Can Menopause Cause Frozen Shoulder? Here's the Science

Frozen shoulder, also known as adhesive capsulitis, is a frustrating shoulder condition that can sneak up on you. It causes the capsule around your shoulder joint (the glenohumeral joint) to thicken and stiffen, leading to a gradual loss of motion and function in the affected arm. Frozen shoulder is often accompanied by significant pain, especially at night, which can wreak havoc on your sleep.

While frozen shoulder can occur without any obvious cause, it often coincides with the timing of menopause, leading many to wonder if there’s a connection. Could the hormonal changes during menopause play a role in this painful condition? Here’s what science has to say about the potential link between menopause and frozen shoulder – and what you need to know about managing your symptoms effectively.

Can menopause cause frozen shoulder?

Frozen shoulder is most commonly experienced by people assigned female at birth, between the ages of 50 and 60. This timing coincides with the average age of menopause (which is 52 in the U.S.), suggesting a possible link between the two. However, there isn’t any scientific evidence to support or rule out this link — at least not at this time. Thought that's not to say you can't get help for frozen shoulder in menopause (more on that below).

The thing is, there is still a lot that scientists don’t know about frozen shoulder — including its potential link to menopause. In fact, researchers often refer to this condition as "puzzling" and "a mystery syndrome." But without more research, it’s hard to dismiss the possibility of a hormonal link.

A study conducted by Duke Health researchers found that post-menopausal women who were on hormone replacement therapy (HRT) had a lower risk of developing frozen shoulder compared to those who did not receive HRT. The study analyzed medical records of nearly 2,000 postmenopausal women between the ages of 45 and 60 who had shoulder pain and stiffness. Among those analyzed, only 3.95% of those who received HRT were diagnosed with frozen shoulder, compared to 7.65% of those who did not receive estrogen replacement. Although the differences were not statistically significant, the findings suggest an important potential link between the loss of estrogen during menopause and the development of frozen shoulder — which a larger study may show.

Researchers in this study point out that estrogen may be a link since it plays a role in stimulating bone growth, reducing inflammation, and promoting connective tissue integrity, which could explain a possible protective effect against adhesive capsulitis prior to menopause. Newer research further explores the connection between menopause and musculoskeletal pain conditions, including frozen shoulder. In this study researchers suggest that hormonal changes during menopause, particularly the decline in estrogen levels, may contribute to the increased prevalence of frozen shoulder among postmenopausal women. The study highlights that estrogen deficiency can lead to changes in connective tissue and inflammation, which are factors involved in the development of adhesive capsulitis.

While the exact cause of frozen shoulder remains unclear, most research agrees that the likely cause involved inflammation and elevated serum cytokine levels (signaling proteins that can increase inflammation), which contribute to the progression of frozen shoulder and changes in the shoulder joint capsule.

Symptoms of frozen shoulder

Frozen shoulder can come on “out of the blue” without any prior injury or medical condition. This is known as idiopathic or primary adhesive capsulitis.

It can also develop after a known injury, surgery, or be associated with a certain health condition like diabetes or a thyroid disorder. When this is the case, it is known as secondary adhesive capsulitis.

The symptoms of frozen shoulder can vary, depending on the stage you are in. There are 4 main phases of a frozen shoulder:

1. Pre-freezing (0-3 months): This phase is characterized by sharp pain at the end range of motion and achy pain at rest. In the pre-freezing stage, sleep disturbances are common.
2. Freezing (3-9 months): This is often the most painful stage, with a gradual loss of your shoulder motion in all directions because of pain and inflammation in the tissues of the joint capsule (synovitis).
3. Frozen (9-15 months): In the frozen phase, the pain can stick around and usually you’ll have significant loss of shoulder motion. Synovitis decreases in this phase while joint capsule fibrosis increases and the shoulder becomes more stiff.
4. Thawing (15-24 months): In the last stage of frozen shoulder, the pain resolves, and there is a gradual improvement in the use and motion of your shoulder and an easing of capsular fibrosis.

The symptoms of frozen shoulder can last anywhere from 1 to 3.5 years.

Who is at risk for frozen shoulder?

Frozen shoulder affects about 5% of the general population, with higher risk for those with:

• Diabetes (Type 1 or Type 2)
• Stroke
• Thyroid disorder
• Dupuytren’s disease
• Shoulder injury
• Parkinson disease
• Cancer
• Complex regional pain syndrome (CRPS)

How can I prevent frozen shoulder in menopause?

Unfortunately, because the specific causes of frozen shoulder are still poorly understood, there isn’t anything that you can do to prevent frozen shoulder, during menopause or otherwise.

Until scientists know more, the most important step when you notice pain and stiffness in your shoulder is to reach out to a physical therapist or other healthcare provider to fully assess your symptoms.

Once other conditions like a neck injury or rotator cuff injury are ruled out, a physical therapist can help you properly address your symptoms and help you feel better as soon as possible.

Frozen shoulder treatment during menopause (or anytime)

Understanding and effectively treating frozen shoulder remains challenging because the cause is still unclear. However, conservative treatment options, such as pain management and physical therapy, are generally the most effective approaches.

Physical therapy for frozen shoulder

Physical therapy (PT) treatment for frozen shoulder can be different from person to person, and depend on whether or not you have primary and secondary adhesive capsulitis. And it’s important that your treatment is aligned with the stage that you are in — pre-freezing, freezing, frozen, or thawing. Each stage requires a slightly different treatment approach:

• Early stages: Pain management is key in these stages. PT may include gentle stretches and movement exercises, as well as developing new ways to use your body so that you can still be productive during the day. During the early stages, it is important not to increase your pain, or too stretch aggressively. Mechanical stress has been shown to make fibrosis and the symptoms of frozen shoulder worse.
• Later stages: As your pain improves, it is important to restore your mobility and the function of your shoulder. Often, manual therapy like joint mobilization techniques and strengthening exercises are helpful as you start to feel better.

Medication pain management for frozen shoulder

Nonsteroidal anti-inflammatory (NSAIDs) medications, oral corticosteroids, and corticosteroid injections may be recommended to help manage your pain in the early stages of frozen shoulder. Studies show that combining anti-inflammatory medications with physical therapy treatment can provide short-term pain relief and functional improvements.

Advanced treatment options for frozen shoulder

When conservative treatments aren’t helping, more invasive medical interventions may be considered. For example:

• Manipulation Under Anesthesia (MUA): A procedure where your shoulder is moved through its range of motion while you’re under anesthesia.
• Arthroscopic Capsular Release (ACR): A minimally invasive surgery to release your tight shoulder capsule.

Tips for getting some sleep when you have frozen shoulder

Finding a comfortable sleeping position is crucial for managing frozen shoulder symptoms, as pain often worsens at night.

Opt for ice

A heating pad may be tempting when your shoulder aches before bed, but since the symptoms are largely related to inflammation, try relaxing with an ice pack instead. Wrap a small bag of ice or a pack of frozen peas and place it on your sore shoulder for about 10-15 minutes before bed.

Sleep strategically

• Do sleep on your back: This position is generally considered the best for when you have a frozen shoulder because it reduces pressure on your shoulder joint, and allows you to rest your full upper body into the mattress. Use pillows to support your forearms and keep them in a comfortable position.
• Do sleep on your unaffected side: If sleeping on your back is uncomfortable, try lying on your unaffected side. Use a body pillow behind you to prevent rolling onto your affected shoulder and also place one in front of you to rest your affected arm. This pillow will help to keep your shoulder supported, and prevent your upper body and shoulder from rotating in towards your mattress.
• Try to avoid sleeping on your stomach: This position can strain your neck and shoulder joint, which can exacerbate pain.
• Try to avoid letting your affected arm hang: This can be too much of a stretch for tight muscles and connective tissues, which can worsen symptoms.

Get help for menopause frozen shoulder at Origin

Frozen shoulder continues to be a challenging shoulder condition to manage, especially during menopause. While more research is needed to better understand the causes of frozen shoulder, and whether the hormonal changes you’re experiencing during menopause are part of the puzzle, physical therapy treatment is one of the best ways to help you manage your symptoms.

To manage frozen shoulder effectively, it is essential to focus on:

• Educating you as possible about frozen shoulder, your treatment options, and what to expect throughout the phases of the condition
• Optimizing pain management through interdisciplinary care and effective PT interventions
• Improving shoulder movement in all directions
• Restoring shoulder function because menopause is a time to be celebrated — you

If you are experiencing symptoms of frozen shoulder, consider reaching out to the specialists at Origin Physical Therapy. They focus on whole-body physical therapy and have expertise in musculoskeletal pain conditions, particularly those more common in individuals assigned female at birth. Origin Physical Therapy offers both virtual and in-person consultations, providing flexible options to meet your wonderfully unique needs. Don't let frozen shoulder limit your life in menopause — take the first step to feel better and meet with one of our physical therapists soon.