Frozen Shoulder and Menopause

Frozen shoulder and menopause – what’s the link?

While frozen shoulder can occur without any obvious cause, it often coincides with the menopause. But how exactly do the hormonal changes of menopause play a role? In this article we will find out exactly what frozen shoulder is, the typical signs and symptoms, as well as the underlying hormonal drivers.  Finally, we’ll look at some tips you can implement to aid prevention and recovery.

What Is Frozen Shoulder?

Frozen shoulder (adhesive capsulitis), is a painful condition that restricts movement in the shoulder joint. It can affect your daily functioning, making it difficult to reach for things, hanging up clothes or brushing hair. 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 stiffness, which can restrict movement. The exact cause of frozen shoulder remains unclear. Research suggests that hormonal shifts, inflammation, elevated cytokines (protein involved in inflammation) and metabolic changes during menopause may play a significant role in its development. Understanding these connections can help women take proactive steps to support their hormones, joint health and recovery.

How Common Is Frozen Shoulder?

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. Asian ethnicity is also a risk factor. It affects both sides of the body equally, and rarely presents in both shoulders at the same time.

Recognising the Signs and Stages of Frozen Shoulder in Menopause

Frozen shoulder typically develops in three phases:

1. Freezing Phase: Shoulder pain gradually increases, and mobility starts to decline (lasting 6–9 months).
2. Frozen Phase: Pain may lessen, but stiffness persists, making daily activities challenging (up to 12 months).
3. Thawing Phase: Mobility slowly returns, though some stiffness may remain (can take 1–3 years without treatment).

How Hormones Influence Frozen Shoulder in Menopause

Estrogen plays a crucial role in maintaining connective tissue health by supporting collagen synthesis, fibroblast function, and joint lubrication. As estrogen levels decline during menopause, synovial fluid decreases, collagen breakdown accelerates, joint flexibility decreases, and inflammation rises, making tissues more prone to stiffness and adhesion formation. 

Beyond structural changes, declining estrogen levels may also contribute to microvascular dysfunction, reducing blood flow to the shoulder tissues and impairing healing. 

Furthermore, hormonal shifts in midlife are often accompanied by metabolic changes, such as increased insulin resistance and systemic inflammation, which can exacerbate joint stiffness. This may explain why frozen shoulder is more common in midlife women.

The FUTURE WOMAN Approach to Addressing Frozen Shoulder

At FUTURE WOMAN, all our hormone tests are paired with a personalised health plan prepared by expert nutritionists. This means that we can recommend specific supplement, diet and lifestyle advice to target the underlying drivers of your frozen shoulder for lasting change.

By addressing your drivers, we can prevent and support symptoms of frozen shoulder.

Some markers which we would focus on include:

1. Estrogen: As we have seen, estrogen is needed to help keep connective tissues healthy, we would look at your overall estrogen levels to see if they are optimal. Low estrogen levels are associated with insulin resistance, which affects collagen structure and increases joint stiffness.  Find out more about estrogen balance.
2. Cortisol and the HPA axis: We look at free cortisol, your daily cortisol pattern and metabolised cortisol to get a clear picture of your HPA axis. High cortisol levels (from chronic stress) can increase systemic inflammation and impair tissue healing, making frozen shoulder symptoms worse. Low cortisol levels (from long-term stress or burnout) can reduce the body’s ability to resolve inflammation, leading to prolonged stiffness and pain. Find out more about the HPA axis.
3. Inflammation and oxidative stress. While the exact cause of frozen shoulder remains unclear most research agrees that the likely cause involves inflammation and elevated serum cytokine levels (signalling proteins that can increase inflammation), which contribute to the progression of frozen shoulder and changes in the shoulder joint capsule. Find out more about inflammation and oxidative stress and the role it plays in menopause.

For many women, hormone replacement therapy (HRT), particularly estrogen, can significantly improve symptoms by supporting collagen production, reducing joint stiffness, and enhancing circulation to affected tissues. Women on HRT often report faster recovery, improved mobility, and fewer muscle and joint-related issues. If you’re struggling with frozen shoulder, balancing your hormones could be the missing piece to your recovery.

3 Tips for Recovery and Prevention

1. Support healthy joints and collagen by incorporating specific vitamins and minerals. As part of your personalised plan with FUTURE WOMAN, we’ll recommend some specific supplements and dietary changes to boost anti-inflammatory nutrients. We may also suggest dietary changes to improve metabolic health, such as balancing blood sugar and reducing refined sugars. 

2. Optimise hormonal health. Understand if a hormone imbalance could be driving your frozen shoulder symptoms and address those directly with a qualified practitioner like those at FUTURE WOMAN. Hormone testing with the Advanced Hormone Test can identify imbalances in estrogen, progesterone, and cortisol, guiding personalized support through diet, lifestyle changes, and, if needed, bioidentical hormone therapy (bHRT). Learn more about our new bHRT clinic opening at FUTURE WOMAN.

3. Physical Therapy and Movement-Based Healing. Gentle stretching, myofascial release, and heat therapy can improve circulation and flexibility. Targeted physiotherapy can enhance mobility and prevent long-term restrictions.

References

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.

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

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/

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

Saltzman E, Kennedy J, Ford A, Reinke E, Green C, Poehlein E, Wittstein J. Poster 188: Is Hormone Replacing Therapy Associated with Reduced Risk of Adhesive Capsulitis in Menopausal Women? A Single Center Analysis. Orthop J Sports Med. 2023 Jul 31;11(7 suppl3):2325967123S00174. doi: 10.1177/2325967123S00174. PMCID: PMC10392282.

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