Emerging research and clinical experience suggest that hormonal changes during perimenopause and menopause may play a role in the development of frozen shoulder. At the OrthTeam Centre, Consultant Shoulder Surgeon Mr Nick Phillips and Consultant Endocrinologist and Menopause Specialist Professor Annice Mukherjee regularly see women experiencing musculoskeletal symptoms that can significantly impact their quality of life.

What Is Frozen Shoulder?

Frozen shoulder, medically known as adhesive capsulitis, is a condition that causes pain, stiffness, and a progressive loss of movement in the shoulder joint.

The condition develops when the capsule surrounding the shoulder joint becomes inflamed and thickened, leading to scar tissue formation and reduced mobility.

Common symptoms include:

• Persistent shoulder pain
• Difficulty reaching overhead
• Problems fastening a bra or reaching behind the back
• Pain that worsens at night
• Reduced range of movement
• Difficulty carrying out everyday activities

Frozen shoulder typically develops gradually and progresses through three stages:

The Freezing Stage

Increasing pain accompanied by a gradual loss of movement.

The Frozen Stage

Pain may lessen slightly, but stiffness becomes more severe.

The Thawing Stage

Shoulder movement slowly returns, although recovery can take many months and, in some cases, several years.

Why Does Frozen Shoulder Affect Women More Often?

Frozen shoulder is most commonly seen in adults between the ages of 40 and 60 and occurs significantly more often in women than in men.

Whilst diabetes and thyroid disease are recognised risk factors, increasing attention is now being paid to the role of hormonal changes during menopause.

According to Professor Annice Mukherjee, changes in oestrogen levels can affect connective tissues, muscles, tendons and joints throughout the body. Increased recognition of these symptoms is now being described as the musculoskeletal syndrome of menopause.

"Many women are unaware that musculoskeletal symptoms can be a feature of menopause. During the menopause transition, hormonal changes can contribute to muscle loss, joint pain, stiffness, reduced tissue elasticity and inflammatory changes that may increase susceptibility to conditions such as frozen shoulder."

The Role of Oestrogen

Oestrogen plays an important role in maintaining the health and function of connective tissues throughout the body.

As oestrogen levels fluctuate during perimenopause and menopause, women may experience:

• Joint aches and pains
• Tendon problems
• Reduced flexibility
• Increased inflammation
• Slower tissue repair

These changes can create an environment in which shoulder stiffness and inflammation become more likely.

Recent studies have highlighted a potential association between menopause and an increased risk of adhesive capsulitis, helping to explain why frozen shoulder so frequently develops during midlife.

Could Your Shoulder Pain Be Menopause Related?

Many women develop shoulder pain at the same time they begin experiencing other menopausal symptoms, including:

• Hot flushes
• Night sweats
• Brain fog
• Fatigue
• Sleep disturbance
• Mood changes
• Weight gain
• Generalised joint stiffness

Whilst not every case of shoulder pain is linked to menopause, it is important to consider hormonal changes as part of the overall assessment.

Professor Mukherjee emphasises that understanding the wider hormonal picture can help guide a more personalised treatment plan.

Getting the Right Diagnosis

According to Mr Nick Phillips, obtaining an accurate diagnosis is essential, as frozen shoulder can often be mistaken for other shoulder conditions such as rotator cuff injuries, arthritis or shoulder impingement.

"Many patients assume they have strained a muscle or suffered a sporting injury. However, frozen shoulder has a very distinctive pattern of stiffness and loss of movement that requires specialist assessment. One key clinical sign is a sudden sharp pain during an unguarded movement, which can be a strong indicator of frozen shoulder."

Assessment may include:

• A detailed medical history
• Review of menopausal symptoms
• Physical examination
• Range of motion testing
• X-rays or MRI scans where appropriate

Treatment Options

Treatment depends on the stage and severity of the condition.

Physiotherapy

Specific stretching and mobility exercises can help maintain and improve movement.

Pain Relief

Anti-inflammatory medication and other pain management strategies may improve comfort and daily function.

Image-Guided Injections

Corticosteroid injections can help reduce inflammation and pain, particularly during the earlier stages.

Hydrodilatation

This minimally invasive procedure involves injecting sterile fluid into the shoulder joint capsule to stretch the capsule, improve movement and reduce stiffness.

Surgery

For patients whose symptoms persist despite conservative treatment, keyhole surgery may be considered to release the tightened joint capsule and improve mobility.

Where Does Menopause Management Fit In?

For women experiencing multiple menopausal symptoms, hormonal assessment and menopause management may form an important part of the overall treatment plan.

Professor Mukherjee explains:

"Addressing hormonal changes alongside musculoskeletal symptoms provides a more integrated approach to care. Whilst hormone replacement therapy (HRT) is not a treatment for frozen shoulder itself, it may help some women who are experiencing wider menopausal symptoms affecting their joints and overall quality of life."

Treatment recommendations should always be tailored to the individual following specialist assessment.

When Should You Seek Advice?

You should consider seeking specialist advice if you are experiencing:

• Shoulder pain lasting more than a few weeks
• Loss of shoulder movement
• Difficulty sleeping because of shoulder pain
• Increasing stiffness affecting everyday activities
• Shoulder symptoms alongside other menopausal symptoms
• Persistent pain that is not improving with self-management

Early diagnosis and appropriate treatment can help reduce discomfort, maintain shoulder function and support a faster recovery.

A Collaborative Approach to Care

At the OrthTeam Centre, we work together to provide an integrated, multidisciplinary team (MDT) approach which ensures outstanding, personalised patient care.

Mr Nick Phillips and Professor Annice Mukherjee work collaboratively to ensure patients receive comprehensive assessment and treatment, considering both orthopaedic and hormonal factors where appropriate.

By understanding the potential connection between menopause and frozen shoulder, women can access the right support sooner and take proactive steps towards improving both their shoulder health and overall wellbeing.