Part 1: Frozen shoulders everywhere...
It’s become abundantly clear recently that a lot of people who are in perimenopause are also suffering from frozen shoulder — and really struggling to find help.
And although this condition is increasingly being referred to as a menopause symptom, I’m not at all sure about that. When there are so many possible causes, some of them directly connected to more serious problems down the road, I think calling this a “menopause symptom” – is short-sighted and possibly dangerous.
Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain, stiffness and immobility in one or both shoulders. Symptoms can develop gradually or come on suddenly. I’ve been hearing about frozen shoulder more and more in recent years; first from the physiotherapists I’ve seen for my own shoulder issues – in 2018 I dislocated both of mine while in puppy pose, an incident I suspect had something to do with perimenopause – as well as anecdotally and through my work with Hotflash inc. This summer in Canada I met someone who had two frozen shoulders, and lost months of her life to it.
No matter how old you are, having something wrong with your shoulders is really life-altering. This is the core of our stability – and survival: we are really unable to do much when our shoulders are weak or immobile. We would not have made it on the savannah, and I think this is part of the reason that people find these injuries so devastating. (I’ve been there. It was very dark.)
The commonly cited statistic I could not track down is that 75 percent of cases are in women. It does seem most everyone recognizes that women ages 40 to 60+ are most affected by this painful and movement-limiting condition. What’s really perplexing is that even though this was first diagnosed almost 100 years ago, the party line is that no one really understands exactly why it happens. This is why it’s called “ideopathic”.
(Side note: The more research I do, the more I see this sort of explanation for syndromes and situations in the body, and the less I actually believe it. Daily my respect grows for these beautiful machines we live in: our bodies are a gorgeous, awe-inspiring, magnificently designed orchestra always trying to get back into balance – which is at the core of what’s happening in this entire peri/menopause transition. There has to be a reason when we malfunction. Often the causes are multifactorial, which is why I think the mainstream medical establishment misses so often, being overly focused on our various parts as they tend to be. But also, no one’s really been studying women, have they? We’ve got entire books on that subject.)
Without a clear consensus for why it happens, research has been choppy and treatments hard to come by. And so it took until 2022 to get the first known study connecting estrogen and frozen shoulder, conducted by researchers at Duke University in the US and presented to the annual meeting of the North American Menopause Society in October.
The Duke researchers worked on a hunch that it has something to do with menopause-related reduction in estrogen, which has a major role in the functioning of our entire musculoskeletal system. The study gleaned enough from its 2,000 subjects to determine that those not on hormone therapy had a greater chance of getting frozen shoulder, and that taking estrogen had a greater protection against it.
Co-author, Dr Anne Ford of Duke University Medical Center, explains from her perspective why this research has been such a long time coming: “As a female orthopedic surgeon in a field that is 94 percent male, I feel it is important to study sex-specific factors and treatment strategies that may benefit women with adhesive capsulitis. A disease that has such a strong predilection for women is unlikely to be truly idiopathic."
When I posted about frozen shoulder on social media, I heard from several women who said going on hormone therapy really helped. And of course if you are on MHT and don’t have frozen shoulder, hurray. But as I learned over the last week, estrogen is just one part of the story. (And if you are looking at the body holistically, as the integrative/functional/naturopathic world does, of course it is). There seems to be range of causes. There is period of immobility, and that often-cited chestnut, inflammation. But the literature reveals links to thyroid dysfunction and diabetes, as well as a range of other conditions impacting the heart, brain and so on. Research shows the prevalence of hypothyroidism is significantly higher in people with frozen shoulder, almost three times higher in this study. It also found a trend toward high serum levels of thyroid-stimulating hormone (TSH) in more severe cases, as well as cases impacting both shoulders.
In a recent IG video, Dr Tyna Moore, an American naturopathic physician and chiropractor intensely focused on metabolic health, calls frozen shoulder “100 percent, all the time, a hormonal issue”. In her clinical experience, the culprits are in this order: thyroid, hormones and third, “nine times out of 10”, metabolic health. She argues it’s never just about biomechanics, even if it seems that there was some sort of “traumatic insult” or inciting incident that’s easy to blame.
“It’s like the straw that breaks the camel’s back: Female, middle age, hormones are sitting on the edge, and then she reaches for something,” she explains.
If you follow Dr Tyna, you’ll see her focused on weightlifting, being outdoors, eating real food and more. It’s all very reasonable stuff. (She has been wildly controversial for her Covid posts, but I’ll leave it to you to decide whether that counts her out of all conversations.)
Her advice for frozen shoulder? “Get your hormones in order, get your metabolic health in order, keep it moving, and make sure you have a professional helping you keeping mobility in that shoulder.”
That same week Dr Carrie Jones, another American naturopath, turned to her IG followers for help after waking up with an immobile and painful shoulder – and got a barrage of info and tips and suggestions. She updated them later after a visit to a chiropractor, where she learned she’d actually partially dislocated it in her sleep and it slipped back into place on its own after she had a cortisone shot.
Still, like my two dislocated shoulders: it’s kind of strange to have that happen while sleeping, no? Could frozen shoulder not be the only shoulder issue impacting us?
Next week: I’ll tackle what the medical community thinks and look at treatment options.
Got a frozen shoulder story? Hit reply and tell me or drop a comment and share with the perimenoposse - maybe someone out there has a solution we haven’t heard about yet.
Frozen shoulder is no fun. It's been just over 3 years since slight pain while working out developed to painful, debilitating frozen shoulder (which I had never heard of before). Physical therapy, 2 capsular distention procedures. After 2 years, I was able to hook my bra! Now, I have 97% mobility, still discomfort when I lift my arm all the way up. Started HRT 2 months ago, no change so far. I was told if you've had it, you're more likely to get it again (in other shoulder?). With pain twinges in the future, I will rush to physical therapy (if possible, but the medical/referral machine is *slow*!) & stretch, stretch!