frozen shoulder. During the early inflammation stages, it’s important not to push on through regardless as the shoulder can get more inflamed – physiotherapy will focus on restoring shoulder mobility. During the developed stage, physiotherapy may be more intensive.

You can also try putting a heat pack (or hot water bottle) on your shoulder for up to 20 minutes at a time. If you are experiencing menopausal symptoms and decide to take HRT as the first-line treatment, you might find your symptoms improve.

Many patients of Newson Health find that taking the right dose and type of HRT and testosterone improves symptoms associated with frozen shoulder, as well as improving other symptoms, including muscle and joint pains.

RELATED: Read more articles on HRT here

Resources

NHS: frozen shoulder

References

1-3. Mezian K., Coffey R., Chang K.V. Frozen Shoulder. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482162/

4. Tang, A.C.-W.; Huang, S.-T.; Wu, S.-Y.; Tang, S.F.-T. (2024), ‘The Clinical and Sonographic Features of Cervical Muscle Involvement in Patients with Frozen Shoulder: A Retrospective Study’, Biomedicines 12, 2395. https://doi.org/10.3390/biomedicines12102395

5. Kingston K., Curry E.J., Galvin J.W., Li X. (2018), ‘Shoulder adhesive capsulitis: epidemiology and predictors of surgery, Journal of Shoulder and Elbow Surgery’, 27(8) pp1437-1443, https://doi.org/10.1016/j.jse.2018.04.004.

6. Nagy M.T., Macfarlane R.J., Khan Y., Waseem M. (2013), ‘The frozen shoulder: myths and realities’, Open Orthop J. 6(7) pp352-5. doi: 10.2174/1874325001307010352

7. Malavolta E.A., Gracitelli M.E.C., Ribeiro Pinto G.M., Freire da Silveira A.Z., Assunção J.H., Ferreira Neto A.A. (2018), ‘Asian ethnicity: a risk factor for adhesive capsulitis?’ Rev Bras Ortop. 23;53(5), pp602-606. doi: 10.1016/j.rboe.2018.02.004

8. Saltzman E., Kennedy J., Ford A., et al. Poster 188: Is Hormone Replacing Therapy Associated with Reduced Risk of Adhesive Capsulitis in Menopausal Women? A Single Center Analysis. Orthopaedic Journal of Sports Medicine. 2023;11(7_suppl3). doi: 10.1177/2325967123S00174