Frozen Shoulder and Perimenopause: What’s the Link?

In perimenopause and menopause, these annoyances seem to come with the territory. But frozen shoulder, also called adhesive capsulitis, is the real party pooper. It’s most common in women aged 40 to 60 and is defined by stiffness, pain and a slow loss of range of movement in the shoulder, turning everyday tasks into a right bother.

Perimenopause, the transitional phase before menopause, brings hormonal shifts that can mess with various body systems, including your musculoskeletal health. While there’s no direct link, there’s a lot going on behind the scenes (hormones, metabolism, inflammation, lifestyle, and even stress) all doing their bit to make frozen shoulder more likely to happen.

In this article with Deirdre Nazareth, Osteopath and Functional Medicine Practitioner, we get pretty deep into what’s happening with your hormones, how this can affect your joints and tissues, and (most importantly) what you can do about it! 

Frozen shoulder usually develops slowly over time. It begins with inflammation in the shoulder joint, which leads to increased thickening (fibrosis) of the joint capsule. 

This thickening shrinks the capsule and tightens it around the joint, causing pain and making movement more difficult. It progresses through three stages that can last months or even years, each bringing different challenges and limitations.

• Freezing (painful) stage (6 weeks to 9 months)
  Pain is sharp and present with active or passive movement, and tends to be worse at night. It’s especially evident with movements like putting on a coat or fastening a seat belt.
• Frozen (adhesive) stage (4 to 6 months)
  Pain subsides but stiffness increases, making daily tasks even trickier. Some may struggle with brushing hair or getting dressed.
• Thawing (recovery) stage (6 months to 2 years) During the thawing stage, shoulder movement is gradually restored without pain and stiffness. Some may take longer to recover or never fully regain full range of movement in the shoulder.

Medical professionals usually diagnose frozen shoulder by examination, but it can be tough to figure out, especially in the later stages or if there are other pre-existing shoulder problems.

Perimenopause is marked by changing levels of oestrogen, progesterone, and testosterone. These hormones are integral to the health of many systems, including the reproductive, cardiovascular, skeletal, and the central nervous system. They help reduce inflammation, protect organs, and maintain brain health.

Perimenopause can last several years, typically starting in women in their 40s, although sometimes earlier or later. Varied perimenopause symptoms largely arise from decreasing oestrogen, which influences all these systems.

How hormones affect your connective tissues

Oestrogen plays a crucial role in maintaining connective tissue integrity, bone density, and anti-inflammatory processes.

Lifestyle factors during perimenopause (including reduced physical activity, poor nutrition, poor sleep, and stress) can further influence musculoskeletal health. 

Sedentary lifestyles contribute to muscle weakness and joint stiffness, while nutritional deficiencies in minerals, vitamin D, vitamin C, and other collagen-building nutrients can impair tissue repair. See later sections for more guidance.

Other health issues linked to frozen shoulder

Thyroid disorders, particularly hypothyroidism, are associated with connective tissue thickening and reduced flexibility. Neurodegenerative conditions like stroke can also elevate the risk of developing frozen shoulder.

Mental health factors

Your mental health matters too. Stress-induced cortisol fluctuations can impair collagen synthesis and immune regulation, potentially worsening frozen shoulder symptoms. 

Conversely, declining progesterone levels negatively impact GABA production, our calming neurotransmitter, which leads to increased anxiety, restlessness and sleep disturbances, further impacting the risk for chronic pain and increased pain perception and sensitivity.  

Recognising the link between perimenopause and frozen shoulder highlights the importance of early intervention. In most cases, frozen shoulders can improve on their own, although some may not recover fully. 

Progress can be slow, but having key strategies in place can make a significant difference, such as:

• Regular physical activity, a balanced whole foods diet rich in anti-inflammatory nutrients and minerals, and stress management.
• Manual and physical therapy (osteopathic, physical, or chiropractic care) to improve range of motion and strength, tailored to your frozen shoulder stage. Too much movement during the freezing stage can worsen pain and may tear the tissue, so gentle stretching and pendulum-like movements are best early on.
• Pain can be managed with anti-inflammatory drugs or steroid injections, but these should only be used for a short time and if other natural options haven’t worked.
• Surgical treatment may be considered after at least a year of conservative treatment, as surgery carries its own risks.
• Hormonal optimisation, such as addressing hormonal imbalances through dietary and lifestyle modifications or medical therapy (such as HRT) under supervision.
• Keep an eye on and manage other health problems like diabetes and thyroid issues.

Want to connect with Deirdre?

To learn more or get in touch, you can visit her website at The Functional Osteopath or follow her on Instagram at The Functional Osteopath.