Frozen Shoulder: The excruciating but often unrecognized symptom of perimenopause
- Ishaan Bhaduri
- Dec 25, 2025
- 5 min read
Are you in your 40s or 50s and struggling with dull to severe shoulder pain that seems to have crept out of nowhere, limiting your shoulder movement and doing everyday activities like lifting your arm or reaching behind your back hard or excruciating? If so, you might be dealing with a condition colloquially known as ‘Frozen Shoulder’ or ‘adhesive capsulitis.’
The hallmark of frozen shoulder is the progressive limitation of shoulder motion. When the shoulder enters the “frozen” stage, its range of motion becomes significantly limited, making movement exceedingly difficult. About 70% of women experience some form of musculoskeletal symptoms during the transition from perimenopause to post menopause with Frozen Shoulder being one of them. The collective of musculoskeletal symptoms during perimenopause – which include but not limited to arthralgia, frozen shoulder, loss of skeletal muscle mass, progression of osteoarthritis, among others – is influenced by the estrogen loss during perimenopause and menopause.
What is Frozen Shoulder?
Frozen shoulder, also called adhesive capsulitis, is a condition where the capsule of connective tissue surrounding the shoulder joint becomes inflamed and adhesions develop within the joint capsule surrounding the shoulder joint. These adhesions cause the joint capsule to thicken and decrease in size, leading to worsening persistent pain, stiffness, and limited movement of the shoulder.
Frozen shoulder is more common in women between the ages of 40 and 60, especially during perimenopause - the transition period leading up to menopause. It typically develops gradually, often without a clear cause of injury, and can be debilitating, making it harder to lift your arm, or reach behind your back, impacting daily activities like reaching for a seatbelt , dressing, driving and even simple tasks like reaching for a shelf.
Link between Frozen Shoulder and Perimenopause
Given the significant debilitating impact that frozen shoulder can have on the quality of life for women navigating perimenopause it can be empowering for women to be aware of the hormonal link with Frozen Shoulder. Despite being more common in women going through perimenopause and menopause, Frozen shoulder remains poorly understood, often un-recognized with limited research.
Growing evidence indicates that hormonal changes during perimenopause and menopause may be a contributing factor to frozen shoulder. A collaborative study led by Duke Health researchers found a connection between loss of estrogen and frozen shoulder in post-menopausal women.
The hormone Estrogen is known to play a key role in musculoskeletal health – stimulating bone growth, reducing inflammation, and promoting connective tissue integrity. Estradiol, the primary form of estrogen produced during a woman’s reproductive years, helps reduce joint pain by reducing inflammation and changes to cartilage. It also slows the breakdown and remodeling of bone, as well as the destruction of cartilage and reduces the body's inflammatory response.
During perimenopause, estradiol is replaced by Estrone, a weaker form of estrogen. Based on research, estradiol is anti-inflammatory, while Estrone, the dominant estrogen after menopause, is pro-inflammatory, stimulating the inflammatory response. Inflammation is considered one of the causes for Frozen Shoulder.
Who is at risk for Frozen Shoulder?
Frozen shoulder affects about 5% of the general population, with higher risk for those with Diabetes or pre-diabetes, Thyroid disorder, lack of movement after a shoulder injury or surgery, shoulder injury, and autoimmune conditions.
Stages and symptoms of Frozen Shoulder
As the name ‘frozen’ shoulder suggests - when someone gets adhesive capsulitis, the shoulder will go through three key phases: Freeze, Frozen, and Thaw. The symptoms can vary, depending on the stage you are in. The pain in frozen shoulder is usually described as dull or aching and localized in the shoulder region. Patients may feel pain that radiates to the neck or down the arm as nearby muscles work harder to compensate for limited shoulder movement.
Frozen Shoulder progression is divided into four phases:
Phase 1 or Pre-Freezing or Pre-adhesive stage - can last between 0-3 months. This stage is marked by sharp discomfort when reaching the limits of motion and a persistent, dull ache even while at rest. In the pre-freezing stage, sleep disturbances are common.
Phase 2 or Freezing stage - this stage could last between 3-9 months. This is stage where pain starts increasing with a gradual loss of your shoulder motion in all directions because of pain and inflammation in the tissues of the joint capsule (synovitis).
Phase 3 or Frozen stage - this stage can last between 9-15 months. In the frozen phase, the pain can stick around and usually you will have significant loss of shoulder motion. During this phase, inflammation of the synovial membrane subsides while fibrosis of the joint capsule progresses, leading to increased stiffness in the shoulder.
Phase 4 or Thawing stage - this stage could last between 15- 24 months. In the final stage of frozen shoulder, pain gradually subsides, shoulder mobility and function slowly improve, and the stiffness caused by capsular fibrosis begins to lessen.
Available treatment options
Frozen Shoulder usually get better but complete recovery can take up to 3 years. Since there is no clear established cause of Frozen Shoulder, the current treatments for frozen shoulder focus on relieving symptoms. Some of the treatments available that could help you manage the pain and regain movement include physical therapy, pain relief medications like aspirin and ibuprofen, Cortisone injections, heat, and cold therapy, and in severe cases, shoulder surgery.
Some women also consider Hormone Replacement Therapy (HRT) to support their bone and muscle health in perimenopause. While research does not clearly show that HRT reduces one’s risk of developing frozen shoulder, many women feel better when they take it.
It does get better over time.
The hallmark of Frozen Shoulder is its progressive limitation of shoulder motion. Once the shoulder reaches the “frozen” stage, movement becomes severely restricted and difficult to perform. Although Frozen Shoulder is painful and frustrating, it does not last forever. Most of the range of motion returns in 3-4 years. The objective of this period is to avail ourselves of the treatments available for managing the symptoms and pain.
References
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“Hormone Therapy Appears to Reduce Risk of Shoulder Pain in Older Women” Duke Health, 11 Oct 2022, https://corporate.dukehealth.org/news/hormone-therapy-appears-reduce-risk-shoulder-pain-older-women (last accessed 2 Nov 2025)
Sasser, Beau. “Frozen Shoulder: you'd rather it was just cold.” Sports Medicine Blog, Southeast Georgia Health System, https://www.sghs.org/sports-medicine-blog/posts/frozen-shoulder-youd-rather-it-was-just-cold/ (last accessed 2 Nov 2025)
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