Is Frozen Shoulder More Common During Perimenopause?

Between the ages of 45 and 55, many women begin to experience physical and psychological changes that signal the start of the menopause transition, also known as perimenopause. This stage lasts an average of four years, although some women may continue to experience symptoms for as long as eight years or more.⁽¹⁾⁽²⁾ Joint pain, including shoulder pain, is one symptom menopausal women may experience during these transitional years. In some cases, shoulder pain may be due to a condition known as frozen shoulder, medically referred to as adhesive capsulitis, which is common among people entering their 50s.⁽³⁾

Frozen shoulder occurs when adhesions develop within the joint capsule surrounding the shoulder joint. The joint capsule is also lined with a synovial membrane, which produces fluid to keep the joint lubricated. These adhesions cause the joint capsule to thicken and decrease in size, leading to pain and stiffness. While the shoulder joint is among the body’s most mobile joints, individuals with frozen shoulder may find it difficult to move the affected area over time.^(3)(4)(5)

Is there a connection between frozen shoulder and perimenopause?

Frozen shoulder is not a symptom of menopause. However, research shows that it tends to occur more commonly during perimenopause. Hormonal fluctuations during the menopause transition may influence the development of frozen shoulder, although no definitive connection has been established.⁽⁵⁾

Estrogen helps maintain bone and joint health, and throughout different stages of menopause, levels of estrogen fluctuate and progressively decline. During early menopause, the body’s bones and joints begin to undergo physiological changes. These changes can make women more susceptible to osteoarthritis, a chronic condition that damages the body’s joint tissues, including the cartilage, ligaments, synovial membrane, and joint capsule. This damage eventually leads to a total breakdown in joint function.⁽⁶⁾ Because of the relationship between estrogen and joint health, the risk of frozen shoulder may increase during perimenopause as levels of estrogen start to decrease. However, more research is needed to confirm this theory.

Symptoms of Frozen Shoulder

Frozen shoulder does not develop overnight. It first manifests as mild pain that gradually worsens over time. Symptoms change as the condition progresses through three stages: freezing, frozen, and thawing. Throughout these stages, individuals may experience the following symptoms:⁽⁴⁾⁽⁷⁾

Freezing: 

• Mild, dull pain in the shoulder

• Pain that spreads to the biceps

• Difficulty sleeping

• Progressive worsening of pain

• Reduced mobility

• Lasts between six weeks and nine months

Frozen:

• Stiff, weak muscles

• Inability to move the shoulder

• Impaired daily functioning 

• Less pain

• Lasts between four and six months

Thawing:

• Improved range of motion 

• Enhanced flexibility

• Improved strength

• Lasts between five months and two years

Causes of Frozen Shoulder During Menopause

There is no known cause of frozen shoulder. While hormonal shifts may play a role in cases that develop during perimenopause, the following contributing factors have also been explored:⁽⁵⁾⁽⁷⁾

• Chronic Inflammation: Research suggests a link between chronic, low-grade inflammation and an increased risk of frozen shoulder. High blood sugar levels, triglycerides, and inflammatory lipoproteins have been associated with the condition.

• Diabetes: Approximately 10% to 20% of people with diabetes are affected by frozen shoulder.⁽⁴⁾ Although the cause of this relationship is not understood, both diabetes and frozen shoulder have been linked with chronic inflammation.

• Cardiovascular Disease: Similar to diabetes, chronic inflammation may be a contributing factor in the connection between cardiovascular disease and an increased risk of frozen shoulder.

• Thyroid Dysfunction: Hyperthyroidism and hypothyroidism may increase the risk of frozen shoulder. While thyroid dysfunction has been linked with musculoskeletal disorders, one study demonstrated a connection between thyroid disease and cases of frozen shoulder among women, specifically.⁽⁸⁾

• Parkinson’s Disease: Increased rates of frozen shoulder have been seen in people with Parkinson’s disease. Frozen shoulder may also be an early symptom of the condition. Parkinson’s disease may also cause changes in posture, potentially affecting shoulder function.⁽⁹⁾

• Natural Aging: Elasticity in the joints gradually declines with age, which may increase the risk of frozen shoulder in older adults.

Although less common, some factors that may contribute to cases of secondary frozen shoulder include the following:⁽⁴⁾

• Physical Injury: Frozen shoulder may develop from physical trauma, such as a broken shoulder or rotator cuff tear.

• Inactivity: A lack of movement may lead to frozen shoulder, such as during prolonged periods of surgical recovery.

Treating Frozen Shoulder

Frozen shoulder does not always require medical treatment. Most cases resolve within one to two years, although some cases may require a longer healing time. However, there are treatment methods that can help with managing symptoms:^(4)(5)(7)

• Physiotherapy: Physiotherapy is among the most common treatment methods for improving shoulder mobility. Treatments may include massage or physical therapy. The intensity of the exercises and stretches will vary depending on the severity of the case.

• Corticosteroid Injections: Corticosteroid injections work by suppressing inflammation. The medication is most effective when administered in the shoulder joint before the frozen stage.

• Over-the-Counter (OTC) Medications: OTC pain-relief medications like nonsteroidal anti-inflammatory drugs (NSAIDs) may provide short-term pain relief depending on the severity of frozen shoulder. Research is limited, but supplements like omega-3 fatty acids and vitamin C may also help reduce joint inflammation.^(10)(11) Individuals should consult their doctor before using any medications or supplements.

• Heating Pads and Cold Packs: Applying a heating pad or cold compress to the shoulder may help reduce swelling and joint pain.

• Surgical Intervention: Surgery is the least common treatment method for frozen shoulder. However, it may be recommended during the frozen stage if symptoms have not improved with alternative treatments. The procedure may involve manual movement of the shoulder while a patient is under anesthesia. Alternatively, a surgeon may perform an arthroscopy, which involves cutting through thick tissue in the joint capsule. 

Frozen shoulder is not typically a recurring problem, although some patients may develop the condition in the opposite shoulder.⁽⁴⁾

Lifestyle Changes to Prevent Frozen Shoulder

Because there is no established cause of frozen shoulder, it’s unclear whether the condition can be prevented. However, implementing the following lifestyle habits that support joint health may help lower the risk of musculoskeletal pain:

• Eating Foods that Reduce Inflammation: An anti-inflammatory diet has been shown to reduce symptoms of osteoarthritis. Women become more prone to osteoarthritis with age. Incorporating spices, fruits, vegetables, and omega-3 fatty acids into diet may reduce inflammation, a known risk factor for osteoarthritis.⁽¹²⁾

• Getting Good Quality Sleep: Research shows a link between physical pain and sleep health. Poor quality sleep or a total lack of sleep may cause or worsen chronic pain. Increased levels of pro-inflammatory substances in the body have been associated with chronic pain conditions as well as with fragmented sleep.⁽¹³⁾

• Exercising to Improve Mobility: Regular stretching and muscle-strengthening exercises can help keep the joints and muscles strong and flexible. Maintaining mobility in the shoulder is particularly important following surgery. A healthcare provider can develop an exercise program specific to a patient’s needs. Following a post-surgery exercise regimen may reduce the risk of frozen shoulder.

The Role of Hormones in Frozen Shoulder Management

Hormone replacement therapy (HRT) is not a treatment method for frozen shoulder. However, because hormones influence joint health, HRT may provide some musculoskeletal benefits. Changes in estrogen and progesterone levels can affect joint stiffness.⁽¹⁴⁾ Increasing the levels of these sex steroid hormones that decrease during the menopause transition may help prevent joint issues. One study found that menopausal women who did not use HRT were at greater risk for frozen shoulder than women who used HRT.⁽¹⁵⁾

More research is needed to determine whether there is a direct link between frozen shoulder and perimenopause. Therefore, it’s important to see a doctor to rule out any underlying causes of persistent shoulder pain. Pain may be related to an injury or alternate health condition. Early intervention can reduce the risk of complications from untreated shoulder pain.