Menopause and Frozen Shoulder: What’s the Connection?
If you are going through menopause and have suddenly experienced shoulder stiffness and pain, you are not alone. There is growing evidence of a connection between menopause and the development of frozen shoulder. Menopause and Frozen Shoulder: What’s the Connection?
What Is Frozen Shoulder?
Frozen shoulder is a condition often characterized by the following:
- Intense shoulder pain (often at night and with sudden movements)
- Progressive loss of movement in the shoulder in all directions.
The medical term for frozen shoulder is adhesive capsulitis of the shoulder–meaning “the inflammation of the shoulder capsule due to adhesions.” Although frozen shoulder is not fully understood, researchers do know that the protective tissue around the shoulder joint (the capsule) starts to thicken and become less flexible and more inflamed.
Frozen shoulder is most commonly seen in people in their 50s and 60s. Women tend to develop frozen shoulder at higher rates than men, but the difference between these two groups can vary widely from study to study.
Unfortunately, why exactly frozen shoulder develops is still unclear. Often, frozen shoulder occurs for no known reason. However, there are known factors that increase the risk of frozen shoulder, including diabetes, thyroid disease, injury to the shoulder, long periods of shoulder immobility (such as after surgery), and poor posture. One risk factor that is gaining more recognition and research is hormonal changes–This is where menopause may come into play in the development of a frozen shoulder.
What Is Menopause?
Women’s reproductive systems rely on different hormones (chemical signals) in the body to function.
The level of these hormones changes throughout a woman’s lifespan. The way these hormone levels change is divided into the following four phases.
- Premenopause: This is a woman’s reproductive years.
- Perimenopause: This is the transition period before menopause. This phase can last for years.
- Menopause: This is the point where someone has officially gone 12 months without a period.
- Postmenopause: This stage is where hormone levels stabilize for the rest of a woman’s life.
The Link Between Frozen Shoulder and Menopause
Perimenopause and menopause are the phases most connected to frozen shoulder because those who are going through perimenopause and menopause are often a similar age to those who develop frozen shoulder. The reproductive hormone that gets the most attention during these two phases is estrogen.
In perimenopause, estrogen levels fluctuate unpredictably, which cause common symptoms such as hot flashes and irregular periods. In menopause, estrogen levels drop significantly and remain permanently low.
Estrogen plays an important role in nearly all parts of the body, including bones, tendons, muscles, cartilage, ligaments, and fat tissue. The loss of estrogen results in the following:
- Increased inflammation
- Connective tissue breakdown
- Decreased bone density (which makes bone more fragile)
- Increased arthritis
- Loss of muscle mass and strength.
Therefore, as estrogen levels begin to fluctuate dramatically and eventually fall to low levels, joints can suffer.
Technically, any joint in the body can be affected by menopausal changes. It is thought that shoulders are more commonly impacted because they tend to have the highest range of motion of any joint in the body. We need our shoulders to have a high range of motion in all directions to complete tasks such as reaching behind us to tuck in our shirt or across us to fasten a seatbelt. This high level of movement can make the shoulder more vulnerable. Any shoulder joint stiffening or inflammation can have a major impact on daily function.
Treatment Options: The Current Research
Research on the link between frozen shoulder and menopause is still growing.
When someone is struggling with the effects of menopause, hormone replacement therapy (HRT) is sometimes an option used to keep hormone changes under control. Estrogen is often included in HRT. HRT is an emerging idea as a way to treat frozen shoulder for patients whose shoulder symptoms seem to relate closely to their menopause transition.
Duke University published what is thought to be the first study on the effect of HRT on frozen shoulder development. In this small study, the group of participants who received HRT had fewer people develop frozen shoulder than the group who did not receive HRT. However, this difference was not significant enough from a research standpoint—potentially because of how small the study group was. Although its results were inconclusive, the study is an exciting starting point for more research in this area that will hopefully give us a better understanding of the role menopause plays in the development and treatment of frozen shoulder.
What Else Is Done to Treat Frozen Shoulder?
The best course of action for treating frozen shoulder is still not well established. Sometimes, the condition can even improve on its own. Common approaches to frozen shoulder relief include physical and occupational therapy, shoulder surgery (to stretch the shoulder joint), and corticosteroid injections (to reduce inflammation).
Corticosteroid injections have been found to reduce pain in the short term, but improvements may be minimal in the long term. Recently, researchers in the UK conducted a major study on three treatment approaches for frozen shoulder: physical therapy, joint manipulation under anesthesia (where the joint is stretched), and arthroscopic capsular release surgery (where the joint capsule is loosened). The effects of these treatments were studied over 12 months. It was found that no treatment was significantly better than the others, so nonsurgical treatment can produce similar benefits with less risk.
Therapy for Frozen Shoulder
This information has led many healthcare professionals to encourage people to seek treatment for frozen shoulder through physical and occupational therapists. Treatment for frozen shoulder by a therapist often includes stretches to the arm and shoulder joint, strengthening exercises, posture work, and pain management techniques.
If you are struggling with pain and loss of movement in your shoulder or having difficulty navigating the menopause transition, talk with your healthcare provider about your options for relief. Schedule your appointment at Freedom PT Services today.
References
Millar NL, Meakins A, Struyf F, et al. Frozen Shoulder. Nature Reviews Disease Primers. 2022;8(1). doi:https://doi.org/10.1038/s41572-022-00386-2
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:https://doi.org/10.1177/2325967123s00174
UK FROST – UK FROST, University of York. www.york.ac.uk. https://www.york.ac.uk/healthsciences/research/trials/ytutrialsandstudies/archive/ukfrost/
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric: The Journal of the International Menopause Society. 2024;27(5):1-7. doi:https://doi.org/10.1080/13697137.2024.2380363