The link between frozen shoulder and menopause

Can menopause cause frozen shoulder?

Menopause is a stage of life that a person who menstruates reaches when they have not had a period for a year. It is associated with a rapid decrease in the amount of the hormone estrogen.

Estrogen has a protective effect on the bones and joints. More than 50% of those who go through menopause experience joint stiffness. However, as menopause generally occurs at an age when musculoskeletal problems are more likely to arise, it is difficult to determine whether this transition is the direct cause of joint stiffness.

The cause of frozen shoulder remains unclear, and there is little evidence in the literature to suggest that menopause is responsible.

However, menopause may indirectly contribute to joint pain and stiffness through its other effects, which may include:

• poor sleep
• fatigue
• depression
• sexual dysfunction

What is the link?

There is little evidence of a direct link between menopause and frozen shoulder. However, frozen shoulder is most common around the time of menopause.

Experts believe that the connection between menopause and frozen shoulder involves hormone changes.

Frozen shoulder explained

The symptoms of frozen shoulder typically begin suddenly and involve extreme pain and stiffness toward the front of the shoulder. People with frozen shoulder usually have difficulty moving the shoulder, and this can affect their daily activities.

The condition generally passes through three stages:

• The freezing stage: This stage involves a gradual increase in pain, along with a reduced range of motion in the joint. It typically lasts from 6 weeks to 9 months.
• The frozen stage: During this stage, there may be an improvement in joint pain, but a continuation of joint stiffness can make daily activities difficult. This stage typically lasts 4–6 months.
• The thawing stage: A gradual improvement in shoulder motion and an eventual return to normal or near-normal joint mobility and strength typically occur during this stage. Gradual improvement tends to take between 6 months and 2 years.

Treatment options

People with frozen shoulder can try various treatment options and management strategies. A healthcare professional will be able to offer an individual advice on the best approach for them.

Hormone replacement therapy

Hormone replacement therapy (HRT) may help alleviate menopause symptoms by replacing hormones that the body no longer produces naturally. The two main hormones in HRT are estrogen and progesterone. Estrogen has a protective effect on the bones and joints, so replacing this hormone may help reduce joint problems.

Calcitonin therapy

A different type of hormone that can affect frozen shoulder during menopause is the thyroid hormone calcitonin. This hormone lowers calcium levels, thereby reducing the buildup of fibrous tissues in the joints.

A 2020 review notes that using a calcitonin nasal spray can reduce the symptoms of frozen shoulder.

Diet

Eating a nutritious, well-balanced diet could reduce the severity of frozen shoulder. According to a 2021 review, people should avoid foods with large amounts of additives, as well as cereals with a high gliadin content. Gliadin is a class of proteins that exists in wheat and certain other cereals. It can increase inflammation in the body.

Some researchers also believe that a ketogenic diet may be beneficial for frozen shoulder, as it may help reduce inflammation and pain. A ketogenic diet is low in carbohydrates, adequate in protein, and high in fat.

Physical therapy

Physical therapy aims to restore, maintain, and promote physical function. It is an important management tool that can help promote shoulder mobility and alleviate pain.

A physical therapist may provide the following treatments and tips for frozen shoulder:

• stretching exercises
• strength exercises
• advice on posture
• advice on pain relief

The type of physical therapy that a person receives will depend on the stage of their frozen shoulder. During the freezing stage, exercises focus on controlling pain and reducing inflammation. During the frozen and thawing stages, these exercises intensify, and the goals shift to restoring joint mobility.

Stretches

Stretching exercises may help improve joint mobility, and they are effective when a person performs them up to a tolerable pain level. However, mechanical stress on the area can worsen the problem, so a person should check with a doctor or physical therapist before introducing a new stretching routine.

Medications

Medical treatment options for frozen shoulder include manipulation under anesthesia, steroid injections, and nerve blocks. The latter involves injecting an anesthetic or anti-inflammatory into a nerve or a cluster of nerve endings to disrupt pain signals to the brain.

Both treatments can provide temporary symptom relief, but they do not stop the buildup of fibrous tissue in the joint.

Therapeutic ultrasound

Therapeutic ultrasound is a form of therapy that uses ultrasonic energy to alleviate pain and promote tissue healing. However, there is little evidence in the literature to suggest that this therapy is effective for frozen shoulder.

Surgery

Surgery is typically a last resort for frozen shoulder because it often has only limited success. The outcome may be the same as it would be with more conservative management strategies.

Surgical treatment options usually involve cutting away and releasing the tight capsule around the shoulder joint.

Summary

Frozen shoulder is an inflammatory condition that causes pain and stiffness in the shoulder joint. Menopause is the stage of life that occurs after the menstrual cycle ends. There is no evidence of a direct link between menopause and frozen shoulder.

However, menopause is associated with a rapid decline in the hormone estrogen, which plays an important role in joint health. Menopause is also associated with other factors that could contribute to joint pain and stiffness. These include poor sleep, depression, and fatigue.

Multiple treatment options exist for frozen shoulder during or following menopause. The type of treatment that a person receives will depend on the stage of their condition. Possible treatment options include HRT, physical therapy, and medication. A person can talk with a doctor about their individual treatment options.