Frozen shoulder and joint pain in menopause: what we really know

Have you started feeling pain in one shoulder out of nowhere, without remembering doing anything unusual? Do you notice that some movements that used to be automatic — fastening a bra, reaching for something on the back seat of the car — have become a small torture? Maybe you also have knee pain, sore hands when you wake up, a diffuse stiffness that you feel in the morning and that eases after a few hours of movement.

If you’re in perimenopause or menopause, this isn’t a string of coincidences. The scientific literature of the last few years has begun to recognize what is now called the musculoskeletal syndrome of menopause, a clinical picture in which joint pain, stiffness, and in some cases frozen shoulder are directly linked to declining estrogen.

This article explains what is happening to your musculoskeletal system in this phase, why it happens, and what the concrete options are for facing the problem rather than resigning yourself to the idea that “it’s just the years going by.”

The musculoskeletal syndrome of menopause: what we’re talking about

For years, joint pain in menopause was dismissed as a generic part of aging. More recently, an important body of literature, summarised in a 2024 publication in the journal Climacteric by Vonda Wright and colleagues, has proposed speaking of a true musculoskeletal syndrome of menopause — a picture that includes arthralgia, reduced muscle mass, worsening osteoarthritis, and more specific conditions such as adhesive capsulitis, commonly known as frozen shoulder.

The starting point is that around 50% of women in menopause report significant joint pain. It is not a marginal symptom — it is one of the most widespread, and yet also one of the least talked about in the media and least investigated in routine medical consultations, where attention tends to focus on hot flashes.

Why estrogen protects the joints

Estrogen does not only deal with the menstrual cycle and fertility. It is a hormone that acts systemically, and in particular plays an important role in the health of connective tissue, tendons, ligaments, articular cartilage, and muscles. To go deeper into how these hormones work in the female body, you can read our article dedicated to estrogen.

When estrogen is present at adequate levels, it supports collagen synthesis in connective tissue, keeps tendons and ligaments elastic and resilient, modulates inflammation, supports articular cartilage, and contributes to muscle strength. When levels drop significantly, as happens in menopause, all of these processes slow down or are altered.

The most typical effects are three. Articular cartilage becomes less resilient and more vulnerable to wear. Connective tissue loses elasticity, and tendons and ligaments become stiffer and more prone to chronic inflammation. Muscle mass declines at an accelerated rate — a phenomenon research calls menopausal sarcopenia — reducing the dynamic support of the joints.

The practical result is a body that inflames more easily, recovers more slowly, and that in the most stressed areas can develop specific clinical pictures.

Frozen shoulder: the most studied case

Adhesive capsulitis, commonly called frozen shoulder, is a condition in which the capsule surrounding the shoulder joint becomes inflamed, thickens, and undergoes fibrosis. The result is pain that can be intense, especially at night, and a progressive loss of arm mobility. Trivial movements like combing your hair or fastening a bra become impossible or very painful.

Frozen shoulder affects about 2-5% of the general population, but the prevalence increases significantly in women between 40 and 60 years old. This gender and age disproportion has drawn research attention to the role of estrogen.

What the 2024 Duke study says

A retrospective study by Jocelyn Wittstein and colleagues at Duke University, also covered in a National Geographic feature, analysed 1,952 medical records of women between 45 and 60 years old, comparing those on hormone replacement therapy with those who were not. Women not taking HRT were 99% more likely to receive a diagnosis of frozen shoulder than their peers on hormone therapy.

The data does not imply that hormone therapy is indicated as a specific treatment for frozen shoulder, and the authors themselves are cautious in their interpretation. What the study shows solidly is that there is a robust correlation between estrogenic protection and reduced incidence of this condition — a correlation that opens new clinical perspectives and justifies the lines of research currently underway, including the University of California San Francisco trial assessing HRT as an adjuvant treatment for adhesive capsulitis.

The molecular mechanism: what happens in the tissue

A 2025 publication in the journal Bone investigated the cellular mechanism by which estrogen protects against capsular fibrosis. The study shows that estradiol acts through a specific receptor called GPER, modulating the PI3K-AKT signalling pathway in synovial fibroblasts. When estradiol is present, this pathway inhibits the transformation of fibroblasts into fibrogenic cells, keeping the joint capsule elastic. When estradiol declines, this biological brake is lost, and fibroblasts produce more type I and type III collagen in a disordered manner, thickening the capsule.

Translated: without estrogen, the capsule tissue has a greater tendency to scar and lose elasticity even in the absence of an obvious trauma. This explains why many women in perimenopause develop frozen shoulder without recalling any triggering event.

The three phases of frozen shoulder

Clinically, frozen shoulder evolves through three typical phases, although the timeframes vary widely from person to person.

In the freezing phase, which on average lasts 2 to 9 months, pain is the dominant symptom. It manifests especially at night, worsens with movements that load the shoulder, and is progressively accompanied by reduced mobility.

In the frozen phase, which lasts 4 to 12 months, pain tends to ease but stiffness becomes the main symptom. The shoulder is significantly limited in both active and passive movements.

In the thawing phase, which can last from 5 months to 2 years, mobility gradually returns, although not always completely without rehabilitation work.

The total duration can therefore exceed two years, with a significant impact on quality of life, sleep, and ability to work, especially for those in manual or care professions.

Beyond the shoulder: the other joint pains of menopause

Although frozen shoulder is the most studied and clinically defined picture, most women in menopause who report joint pain have more diffuse and less localised symptoms.

Hands and fingers

The joints of the hands are particularly sensitive to declining estrogen. Many women report morning stiffness, pain in the finger joints, and intermittent swelling. So-called osteoarthritis of the hands worsens in a statistically significant way in the first years of post-menopause, with an acceleration that then eases over time.

Knees

Knee pain in menopause has multiple compounding causes. Articular cartilage responds to declining estrogen, the weight gain typical of this phase increases load, and reduced muscle mass reduces dynamic support. The result is a joint that inflames more easily and recovers more slowly from effort.

Hips, back, diffuse pain

A significant proportion of women in menopause report migrating or diffuse pain that changes location from week to week, accompanied by a general morning stiffness. This picture can be confused with other conditions, from fibromyalgia to polymyalgia rheumatica, and deserves a clinical evaluation to rule out alternative diagnoses.

When to worry: red flags

Not all joint pain in menopause is explainable by hormonal decline, and some presentations require a more thorough medical evaluation to rule out other pathologies.

It is worth consulting a doctor if one or more of these signs appear:

• Significant and persistent swelling of one or more joints, especially if accompanied by redness and warmth.
• Morning stiffness lasting more than an hour and not resolving with movement.
• Intense night pain that wakes you regularly.
• Rapid or asymmetric loss of mobility, especially in a single joint.
• Associated systemic symptoms such as fever, weight loss, profound fatigue.
• Family history of autoimmune rheumatological diseases.

In these cases, an evaluation including targeted blood tests, possibly a rheumatology consultation, and appropriate imaging is needed.

What you can do: from daily habits to therapies

Movement: the first lever, and one of the most powerful

Regular physical activity is the single most effective intervention for joint pain in menopause, and the literature on this is solid. We’re not talking about extreme training. We’re talking about consistent movement that combines moderate aerobic exercise, strength training, and mobility work. To go deeper on how to structure it, see our article dedicated to physical activity in menopause.

Strength training in particular has direct effects on bone density and muscle mass, two factors that concretely protect the joints. Clinical studies show significant reductions in joint pain even after a few weeks of structured work, especially for knees and back.

Anti-inflammatory nutrition

A diet rich in omega-3 (oily fish, walnuts, flaxseeds), polyphenols (berries, extra virgin olive oil, colourful vegetables), and low in refined sugars and alcohol has been documented to reduce systemic inflammation markers. To go deeper, see our guide to nutrition in menopause.

Weight and load management

Every extra kilo translates into a significant additional load on the weight-bearing joints, particularly knees and hips. This doesn’t mean that the priority must be losing weight at all costs — it means that working on body composition, maintaining or increasing muscle mass and managing visceral fat, has direct effects on joint pain.

Hormone replacement therapy: the individual evaluation

The data we have on frozen shoulder and the musculoskeletal syndrome of menopause more generally suggest that HRT, when indicated, can play a protective role. This doesn’t make it a universal treatment for joint pain, but it represents an additional element to consider in the overall clinical evaluation. The decision requires a detailed conversation with a menopause specialist who evaluates the individual risk profile, the symptoms present, and the goals of therapy. To learn more, see our guide to hormone replacement therapy.

Targeted physiotherapy, injections, surgery

For frozen shoulder in particular, physiotherapy carried out by a therapist experienced in adhesive capsulitis is the cornerstone of treatment. Progressive mobilisation exercises, performed consistently, significantly accelerate the recovery of mobility.

Ultrasound-guided intra-articular corticosteroid injections can reduce pain in the more acute phases. In cases that do not respond to conservative treatment, capsular hydrodistension or mobilisation under anaesthesia remain options available to the orthopaedic specialist.

Supplements: what the science says

Many supplements are advertised for joint pain, and the quality of the evidence varies widely from product to product. Among those with more solid data in the menopause context are vitamin D (whose dosage should always be verified with a blood test), omega-3, magnesium for the muscular component, and hydrolysed collagen, where research is still evolving. For a more complete overview, see our guide to supplements in menopause.

Pausetiv’s integrated approach

Joint pain in menopause is rarely an isolated problem. It often intertwines with hormonal imbalances, changes in weight and body composition, sleep quality, and physical activity levels. That’s why at Pausetiv musculoskeletal pain is addressed within a comprehensive clinical evaluation that integrates a gynecologist specialised in menopause, an endocrinologist, and a nutritionist, in dialogue with an orthopaedic or physiatric specialist when the picture requires it.

An endocrinology consultation can help to frame the overall hormonal profile, evaluate whether hormone therapy is appropriate, and investigate possible co-causes such as thyroid issues or vitamin D. A gynecology consultation with a menopause specialist allows the pieces of the puzzle to be put together — from vasomotor to musculoskeletal symptoms — and a coherent plan to be built.

Conclusion: joint pain in menopause is not just a matter of age

If you have started having joint pain alongside the first changes in your cycle, hot flashes, or other symptoms of the hormonal transition, the connection is very likely to be real and not coincidental. The musculoskeletal syndrome of menopause is a clinical picture recognized by the most up-to-date scientific literature, and it has concrete answers.

What makes the difference is not resigning yourself to the idea that “it’s just the years going by.” It is the hormones that are changing, and that changes the physiology of your musculoskeletal system. Understanding what is happening is the first step toward acting in an informed way — both with daily habits and, when appropriate, with a structured clinical pathway.

At Pausetiv we work to offer Italian women the specialist care they deserve, based on the best available scientific evidence. To find out where to start, explore all our services or book an evaluation with the specialist most suited to your case.

FAQ: frequently asked questions about frozen shoulder and joint pain in menopause

How common is frozen shoulder in women in menopause?

Adhesive capsulitis affects about 2-5% of the general population, but the prevalence is significantly higher in women between 40 and 60 years old. The 2024 Duke study on nearly 2,000 patients showed that women not taking hormone replacement therapy were 99% more likely to receive a diagnosis of frozen shoulder compared to those on HRT.

Can hormone replacement therapy cure frozen shoulder?

HRT is not currently prescribed as a specific treatment for frozen shoulder. The available data does, however, suggest a significant protective effect, and clinical trials are underway evaluating its role as adjuvant therapy. The decision on HRT requires an individualized evaluation with a menopause specialist who takes the whole clinical picture into account.

How long does frozen shoulder last?

The full course typically unfolds in three phases (freezing, frozen, thawing) and can last from 18 months to over 2 years in total. Early and targeted physiotherapy can significantly accelerate recovery. Uninterrupted treatment and timely diagnosis are the two factors that make the biggest difference to duration.

Can I exercise if I have joint pain in menopause?

Yes, and in general you should. Regular physical activity is one of the most effective documented interventions to reduce chronic joint pain in menopause, especially when it combines strength work, moderate aerobic exercise, and mobility. The important thing is to set up the program with a professional who takes your specific situation into account, avoiding loads that are too aggressive in acute pain phases.

What tests should I do if I have diffuse joint pain in menopause?

An initial evaluation should include basic blood tests (complete blood count, inflammation markers such as ESR and CRP, vitamin D, thyroid function) and, if the picture suggests it, specific tests for rheumatological diseases. A consultation with a gynecologist specialised in menopause or with an endocrinologist can help to frame the hormonal component, while an orthopaedic or rheumatological evaluation is indicated when specific red flags are present.

Do joint supplements really work?

The evidence varies widely from product to product. Vitamin D (with personalised dosage based on tests), omega-3, magnesium, and hydrolysed collagen have more solid data than other heavily marketed compounds. Supplements are a support tool, not a substitute for movement, nutrition, and any clinical therapy.

Can frozen shoulder come back after it has resolved?

Recurrence on the same shoulder is uncommon. It is, however, relatively frequent for the condition to develop subsequently on the contralateral shoulder, in some cases months or years later. This data reinforces the hypothesis of a systemic and hormonal predisposition, and justifies clinical attention even after the first episode has resolved.

Scientific sources

All sources are peer-reviewed or guidelines from international medical societies. The Pausetiv clinical protocol is developed in compliance with IMS and EMAS guidelines.

• Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466-472. https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2380363
• Wittstein JR et al. Association between menopausal hormone therapy and adhesive capsulitis: retrospective study of 1,952 patients. Presented at the NAMS congress, October 2024. Duke Health press release: https://ortho.duke.edu/blog/jocelyn-wittstein-study-connects-estrogen-and-frozen-shoulder-menopausal-women
• Mechanistic insights into the anti-fibrotic effects of estrogen via the PI3K-Akt pathway in frozen shoulder. Bone, 2025. https://pubmed.ncbi.nlm.nih.gov/40095380/
• Navarro-Ledesma S. Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications. J Clin Med. 2025;14(20):7315. https://pmc.ncbi.nlm.nih.gov/articles/PMC12564958/
• Chidi-Ogbolu N, Baar K. Effect of estrogen on musculoskeletal performance and injury risk. Front Physiol. 2018;9:1834. https://pmc.ncbi.nlm.nih.gov/articles/PMC6341375/
• EMAS (European Menopause and Andropause Society). Position statements and clinical guides. https://emas-online.org/publications/
• International Menopause Society (IMS). 2023 Practitioner’s Toolkit for Managing Menopause. https://www.imsociety.org/wp-content/uploads/2023/12/The-2023-Practitioner-s-Toolkit-for-Managing-Menopause.pdf
• National Geographic. Frozen shoulder is real. Here’s how it affects you during menopause. 2025. https://www.nationalgeographic.com/premium/article/frozen-shoulder-menopause-hormones
• UCSF Adhesive Capsulitis of the Shoulder Trial: Frozen Shoulder and Hormone Replacement Therapy. ClinicalTrials.gov, NCT07278323. https://clinicaltrials.ucsf.edu/trial/NCT07278323

Article written by the Pausetiv team. The information provided is for educational purposes only and does not replace the advice of a healthcare professional.