Emma Mapp felt a dull ache in the center of her left shoulder and thought she had simply strained a muscle while working out at the gym.
But within a month that ‘little problem’ had worsened to the point that Emma could no longer lift her left arm or turn her neck, and she had difficulty washing and dressing herself.
‘I limited my social life because I was afraid someone would bump into my shoulder and that would be very painful,’ says Emma, 52, a lawyer from Twickenham.
‘When I did go outside, I wore a sling over my jacket so that people were warned that I was injured and to be careful around me.’
Ultimately, Emma was diagnosed with frozen shoulder: pain and stiffness that is often the result of an injury, which can last for months (sometimes years) and makes daily activities difficult.
And because there was no injury, the private physiotherapist who saw Emma had a surprising explanation for the problem: the menopause.
Emma started experiencing common menopause symptoms around that time, like hot flashes, brain fog and sleep problems, “but I never thought a frozen shoulder could be one of them,” she says.
The link between frozen shoulder and menopause may seem unlikely, but there is some research to support it.
At one point, Emma Mapp could no longer lift her left arm or turn her neck, and had difficulty washing and dressing herself. It also impacted her social life as she was afraid someone would bump into her shoulder and cause her pain
Frozen shoulder, which causes pain and stiffness often caused by an injury, can last for months (sometimes years) and make daily activities difficult
Frozen shoulder, also known as adhesive capsulitis, affects around a million people a year in Britain and occurs when the tissue capsule around the shoulder joint becomes inflamed and thickened.
‘The capsule is usually large enough to allow full range of motion in a normal shoulder,’ says Rajeev Sharma, an orthopedic surgeon at private clinics in London and Hertfordshire, specializing in shoulder, elbow and hand surgery.
‘With an inflammatory condition such as frozen shoulder, the capsule thickens, which also reduces the range of motion, which is the main cause of stiffness.’
Some people also develop neck pain, because stiffness in the shoulder joint can cause the muscles in the neck to overcompensate for the lack of movement in the shoulder.
Often caused by injury “such as a fall or even a small stretch such as reaching for something in the back of a car,” Mr Sharma says frozen shoulder is also more common if you have diabetes. The theory is that persistently high blood sugar levels can thicken the surrounding shoulder tissue.
However, he adds that women in the 40 to 60 age range – the age at which most women go through menopause – are at greatest risk for the condition.
The question is: why?
Research has suggested a link between the drop in estrogen levels that occurs around menopause and an increased risk of frozen shoulder.
Rajeev Sharma, an orthopedic surgeon, says women between the ages of 40 and 60 – the age at which they go through menopause – are at the greatest risk of developing frozen shoulder.
A study from Duke University in the US involving 1,952 women – 152 of whom were taking hormone replacement therapy (HRT) normally given to compensate for the drop in estrogen levels during menopause – found that patients who did not use HRT were 99 percent more likely to develop frozen shoulder compared to those who received HRT.
The results, published in the Orthopedic Journal of Sports Medicine in 2023, make sense, says Dr. Elise Dallas, menopause specialist at The London General Practice, as estrogen “plays several important roles in musculoskeletal health.”
“Estrogen has anti-inflammatory properties and supports bone growth and connective tissue health,” she says.
As estrogen levels drop during menopause, collagen (an integral part of the connective tissue that forms muscles, ligaments and tendons) can become stiffer, reducing the flexibility of joints, including the shoulder.
The drop in estrogen levels also leads to an increase in the amount of cytokines, substances that can cause inflammation in the shoulder joint.
“This inflammation can cause pain, thickening of the ligaments, and tightening of the joint capsule – hallmarks of frozen shoulder,” says Dr. Dallas.
However, others argue that one study is not enough proof that the hormonal change that occurs during menopause is the cause.
Mr Sharma says that as women between the ages of 40 and 60 make up the majority of frozen shoulder patients, the condition will ‘often be associated with menopause, even though there is no direct link with the hormonal changes during menopause’.
Currently, there is no ‘cure’ for frozen shoulder, but treatments can help improve symptoms while the healing process takes place.
The most common, says Mr Sharma, is hydrodistension or hydrodilation, in which a combination of saline, local anesthetic and a steroid is injected into the joint capsule.
‘The steroid helps reduce the symptoms of the pain and the high volume of saline tries to relax the capsule for greater mobility of the shoulder joint,’ says Mr Sharma.
Physical therapy and exercises can help maintain shoulder strength — “although exercises and physical therapy can sometimes cause more pain when the frozen shoulder is in its initial and aggressive phase,” he adds.
Emma tried physiotherapy and home remedies such as ice, wheat bags (bags that you heat in the microwave), massages, a massage gun and ‘all kinds of painkillers’, all of which helped in the short term, ‘but sometimes the pain was terrible’.
‘Even sitting down to relax and watch TV was painful. “I had to rest my left arm on a pillow because I couldn’t let it fall to the side because it was too painful.”
In severe cases, patients may need to undergo an MRI scan to confirm the diagnosis. Then an injection of hydrocortisone. Mr Sharma says steroid injections ‘help reduce inflammation and provide pain relief while allowing the condition to repair itself naturally and can make the recovery process more comfortable’.
But Emma’s GP initially refused to refer her.
Then fate intervened just before Christmas in 2023 when Emma fell and injured her shoulder. An X-ray and MRI were taken in the emergency room, which confirmed the diagnosis of ‘frozen shoulder’.
“The doctor said they see a lot of women my age with it.”
Emma was referred to a specialist at Kingston Hospital for an injection of hydrocortisone.
She received the injection in January last year.
“I have to admit that I have never felt so much pain before,” says Emma. ‘It was unbearable.’
But within a week she felt some improvement and over the next few months her shoulder continued to improve.
She went on holiday with her partner Stuart, 57, to Indonesia and Singapore, where “they call frozen shoulder ’50s shoulder’ – they are clearly more aware of the link with menopause,” says Emma.
A year later, Emma’s shoulder mobility has improved dramatically.
‘My shoulder mobility is now around 97 per cent and although I find it too painful to play tennis for example, which I used to do two or three times a week, I am largely back to normal.
‘I do three or four aqua aerobics sessions every week to improve it further.
‘I just want more women to know that if they experience shoulder pain at this stage of life, it is worth seeking medical advice as soon as possible.’
