Frozen shoulder and menopause: is there a link, and what helps?

It might have started as a niggle when you reached for your seatbelt. Now you can't do up your bra, brush the back of your hair or reach a high shelf. The ache is worst at night, and you can't find a comfortable way to lie.

That's what frozen shoulder can feel like. Many women notice it in their 40s and 50s, and wonder about a link between frozen shoulder and menopause. There's good reason to ask. NHS leaflets say women aged around 40 to 60 are the people most likely to get it.

But the honest answer is that the menopause link isn't proven yet. Here's what we know, what helps, and when to get help.

What is frozen shoulder?

Your shoulder joint sits inside a bag of tissue called the capsule. Normally it's loose and stretchy. With frozen shoulder, the NHS says this tissue becomes inflamed, then tightens and shrinks. That causes pain and stiffness.

The main signs are:

• pain in your shoulder, which is often worse at night and can disturb your sleep
• stiffness that makes it hard to move your arm, especially reaching up or behind you
• trouble with everyday things, like getting dressed, bathing, driving or lying on that side (NHS Grampian)

A leaflet from the Royal United Hospitals Bath notes that the night pain isn't only there when you lie on the sore shoulder.

Is frozen shoulder linked to menopause?

Frozen shoulder clearly favours women in midlife. A King's College Hospital leaflet says women aged 40 to 59 are at the highest risk. That's the same age as perimenopause and menopause, so researchers have started asking whether falling oestrogen plays a part.

So far, the evidence is early:

• A small US study looked at the records of 1,952 women aged 45 to 60. Frozen shoulder was found in 4% of women taking HRT and almost 8% of those who weren't. But the result wasn't strong enough to rule out chance, and the authors called it preliminary. It was presented at a conference, not published as a full paper.
• The same Duke University team suggested that oestrogen might help protect against it, but a study of records can only show a link. It can't prove one thing causes another.

So it's fair to say frozen shoulder is more common at the age of menopause. It's too early to say menopause causes it, or that HRT prevents it.

What else raises the risk?

The NHS says it's often unclear why frozen shoulder starts. Things known to make it more likely include:

• Diabetes. The NHS says it's important to keep up with your diabetes check-ups.
• Thyroid problems, either an overactive or underactive thyroid (Kingston and Richmond NHS).
• Keeping your arm still for a long time, for example after an injury, a broken arm or surgery.
• Heart disease, smoking and Parkinson's disease, according to the Kingston and Richmond leaflet.

What else could be causing my shoulder pain?

Not every sore shoulder is frozen shoulder. A 2018 review by Oxford rheumatologist Dr Fiona Watt notes that rotator cuff problems (in the tendons around the shoulder) are a common cause of shoulder pain at this age. Arthritis and general menopause joint pain can also make shoulders ache.

The difference matters, because the right exercises aren't the same for each. That's why it's worth getting a GP or physiotherapist to look at it.

How long does frozen shoulder last?

Frozen shoulder usually gets better on its own, but slowly. The NHS says it can take months or years. Most NHS leaflets describe three stages:

Stage	What happens	Roughly how long
Freezing	Pain builds and movement gets less	6 to 9 weeks
Frozen	Pain may ease, but the shoulder gets stiffer	4 to 6 months
Thawing	Movement slowly comes back	6 months to 2 years

These timings come from the Kingston and Richmond leaflet, which says recovery takes anything from 6 months to 3 years. Other NHS leaflets give longer stages, and NHS Grampian says recovery tends to take 18 to 36 months. Everyone is different.

What helps frozen shoulder?

Things you can do yourself

The NHS suggests:

• Keep moving your shoulder. Keeping it still makes the pain worse.
• Take paracetamol regularly, up to the recommended daily dose. Ask a pharmacist if you're not sure what's right for you.
• Use heat. A heat pack or hot water bottle wrapped in a tea towel, for up to 20 minutes at a time.
• Don't make up your own hard workouts. The NHS warns that gym equipment can make the pain worse.

The Bath leaflet says that in the early, painful stages you should move the shoulder little and often, and only as far as is comfortable. Its exercises include gentle swinging, where you let your arm hang and move like a pendulum. Strengthening work comes later, as movement returns.

What a GP or physio can offer

The NHS describes a step-by-step approach:

1. Pain relief, starting with paracetamol, then anti-inflammatory painkillers such as ibuprofen if needed.
2. Stronger painkillers or a steroid injection into the shoulder. NHS Grampian says the effect of an injection usually wears off after about 6 to 12 weeks, so keep up your exercises.
3. Gentle exercises at home, and a referral to a physiotherapist if the pain carries on. The NHS says physio usually lasts at least 6 weeks. NHS Grampian is honest that physio doesn't make recovery quicker, but it can help you manage the symptoms and keep your strength.

If none of this helps, a specialist may talk to you about other options. These include hydrodilatation (an injection that stretches the capsule) or keyhole surgery to release it. A large UK trial called UK FROST compared keyhole surgery, moving the shoulder under anaesthetic, and physio with a steroid injection. After a year, none was better than the others by enough to make a real difference to patients.

Should I ask about HRT?

NICE says doctors should offer HRT for hot flushes and night sweats. If you have those as well, it's worth discussing. But there's no good evidence yet that HRT treats frozen shoulder, so it isn't a reason to start HRT on its own.

Frozen shoulder pain at night

Night pain is one of the hardest parts. The Kingston and Richmond leaflet says it's common and can disrupt your sleep. Things that may help:

• ask your physio about the most comfortable way to lie and support your arm
• use your heat pack as part of winding down before bed
• keep to a regular bedtime and getting-up time, and keep your bedroom cool, dark and quiet, as Women's Health Concern suggests for menopause sleep problems
• if you're lying awake and frustrated, get up and do something calm until you feel sleepy again

When to see a GP

The NHS says to see a GP if:

• you have shoulder pain and stiffness that doesn't go away
• the pain is so bad it's hard to move your arm and shoulder
• it's still bad after physiotherapy (go back to your GP or physio)

You can also talk to your GP about any other menopause symptoms at the same appointment.

Where relaxation fits in

Frozen shoulder can mean months of broken nights. If shoulder pain is keeping you awake at night, our menopause sleep hypnosis, Deep Sleep Through the Change, is a bedtime recording to help you relax and drift off once you're settled. It won't do anything for the shoulder itself, so keep up your exercises and your physio. It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.

Related

You might also find our pages on menopause joint pain, hip pain in menopause and the musculoskeletal syndrome of menopause useful, or see all the perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms