Perimenopause and Frozen Shoulder: Why This Painful Condition Strikes During the Transition

Why Frozen Shoulder Hits More Often During Perimenopause

Frozen shoulder, the medical term is adhesive capsulitis, is a condition in which the connective tissue capsule surrounding the shoulder joint thickens, tightens, and fills with scar tissue. The result is a shoulder that becomes progressively more painful and then increasingly immobile, sometimes to the point where you cannot lift your arm past waist height.

Most people are surprised to learn that frozen shoulder disproportionately affects people in perimenopause. Research has confirmed that the condition peaks in the 40 to 60 age range, and that women, particularly those in the perimenopause transition, are affected at roughly twice the rate of men.

This is not a coincidence. Estrogen receptors have been identified in the connective tissue of the shoulder capsule and in the tendons of the rotator cuff. When estrogen levels decline and fluctuate, these tissues may become more vulnerable to the inflammatory process that initiates frozen shoulder. It is the same mechanism that contributes to joint pain and tendon problems throughout the body during this transition.

The Three Stages: What Frozen Shoulder Actually Feels Like

Frozen shoulder typically progresses through three distinct stages, and understanding them helps you know what to expect and how to respond at each point.

The first is the freezing stage, which lasts roughly two to nine months. Pain develops gradually, often starting at night or with reaching movements. The pain is often worst at the beginning of this stage. Range of motion begins to decrease. This is when many people first seek medical care, and also when treatment is most effective at changing the trajectory.

The second is the frozen stage, lasting four to twelve months. Pain often decreases somewhat in this phase, but stiffness is at its worst. Daily tasks like fastening a bra, reaching overhead, or brushing your hair become difficult or impossible. While this stage feels discouraging, it is normal progression.

The third is the thawing stage, lasting five to twenty-four months. Range of motion gradually returns. This is the longest and in many ways the most hopeful phase, though recovery can feel frustratingly slow.

Total duration varies widely from person to person. Most cases resolve within one to three years, though some people experience residual stiffness or recurrence.

Getting a Diagnosis: What to Tell Your Doctor

Treatment Options: From Conservative to Medical

The evidence on frozen shoulder treatment is genuinely mixed, and what works varies from person to person. What is clear is that doing nothing tends to result in a longer and more painful course.

Physical therapy is the cornerstone of treatment. A physiotherapist experienced with frozen shoulder will guide you through gentle range-of-motion exercises during the freezing stage and more active mobilization during the thawing stage. Pushing too hard too early can increase inflammation. The right physiotherapist knows how to progress treatment appropriately.

Corticosteroid injections into the shoulder joint can provide significant pain relief and may shorten the duration of the freezing stage, particularly when given early. The evidence for injections is strongest in the first stage of the condition. Multiple injections are sometimes needed.

Hydrodilation, in which fluid is injected into the joint capsule under imaging guidance to stretch it, is another option that some people find helpful. The evidence is less consistent than for corticosteroids, but it is a reasonable choice if other approaches have not provided relief.

In severe or prolonged cases, surgical options including manipulation under anesthesia or arthroscopic capsular release are available. These are generally reserved for cases that have not improved after 12 to 18 months of conservative treatment.

How to Exercise Safely During Recovery

One of the most common mistakes people make with frozen shoulder is either doing nothing for fear of making it worse, or pushing through pain in the belief that they need to force the joint to move. Both approaches tend to prolong recovery.

During the freezing stage, gentle pendulum exercises and pain-free range-of-motion work are generally appropriate. The goal is not to push your range but to maintain blood flow and prevent further capsule tightening. Your physiotherapist will guide you on the appropriate intensity.

During the frozen stage, when pain has decreased but stiffness is maximal, more active stretching and range-of-motion work becomes appropriate. Wall walking, pulley exercises, and cross-body stretches are commonly used. Again, these should be guided by a physiotherapist who can monitor your progress.

For the rest of your fitness, you can often continue lower body training, core work, and cardiovascular exercise throughout recovery. Keeping your overall fitness up supports healing and mental health during what can be a long and frustrating process.

If strength training is part of your routine and you want to continue, your physiotherapist can help you modify exercises to avoid loading the affected shoulder while keeping the rest of your body strong.

The Connection to Other Perimenopause Joint Symptoms

Frozen shoulder does not exist in isolation. The same hormonal environment that increases the risk of frozen shoulder also contributes to the joint pain, tendon stiffness, and general musculoskeletal discomfort that many people experience throughout perimenopause.

Estrogen plays a role in collagen synthesis, tendon health, and joint lubrication. As estrogen declines, tendons may become less elastic and more prone to injury, cartilage may thin, and synovial fluid production may decrease. This can manifest as general joint pain, trigger finger, carpal tunnel syndrome, and yes, frozen shoulder.

If you are experiencing multiple joint or tendon issues simultaneously during perimenopause, this is worth mentioning to your doctor as part of a broader hormonal picture, not just treating each joint problem in isolation.

Some people find that hormone therapy improves their general musculoskeletal symptoms, though the evidence specifically for frozen shoulder is limited. It is a reasonable topic to raise with a menopause specialist, particularly if you have multiple joint-related complaints.

Managing the Emotional Side of Frozen Shoulder

A shoulder condition that lasts one to three years and affects your ability to do basic daily tasks is not just a physical problem. It affects your sleep, your exercise routine, your work, and your sense of capability.

Many people with frozen shoulder develop depression or anxiety during the course of the condition, and this is understandable. The pain disrupts sleep. The inability to exercise in your usual way affects mood. The slow pace of recovery is genuinely frustrating.

Acknowledging this is important. Ask for support, whether that is from your physiotherapist about adapting your exercise, from your doctor about pain management, or from a therapist or counselor if the emotional weight is significant. You do not have to wait until you are at a breaking point.

Practical adaptations help. Voice assistants and hands-free tools reduce strain. Sleep positioning with a pillow under the affected arm reduces nighttime pain for many people. Ice or heat depending on which provides you relief can manage day-to-day discomfort.

Timeline Expectations: What Recovery Actually Looks Like

One of the most important things to understand about frozen shoulder is that recovery is rarely linear. You may have weeks of improvement followed by weeks of plateau or slight regression. This is normal and does not mean treatment is failing.

Most people see meaningful improvement within 12 to 18 months from the onset of symptoms, though complete resolution can take up to three years. Early treatment, including physiotherapy and corticosteroid injections during the freezing stage, tends to shorten this timeline.

It is also worth knowing that roughly 20 to 30 percent of people with frozen shoulder in one shoulder develop it in the other shoulder within five years. This is not something to be alarmed by, but it means that if you develop shoulder pain on the other side, you should seek evaluation early rather than waiting to see if it passes.

Keeping a simple log of your pain levels and range of motion milestones can help you see progress that is otherwise hard to notice when you are living through it day by day.

Working With Your Healthcare Team

Frozen shoulder recovery benefits from a team approach. A physiotherapist experienced with adhesive capsulitis should be the primary guide for your physical rehabilitation. Your general practitioner or a sports medicine or orthopedic specialist can manage pain interventions and consider whether imaging or injection is appropriate.

If you are in perimenopause, a menopause specialist or gynecologist may be worth consulting, particularly if you have multiple musculoskeletal symptoms. The hormonal context of your shoulder condition is relevant to your overall care.

Be your own advocate. Ask questions. If progress stalls after several months of consistent physiotherapy, ask about additional interventions. If pain is not adequately controlled, ask about stronger options. Your discomfort matters and your recovery timeline matters.

PeriPlan can help you track your shoulder symptoms alongside your other perimenopause symptoms, which can help you and your providers understand the full picture of what you are experiencing.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.