Shoulder Pain During Perimenopause: Understanding the Hormonal Link
Shoulder pain and frozen shoulder are more common during perimenopause than most women realise. Find out why, and what you can do to manage it.
Why Shoulders Are Vulnerable During Perimenopause
Adhesive capsulitis, commonly known as frozen shoulder, peaks in women between the ages of 40 and 60, which overlaps closely with perimenopause. Research suggests that falling estrogen increases the risk of capsular thickening and tendon inflammation in the shoulder. Estrogen helps maintain collagen quality in connective tissue, so as levels decline, tendons and the shoulder capsule can become stiffer and more prone to irritation. Wider musculoskeletal inflammation driven by hormonal fluctuation also puts the shoulder at risk.
What Shoulder Pain in Perimenopause Looks Like
Symptoms vary depending on the underlying issue. Frozen shoulder typically starts with a deep aching pain, particularly at night, followed by a gradual loss of range of movement over weeks to months. Rotator cuff tendinopathy causes pain on specific movements, especially lifting the arm above shoulder height or reaching behind the back. Some women experience a diffuse aching across both shoulders that is harder to pinpoint and tends to move around, which is more typical of general inflammatory joint changes. Night pain that disrupts sleep is one of the most common and frustrating features.
When to Seek Medical Assessment
See your doctor if shoulder pain is severe, if you are rapidly losing the ability to move your arm, or if pain does not respond to simple measures after four to six weeks. Early physiotherapy for frozen shoulder significantly reduces the length of the condition. Your GP can also exclude other causes such as referred pain from the cervical spine, rotator cuff tears, or shoulder joint osteoarthritis, all of which require different treatment approaches.
Physiotherapy and Movement
Physiotherapy is the cornerstone of treatment for perimenopausal shoulder pain. A physio can assess which structures are involved and design a targeted rehabilitation programme. Gentle range-of-motion exercises done daily prevent the stiffness from progressing. Pendulum exercises, wall walks, and passive stretching with support are standard early-stage approaches. Once pain settles, rotator cuff strengthening with resistance bands helps restore stability. Avoid complete rest, as immobility worsens adhesive capsulitis.
Heat, Supplements, and Lifestyle Adjustments
Heat applied to the shoulder before exercise loosens the joint capsule and makes movement easier. For acute inflammatory flares, ice for 10 to 15 minutes can reduce swelling. Magnesium and omega-3 supplementation may reduce the background inflammation that makes perimenopausal joint pain more persistent. Adjusting your sleep position to avoid lying on the affected shoulder, using a supportive pillow, and being mindful of posture at a desk can all help reduce daily loading on the joint.
Medical Treatment Options
A corticosteroid injection into the shoulder joint can provide significant short-term pain relief and is particularly useful in the early painful phase of frozen shoulder, allowing physiotherapy to progress. HRT has helped some women with perimenopausal shoulder pain, likely through its effects on connective tissue quality and overall inflammation. If frozen shoulder does not respond to conservative treatment after several months, a hydrodilatation procedure (injecting fluid to stretch the capsule) or surgical release may be considered by a specialist.
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