The Surprising Perimenopause Condition That Can Freeze Your Shoulder

When Liz Gumbinner first noticed a twinge in her right shoulder, she assumed she’d pulled a muscle. It was during the pandemic, when many exercise studios were closed, and Gumbinner, a writer who teaches advertising at Boston University, had been doing a lot of yoga and dance at home. But the pain, mild at first, gradually became excruciating, shooting down her arm whenever she extended it. “We're talking worse than labor contractions,” she says. Pretty soon, Gumbinner couldn’t zip up a dress, turn off a light switch on the wall, or even hold hands with her boyfriend. The only way she could sleep was flat on her back with her arms at her sides. “That's when I realized it wasn't a pulled muscle,” she says. A few months later, she was diagnosed with adhesive capulitis, colloquially known as “frozen shoulder,” a condition in which the shoulder capsule—a fibrous sheath which surrounds the joint—becomes thick and inflamed. It usually develops in three phases: the freezing stage, which can last several months and cause severe pain; the frozen stage, during which the shoulder becomes stiffer and difficult to use, often for up to a year; and the thawing stage, when mobility finally begins to improve. In most cases, frozen shoulder is not caused by an external injury or trauma, says Dr. Jocelyn Wittstein, a sports medicine specialist and associate professor of orthopedic surgery at Duke University. Instead, patients often experience a sudden, spontaneous onset of pain, “and they’re kind of wondering, ‘What could I have possibly done to my shoulder?’” she says. Women in mid-life are most at risk Frozen shoulder affects around 2-5% of the population, and occurs more frequently in women, predominantly those from ages 40 to 60. It’s also more common in people with endocrine disorders, like diabetes and thyroid disease.During perimenopause and menopause, the loss of estrogen—which plays a key role in protecting musculoskeletal tissue—can lead to inflammation and loss of elasticity throughout the body. This hormonal shift can also cause metabolic changes, making women more susceptible to thyroid disease and diabetes. “There's likely a combination of things going on,” says Wittstein. “There's withdrawal of estrogen and the effect on the joint lining, but there's also probably some endocrine changes happening.”Gumbinner, who hit perimenopause during the pandemic, had never heard of frozen shoulder before. “Here we are, with yet another ailment that impacts middle-aged women that gets no attention,” she says. Women who are being treated for breast cancer are also “a special at-risk population for frozen shoulder,” Wittstein says. Many take a kind of hormone therapy called aromatase inhibitors, which drastically decreases estrogen and can cause joint and muscle pain. Early diagnosis can be crucialThe earlier you catch frozen shoulder, the easier it can be to resolve, Wittstein says. “If you get into where you have really significant loss of motion, not just the early loss of motion, it takes longer to get better,” she explains.The problem is that if you’re unfamiliar with the condition, you might mistake it for something else.“We call it ‘the great mimicker,’ because it can look like everything,” says Dr. Stephanie Wong, an orthopedic surgeon and sports medicine specialist at UCSF. “It looks like a rotator cuff tear, it looks like biceps tendonitis.”That’s why it’s important to get evaluated by an orthopedic surgeon or shoulder specialist as soon as possible. “It’s a very straightforward diagnosis for us,” Wong says. The giveaway, she explains, is that not only will the patient be unable to move their arm during a physical exam, but another person won’t be able to either. “So when I try to raise your arm up, your arm is literally frozen,” she says. An X-ray or MRI can be helpful in ruling out other conditions, Wong says, but “it’s really a clinical diagnosis.” New treatment may be on the horizon The standard of care for frozen shoulder is physical therapy and anti-inflammatory injections into the joint; the majority of people get better with these interventions, Wong says, though “it can just take a really long time.” Most people recover within one to three years, and requiring surgery is rare, she adds: “We reserve that for the very stubborn cases.” Though there isn’t yet enough definitive research to demonstrate that hormone therapy (HT) can help prevent or treat frozen shoulder, the clinical benefits are promising, says Wittstein, who is currently exploring the link; she recently presented new data on more than 10,000 women at the American Orthopedic Society for Sports Medicine suggesting that HT is associated with a reduced risk of developing frozen shoulder.At UCSF, the orthopedic and ob-gyn departments are also investigating whether HT reduces the course of frozen shoulder, which Wong hopes will give women another treatment option. “It’s just so disappointing to have things be chalked up to perimenopause or menopause, and you have to suffer through it,” she says. It’s important, Wittstein says, to recognize that some women, including many breast cancer survivors, may not be able to use HT. “There’s this huge group of women who take a double hit,” she says. “They get early menopause from chemotherapy or they get aromatase inhibitor-associated musculoskeletal syndrome, and then they can't use this medication.”What to do (and not do) Physical therapy for frozen shoulder focuses mainly on stretching and manual therapy, which may differ depending on what stage you’re in, and can often cause discomfort. That’s why it’s important to do it under the guidance of an experienced physical therapist, says Dr. Ariana Lott, an orthopedic surgeon at NYU Langone who specializes in sports medicine. “It’s really hard for patients to do these kinds of movements by themselves,” she says, because “it hurts.” In terms of regular exercise and activity, “I hate to restrict people,” Wong says. “I always say, unless I think it’s really going to do you harm, do whatever’s in your realm of comfort. So if you want to do some light weights, totally fine. If you don’t feel up to that, also totally fine.”The one thing she cautions patients against doing is immobilizing their shoulder by wearing a sling. “Generally, we worry about that making it more stiff,” she explains. Lott reassures her patients that they didn’t cause their frozen shoulder, which she says they can find freeing. “A lot of people place blame, like, ‘Oh, it’s because I did this or I didn’t do this,’” she says. “And it's like, ‘No, actually this is nothing that you did. And we can fix it. It's going to be a long process, but you can't blame yourself, too.’” For Gumbinner, that process is still ongoing. After her original right-side pain finally resolved, it resurfaced again in 2024, this time on the left. Multiple steroid shots, along with heating pads and ibuprofen, have provided stretches of reprieve, but almost two years later, she’s still dealing with it. “I can work around it, but it’s not ideal,” she says. “I just want to be able to slip on a dress again without a whole gymnastics routine.”