Frozen Shoulder: Menopause Increases The Risk | Here’s Why, Treatments, And More

Frozen shoulder and menopause aren’t conditions you’d associate together. But, research shows that around 70% of frozen shoulder patients are women, mostly between the ages of 40-60. (1)

Researchers think this can be due to the hormonal imbalances from menopause. The decrease of estrogen can affect joint health in several ways, increasing the risk of suffering from adhesive capsulitis.

Below, we’ll discuss why menopause can increase the risk of frozen shoulder and what to do about it. Here’s a summary of the topics we’ll cover, tap on the section that interests you the most to go straight there:

• Can menopause cause frozen shoulder?
• What is frozen shoulder?
• Treatments for menopausal frozen shoulder
• 5 home exercises for women with menopause and frozen shoulder

Let’s dive right in!

Can menopause cause frozen shoulder?

No, menopause itself doesn’t cause frozen shoulder. However, the relationship between these two hasn’t been studied in depth.

Researchers believe that the estrogen imbalances from menopause can have a huge role in this. See, this hormone affects several processes of your body and has a huge role in joint health. (2)

The role of estrogen in your shoulder joint health

Aside from regulating your menstrual cycle, this hormone aids in your joint health, inflammation management, and pain relief in the following ways:

Keeps your cartilage healthy

Your shoulder cartilage is made up of collagen. This tissue allows your upper arm bones to move smoothly with every shoulder movement.

This tissue breaks down due to the natural aging process and daily wear and tear. But it also rebuilds itself constantly, thanks to growth hormones. Estrogen is one of many chemicals that help keep this process of breakdown and regeneration balanced. (3)

Now, during menopause, the levels of estrogen decrease. This can result in an abnormal production of growth hormones around your shoulder capsule. (4) In turn, this excess can increase the quantity of collagen in your joint.

A high amount of collagen can make the joint less flexible and more rigid. This can decrease your range of motion and can make you prone to adhesive capsulitis.

Makes your bones stronger

Estrogen helps produce another hormone called “calcitonin,” which allows the absorption of calcium into our bones. This process is key to keeping our bones strong and resistant to fractures. (5)

However, the low levels of estrogen due to menopause can affect this, making our bones weaker and prone to fractures.

Keeps pain and inflammation at bay

With daily movement, is normal to have a low level of inflammation build-up in our joints. Normal levels of estrogen keep this at bay. They also help manage joint pain by stimulating pain-blocking signals from your spinal cord. (6)

But after menopause, your estrogen level significantly drops down. As a result, joint inflammation will accumulate and you’ll likely feel more pain than before.

These may explain why menopausal women are twice as likely to experience joint pain and stiffness, mimicking a frozen shoulder. (7)

What is frozen shoulder syndrome?

Frozen shoulder, or adhesive capsulitis, is the progressive limitation of motion and severe pain in your shoulder joint. 

Frozen shoulder goes through 3 stages before resolving on its own:

Learn more: Here’s our complete guide on frozen shoulder!

1) Freezing stage

Duration: 2 to 9 months.

The main symptoms are spontaneous and diffuse shoulder pain. It’s mostly painful at night. As it progresses, it will eventually be painful at rest. Your shoulder range of motion also starts to decrease. 

2) Frozen stage

Duration: 4 to 12 months.

At this point, there is a gradual reduction in your shoulder pain. But, the limitation of range of motion still remains. This restriction will likely be present on all shoulder movements.

3) Thawing stage

Duration: 12 months to 24 months.

This is the recovery phase of frozen shoulder. Your range of motion will steadily improve, with minimal to zero shoulder pain, until it gets back to normal.

Further reading: In-depth guide about frozen shoulder stages

Treatment options for menopausal frozen shoulder

Hormone replacement therapy

Hormone replacement therapy (HRT) consists of taking a medication that contains female hormones, like estrogen and progesterone – the ones that decline after menopause. (8)

It goes by in two forms (8):

Oral 

Allows a faster absorption and effect of estrogen in your body. The downside is you may need a higher dose, which can increase the risk of blood clot formation.

Transdermal

Usually in the form of a patch or gel applied to the skin. This form lowers the risk of blood clots since you don’t need to use a high dosage of medication.

Disadvantages are that the patch may fall off accidentally and the risk of skin irritation.

P.S.: Keep in mind that HRT deals with menopausal symptoms but does not directly treat frozen shoulder.

Relaxin injection

Relaxin is a hormone usually elevated during pregnancy. It loosens joints and ligaments to help accommodate the size of the baby inside a mother’s womb. 

Now, some studies show that injecting this hormone into the affected shoulder may increase your range of motion. (9) This can be helpful for the frozen and thawing stages.

Corticosteroid injections

Steroid injections are a common treatment option for the frozen shoulder, right when it starts to ramp up the pain – in the first stage.

These drugs work by lowering inflammation levels in your affected arm, thereby improving your shoulder mobility. 

Each shot may last up to 24 months, with a maximum dose of two injections per year to prevent complications. (10)

NSAIDs

NSAIDs are another form of anti-inflammatory medication that can be taken in oral or topical form. They’re effective in quickly helping reduce pain and joint stiffness. 

Heat therapy

Heat therapy promotes blood circulation to your shoulder. This in turn can reduce muscle pain and improve the range of movement in your joint capsule. 

You can do this with a hot towel/bag and or warm shower. Just make sure to not exceed 20 minutes per application to prevent skin burns. 

Extracorporeal shockwave therapy

Extracorporeal shockwave therapy (ESWT) uses low-energy acoustic pulses, which can promote local healing. It can help treat frozen shoulder by (11):  

• Improving blood flow and muscle flexibility.
• Releasing pain-reducing chemicals.
• Reducing inflammation.

Physical therapy

Physical therapy is a widely utilized treatment method for frozen shoulder. It combines physical assessment plus various therapeutic approaches in helping you recover. 

Depending on your location, you can start physical therapy as a walk-in patient or from a referral from your doctor.

You will be guided by a physical therapist with basic exercises to stretch and strengthen your affected arm. As your body becomes stronger, more advanced techniques will be used to speed up your recovery. 

Your total number of visits will depend on how well your body responds to physical therapy. 

Acupuncture

Acupuncture is a form of traditional Chinese medicine. Here, a certified acupuncturist inserts thin needles in different points of your body to promote healing and well-being.

Learn more: Does acupuncture really help frozen shoulder?

Top 5 home exercises for menopausal frozen shoulder

There are several exercises to prevent frozen shoulder. But if you already have it, these are 5 that can help in any stage:

1) Wand exercise

What it works on: Improving your range of motion for a specific shoulder movement.

Item/s needed: Stick or small PVC pipe.

Note: Do any movement that you find that’s most limited. Don’t push through the pain.

For limited flexion 

• Start by either sitting, standing, or lying on your back.
• Use both of your hands to hold the ends of the stick with your palms facing towards you.
• Keeping your elbows straight, raise both of your arms, as far as you can tolerate.
• Hold for 3 seconds at your end-range.
• That counts as 1 repetition.
• Perform for a total of 10 repetitions.

For limited abduction 

• Same starting position as above.
• Hold the ends of the stick with your palms facing away from you.
• Slowly move your arms out to the side, as far as you can go.
• Hold for 3 seconds at end-range.
• That counts as 1 repetition.
• Perform for a total of 10 repetitions.

Try this: 10 wand exercises for shoulder health.

2. Pendulum exercise

What it works on: Increasing the space inside your capsule, improving your mobility. 

Item/s needed: Chair or table.

• With your good arm, hold onto a sturdy table/chair.
• Bend at your hips and let your affected arm hang loose.
• Shift the weight of your body forward, and then backward.
• Use your momentum to swing your affected arm.
• Perform for 10 repetitions.

Note: Once your shoulder begins to loosen, use a 2lb dumbbell or small bottled water to further stretch your joint capsule.

3. Sleeper stretch

What it works on: Lengthens tight tissues around your shoulder, lowering joint stiffness.

• Lay on the side of your affected arm, putting weight on your ribs.
• Place your arm in front and bend your elbow at a 90°.
• Use your good hand to push down on your forearm.
• Go as far as you can go, feeling the stretch at the back of your shoulder.
• Hold for 30 seconds at end-range.
• That counts as 1 repetition. Perform for 3 repetitions.

4. Full can

What it works on: Strengthens the muscles around your shoulder joints.

Item/s needed: 5lb dumbbell or a large bottled water.

• With your arms at the side, hold the dumbbell with your palms facing towards you.
• Raise your arm to parallel in an oblique direction.
• Slowly lower your arm back to starting position.
• Perform for 10 repetitions.

5. Reverse corner push-ups

What it works on: Strengthens the muscles on your upper back.

Item/s needed: Sturdy wall.

• Stand right behind the corner of a wall.
• Make a T-posse by placing both your arms on side of the wall.
• Bend both your elbows at a 90° angle.
• Using your elbows, push your body away from the wall.
• Squeeze your shoulder blades at end-range and hold it for 3 seconds.
• That counts as 1 repetition. Perform 10 times.

Learn more: 14 exercises to treat frozen shoulder and boost your recovery.

FAQs

Conclusion: Frozen shoulder and menopause

Frozen shoulder may be a popular condition in menopausal women, but you can manage symptoms with the treatments above.

Menopause symptoms are more manageable than ever, thanks to the development of hormone therapy. While there are many ways to overcome frozen shoulder without ever going under the knife.

Consult your local physical therapist and/or your OB-GYN to start your road to recovery!

Resources

1. Hannafin, J A, and T A Chiaia. “Adhesive capsulitis. A treatment approach.” Clinical orthopaedics and related research,372 (2000): 95-109. https://journals.lww.com/clinorthop/Fulltext/2000/03000/Adhesive_Capsulitis__A_Treatment_Approach.12.aspx
2. Shea, Karen L et al. “Body composition and bone mineral density after ovarian hormone suppression with or without estradiol treatment.” Menopause (New York, N.Y.) vol. 22,10 (2015): 1045-52. doi: 10.1097/GME.0000000000000430
3. Chlebowski, Rowan T et al. “Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial.” Menopause (New York, N.Y.) vol. 20,6 (2013): 600-8. doi: 10.1097/GME.0b013e31828392c4
4. Kilian, Olaf et al. “Enhanced alpha 1(I) mRNA expression in frozen shoulder and dupuytren tissue.” European journal of medical research vol. 12,12 (2007): 585-90. https://pubmed.ncbi.nlm.nih.gov/18024269/
5. Agnusdei, D et al. “Calcitonin and estrogens.” Journal of endocrinological investigation vol. 13,8 (1990): 625-30. DOI: 10.1007/BF03349583
6. Watt, Fiona E. “Musculoskeletal pain and menopause.” Post reproductive health vol. 24,1 (2018): 34-43. DOI: 10.1177/2053369118757537
7. Tobell, Dominique. “Medicalizing Menopause”. Science History Institute. 14 July 2008. https://www.sciencehistory.org/distillations/medicalizing-menopause
8. Harper-Harrison G, Shanahan MM. Hormone Replacement Therapy. [Updated 2021 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493191/
9. Blessing, William A et al. “Intraarticular injection of relaxin-2 alleviates shoulder arthrofibrosis.” Proceedings of the National Academy of Sciences of the United States of America vol. 116,25 (2019): 12183-12192. DOI: 10.1073/pnas.1900355116
10. Sun, Yaying et al. “Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis.” The American journal of sports medicine vol. 45,9 (2017): 2171-2179. DOI: 10.1177/0363546516669944
11. Vahdatpour, Babak et al. “Efficacy of extracorporeal shockwave therapy in frozen shoulder.” International journal of preventive medicine vol. 5,7 (2014): 875-81. https://pubmed.ncbi.nlm.nih.gov/25104999/