Frozen shoulder linked to menopause in growing body of research, doctors say

A common but often painful condition known as frozen shoulder may be linked to the hormonal changes of menopause, doctors and recent research say, raising awareness that new shoulder pain in women in midlife merits early medical assessment.

Emma Mapp, 52, said a dull ache in the centre of her left shoulder quickly progressed to severe pain and stiffness that left her unable to raise her arm or turn her neck. Within weeks she struggled with everyday tasks such as washing and dressing and avoided social situations for fear of being bumped. A hospital scan and specialist assessment confirmed adhesive capsulitis, commonly called frozen shoulder.

Frozen shoulder occurs when the capsule of tissue surrounding the shoulder joint becomes inflamed and thickens, reducing the space available for movement and producing pain and stiffness that can last months or years. It affects an estimated one million people a year in the United Kingdom and is most commonly seen between the ages of 40 and 60.

"The capsule is usually large enough to allow for a full range of motion in a normal shoulder," said Rajeev Sharma, a consultant orthopaedic surgeon who specialises in shoulder, elbow and hand surgery. "With an inflamed condition such as frozen shoulder, the capsule thickens — and as a result the space for movement also reduces, which is the main cause for the stiffness."

Frozen shoulder often follows an injury, such as a fall or an overstretch, and is also more common in people with diabetes. But clinicians and researchers have noted that women in the typical menopausal age range appear disproportionately affected, prompting studies into a possible hormonal contribution.

A 2023 study published in the Orthopaedic Journal of Sports Medicine examined 1,952 women, 152 of whom were taking hormone replacement therapy (HRT). The researchers reported that women not on HRT were 99% more likely to develop frozen shoulder than those receiving HRT. The study does not establish causation but provides statistical evidence of an association between menopausal hormonal changes and the condition.

"Oestrogen plays several important roles in musculoskeletal health," said Dr. Elise Dallas, a menopause specialist at The London General Practice. "Oestrogen has anti-inflammatory properties and supports bone growth, as well as connective tissue health. As oestrogen levels drop during menopause, collagen can become stiffer, reducing the flexibility of joints, and levels of cytokines that trigger inflammation can rise. This inflammation can cause pain, thickening of the ligaments, and tightening of the joint capsule — hallmarks of frozen shoulder."

Not all clinicians accept a direct causal link between menopause and adhesive capsulitis. "Women aged 40 to 60 account for most frozen shoulder patients, so the condition will often get correlated with menopause, even though there is no direct link to the hormonal changes of menopause," Mr. Sharma said, emphasising that other risk factors such as injury and metabolic conditions remain important causes.

There is no single cure for frozen shoulder, but a range of treatments aim to relieve pain and restore mobility while the condition resolves. Conservative measures such as physiotherapy and targeted exercises are commonly recommended to maintain strength and range of motion, though patients can experience increased pain during the early, most inflammatory phase.

Interventional treatments include hydrodistension, also called hydro-dilatation, in which a mixture of saline, local anaesthetic and steroid is injected into the joint capsule to expand and relax it. Steroid injections are often used to reduce inflammation and allow patients to engage more effectively with rehabilitation. In more persistent or severe cases, imaging such as MRI can confirm the diagnosis and guide treatment.

Emma said she tried physiotherapy, heat packs, ice, massage and standard painkillers with only short-term relief. After a fall in late 2023 she attended accident and emergency where X-ray and MRI imaging confirmed frozen shoulder and a specialist referral led to a hydrocortisone injection in January. Although the injection was acutely painful, she reported progressive improvement within weeks and substantial recovery over the following year. She now takes part in regular aqua aerobics and estimates her shoulder mobility is about 97% restored, although she has not returned to high-impact activities such as tennis.

Specialists advise that early recognition and appropriate management can shorten the period of disability for some patients. "Steroid injections help reduce inflammation and provide pain relief while the condition resolves itself naturally and can make the recovery journey more comfortable," Mr. Sharma said.

Dr. Dallas urged clinicians and patients to consider menopausal status when assessing new shoulder pain in midlife women and to discuss HRT where appropriate as one part of a broader clinical appraisal. She noted that the decision to use HRT remains individualized and based on a woman’s overall health profile and symptom burden.

Emma said she wishes she had sought specialist advice sooner and encouraged other women to mention shoulder pain when consulting their doctor during the perimenopausal and menopausal years. "If they start experiencing shoulder pain around this stage of life, it's worth seeking medical advice sooner rather than later," she said.

Further research is needed to determine whether hormonal changes directly cause frozen shoulder and whether HRT might have a preventative role. In the meantime, clinicians recommend a combination of pain control, guided rehabilitation and targeted injections where indicated to manage symptoms and support recovery.