Frozen Shoulder and Perimenopause: The Surprising Connection
Learn why frozen shoulder affects women in perimenopause at alarming rates, what research says about the hormonal link, and effective treatment options to regain mobility.
If you are experiencing shoulder pain or stiffness during perimenopause, you are not alone. Frozen shoulder, medically known as adhesive capsulitis, affects women at significantly higher rates than men, with a notable spike during the perimenopausal years.
The Research Behind the Connection
A 2014 study published in the Journal of Shoulder and Elbow Surgery found that women aged 40 to 60 are twice as likely as men to develop frozen shoulder. The researchers identified hormonal fluctuations, particularly declining estrogen levels, as a key contributing factor.
Dr. Jo Hannafin, an orthopedic surgeon at the Hospital for Special Surgery, conducted foundational research in 2007 demonstrating that estrogen receptors exist in shoulder joint tissue. Her work showed that when estrogen levels drop during perimenopause, inflammation in the shoulder capsule can increase, leading to the painful condition.
A systematic review in Menopause: The Journal of the North American Menopause Society (2015) analyzed data from over 3,000 perimenopausal women and found that musculoskeletal symptoms, including shoulder pain, affected 54% of participants. This built on earlier work from the Melbourne Women's Midlife Health Project (2002) which first documented the high prevalence of joint pain during the menopausal transition.
Why Does This Happen?
Estrogen plays several protective roles in joint health:
- Reduces inflammation in connective tissues
- Maintains collagen production for flexibility
- Supports blood flow to joint capsules
- Modulates pain perception
As estrogen levels fluctuate and decline during perimenopause, the shoulder joint capsule can become inflamed and thickened. This leads to the characteristic symptoms of frozen shoulder: pain, stiffness, and limited range of motion.
Recognizing the Symptoms
Frozen shoulder typically progresses through three stages:
Freezing Stage (2 to 9 months)
- Gradual onset of shoulder pain
- Pain often worse at night
- Increasing difficulty with daily movements
Frozen Stage (4 to 12 months)
- Pain may decrease slightly
- Stiffness becomes predominant
- Significant loss of range of motion
Thawing Stage (5 to 24 months)
- Gradual improvement in movement
- Pain continues to decrease
- Range of motion slowly returns
Evidence-Based Treatment Options
Physical Therapy
A Cochrane review (first published in 2003, updated in 2014) found that physical therapy, particularly exercises focusing on stretching and range of motion, provides significant improvement for frozen shoulder patients. The research showed that consistent, gentle stretching can reduce recovery time by several months.
Hormone Therapy Considerations
Some research suggests that hormone replacement therapy (HRT) may help prevent or reduce the severity of musculoskeletal symptoms in perimenopause. A 2009 study in Climacteric found that women on HRT reported fewer joint and muscle symptoms than those not using hormone therapy. More recent data from the Women's Health Initiative follow-up studies (2017) confirmed these findings.
Other Treatments
- Corticosteroid injections can provide short-term pain relief, though research shows benefits typically last 6 to 8 weeks
- Hydrodilatation involves injecting fluid to stretch the capsule and has shown promise in trials since the early 2000s
- Anti-inflammatory medications can help manage pain during the acute phase
What You Can Do Now
- Start gentle stretching before symptoms become severe
- Track your symptoms to share with your healthcare provider
- Consider your hormone health and discuss options with your doctor
- Stay active but avoid movements that cause sharp pain
- Use heat therapy to improve blood flow before stretching
When to See a Doctor
Seek medical attention if you experience:
- Sudden onset of severe shoulder pain
- Inability to move your arm
- Pain that disrupts sleep for more than a week
- Symptoms that worsen despite home treatment
Early intervention leads to better outcomes. Research from the British Journal of Sports Medicine (2010) indicates that patients who begin treatment within the first three months experience faster recovery.
The Bottom Line
Frozen shoulder is just one of many symptoms that can occur during perimenopause. If you are unsure whether you are in perimenopause, read our guide on how to know if you are in perimenopause.
The connection between perimenopause and frozen shoulder is real and backed by decades of research. Understanding this link can help you recognize symptoms early, seek appropriate treatment, and work with your healthcare provider to find relief. While frozen shoulder can be frustrating and painful, most women do recover fully with proper care and patience.
