During the early days of Covid (I was around 43), I began to experience a kind of pain in both of my shoulders that I had never had before. It bothered me at ALL times, especially when reclining in my chair, watching TV, and, at its worst, when trying to fall asleep at night.
The pain, even now, is difficult to describe. It was almost like I couldn't relax my shoulders (particularly my left), and no matter what position I was in, I had deep aching pain around the joint and into my left bicep and pectoral muscle.
I couldn't close my bra, pick up my dogs, and DON'T even get me started with how hard it was to put on a sports bra. That was HELL to get in and out of!
I was cranky and in pain all of the time. Any of you living out there with chronic pain no how draining and awful this is.
I wouldn't wish it on my worst enemy. Well. Maybe one, and his name starts with a "t" and rhymes with "rump."
When I was finally able to see an actual doctor, it took several appointments, a steroid injection (which did nothing), and about five PT appointments before someone told me it "might" be frozen shoulder.
This was the first I had ever heard of this condition. Then again, I had not heard of perimenopause at that time either, let alone a link between frozen shoulder and menopause.
The human body operates as an intricate system, with hormones playing a critical role in all its functions. One key hormone is estrogen, commonly associated with the female reproductive system. However, its effects reach far beyond that, influencing various bodily functions, including joint health. But is there a connection between estrogen and frozen shoulder?
Understanding Frozen Shoulder
Frozen shoulder, medically known as adhesive capsulitis, is marked by stiffness and pain in the shoulder joint. The condition typically evolves through three stages:
Freezing Stage: Pain gradually intensifies, and stiffness increases.
Frozen Stage: Marked reduction in shoulder movement occurs.
Thawing Stage: Gradual motion returns and may take several months to a few years.
You read that last part right. SEVERAL MONTHS TO A FEW YEARS.
Frozen shoulder most commonly affects people between the ages of 40 and 60, and it occurs more often in women than men. It can usually lead to challenges in routine activities like dressing or reaching for objects.
The unpredictable nature of frozen shoulder complicates the condition, which can arise without a clear cause. However, research suggests a potential connection between hormonal changes—particularly the drop in estrogen—and the onset of this condition.
The Role of Estrogen in Joint Health
Estrogen is famous for its role in reproductive health, but it also plays several key roles in joint health. It significantly impacts:
Bone Density: Estrogen aids calcium absorption, which is vital for bone strength. A decline in estrogen can lead to a 5% to 10% decrease in bone density in post-menopausal women, raising the risk of osteoporosis.
Tendon and Ligament Health: Estrogen helps maintain the elasticity and flexibility of tendons and ligaments, which are essential for smooth joint functioning. Research illustrates that women with low estrogen levels are at risk for joint injuries.
Anti-Inflammatory Properties: Estrogen can reduce inflammation, which is crucial for conditions like arthritis. Studies indicate that women with lower estrogen levels have higher markers of inflammation, which contributes to joint pain.
As estrogen levels drop, particularly during menopause, these protective effects lessen, leaving women more susceptible to musculoskeletal disorders, frozen shoulder included.
Estrogen Decline and Frozen Shoulder
Estrogen production naturally decreases as women age. This decline can happen during several life stages, including:
Menopause: The peak drop typically occurs between the ages of 45 and 55, when estrogen levels can decrease by as much as 90%.
Post-Menopause: While hormone levels tend to stabilize, they remain low, impacting various bodily systems.
This reduction in estrogen joint support can lead to the formation of fibrous tissue in the shoulder capsule. This tissue restricts mobility and raises the risk of frozen shoulder significantly.
Frozen Shoulder and the Menopause Link
Studies indicate that women are disproportionately affected by frozen shoulder, especially during and after menopause.
The question is: how does reduced estrogen directly contribute to this painful condition?
Inflammation and Pain: Lower estrogen levels correlate with increased inflammatory markers. Chronic inflammation can provoke stiffness in the shoulder joint.
Decreased Range of Motion: Reduced estrogen affects the flexibility of ligaments and tendons, making it easier for the shoulder capsule to tighten and become immobile. Research shows that nearly 70% of frozen shoulder cases occur in women over 50.
Tissue Healing: Estrogen plays a role in tissue repair. Its decline hampers the body’s ability to recover from minor injuries, making women more susceptible to frozen shoulder even from slight trauma.
Risk Factors Amplifying the Estrogen Link
Beyond natural estrogen decline, other risk factors may increase the likelihood of developing frozen shoulder in women:
Age: Older women, particularly those undergoing significant hormonal changes, are more susceptible.
Diabetes: Women with diabetes have a 30% higher incidence of frozen shoulder, likely linked to hormonal imbalances and increased inflammation.
History of Shoulder Injuries: Previous injuries may predispose individuals to frozen shoulder when combined with the effects of declining estrogen.
Managing Frozen Shoulder Linked to Estrogen Decline
Recognizing the link between estrogen levels and frozen shoulder opens avenues for effective prevention and management. Here are helpful strategies:
Consult Healthcare Professionals: Speak to an orthopedist about your symptoms and treatment options. This can include injections and the recommendation/prescription for physical therapy.
Physical Therapy: Targeted physical therapy can improve shoulder strength and mobility, helping mitigate low estrogen's effects.
Menopause Hormone Therapy (MHT): MHT may benefit some. It can reduce joint-related issues. Studies show that women undergoing MHT may experience less joint pain.
Lifestyle Modifications: Staying active with exercises that promote shoulder mobility is critical. Low-impact activities like swimming, yoga, and Pilates can significantly help prevention and management.
What Worked for Me
Getting a diagnosis was the most challenging part.
Diagnosing frozen shoulder can be difficult because the symptoms often resemble those of other shoulder problems, such as a rotator cuff tear, which makes it difficult to distinguish between these conditions without additional imaging tests like X-rays or MRI.
This is especially true in the early stages of frozen shoulder, when pain may be the main symptom. Furthermore, some doctors may not take the condition seriously due to its gradual onset and the fact that it is not visibly noticeable.
AKA the patriarchy not taking women's pain seriously.
While physical therapy was helpful, the game changer (for me) was going on MHT. That was when I finally made a full recovery, but it took over a year and it was a hellscape! Also, just four months ago, it started up again. Panic really began to set in, let me tell you! However, I spoke to my menopause specialist and increased my estrogen dose, and sure enough, about a month later, it began to subside.
To this day, it is one of the most frustrating conditions I've ever encountered. If you or someone you know is experiencing frozen shoulder, please know there is hope! Make an appointment with an orthopedist, request physical therapy, and explore the option of MHT.
AND. If you're interested in learning more about estrogen's effects on the musculoskeletal system, I'm teaching a one-hour workshop on the subject at The Movement Study on Feb. 28th.
Learn more here!
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