One perimenopause symptom that you really don’t want to get – as if you want to get any of them – might also not really be a perimenopause symptom at all.
And calling it a symptom might be not only short-sighted, but possibly dangerous.
Frozen shoulder, also known as adhesive capsulitis, is a condition caused by a stiffening of the adhesive cap that covers the shoulder joint, causing pain, stiffness and immobility in one or both shoulders. It is a painful and movement-limiting condition, with three stages – freezing, frozen and thawing – that all told can add up to a two year arc.
No matter how old you are, having something wrong with your shoulders is life-altering. This is the core of our stability – and survival: we are unable to do much when our shoulders are weak or immobile.
It’s been recognized for years that women over 40 are most affected by frozen shoulder. What’s really perplexing is that despite knowing this, and even though frozen shoulder was first diagnosed in 1934, the party line is that no one really understands exactly why it happens. This is why it’s called “idiopathic”.
Research has been choppy and treatments hard to come by. 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 a frozen shoulder, and that taking estrogen had a greater protection against it.
According to co-author Dr Anne Ford of Duke University Medical Center, “a disease that has such a strong predilection for women is unlikely to be truly idiopathic”.
When you check with the literature, a range of causes are cited, many that are never mentioned to women when they seek treatment. There is period of immobility, and that often-cited chestnut, inflammation. There are links to thyroid dysfunction, and 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. There are links to diabetes and a range of other conditions impacting the heart and brain.
A 10-year systematic review of literature published in the Journal of Pain Research in August pegged thyroid and diabetes as risk factors and cited the “non-dominant” shoulder as falling most prey, found no treatment that emerged as preferable and called for future randomized controlled trials.
What is clear is that something else is going on, and while estrogen reduction may be part of the story, it’s clearly not all of it.
Dr Tyna Moore, an American naturopathic physician and chiropractor intensely focused on metabolic functioning, is adamant when she says 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 incident that prompted it.
“It’s like the straw that breaks the camel’s back,” she explains. “Female, middle age, hormones are sitting on the edge, and then she reaches for something.”
This is why calling frozen shoulder a perimenopause symptom may be dangerous. Sure it happens in perimenopause, and it has something to do with perimenopause, but when examined, it really seems to be a signal of much deeper issues that need to be addressed for long-term health.
So many of the illnesses and events that are described as “idiopathic” in mainstream medicine do have causes in the integrative, functional and naturopathic world, because over there we are treated as a whole, not a bunch of parts. Frozen shoulder is a prime example: it’s a multifactorial issue, which seems to short out the medical-industrial complex’s ability to properly address it.
No wonder women are frustrated: there is literally zero consensus on how to treat it, and a lot of confusion, which was reflected in an October 2022 research article published in the Journal of Sports Medicine.
When surveyed, 140+ specialists found thyroid screening “unnecessary” and couldn’t agree on whether to test for diabetes in patients who presented with frozen shoulder.
There wasn’t even a consensus on what to call it, or what physical therapy to use, how to properly diagnose it and even what complications might arise from one approach, which is called “movement under anesthesia”.
Even more fascinating is when emotional contributing factors are layered in. Because when you talk to the people who see these women as they try to deal with this, everyone from acupuncturists to physiotherapists to osteopaths, many of them will tell you grief, anger and trauma have a definite role.
Treatments range from cortisone shots for acute pain – anecdotal reports show varying degrees of effectiveness – to physiotherapy, acupuncture, massage and more recently, dry needling.
A clinical trial ongoing at Duke University, with results expected in 2023, is testing dry needling in 100 patients. Lead researcher Derek Clewley, assistant professor and core faculty in the Doctor of Physical Therapy division, already published a case study in the Journal of Orthopedic Sports Physical Therapy in 2014 on the subject. In it, a 54-year-old woman he treated experienced rapid improvement after just two sessions.
Dr Moore’s advice? Not surprisingly, it requires lifestyle changes.
“Get your hormones in order, get your metabolic health in order, keep it moving, and make sure you have a professional helping you keep mobility in that shoulder.”
Because even if you can figure out how to fix the frozen shoulder over time, even if you go on hormone therapy and it gets better, the real cause or concert of causes – thyroid or metabolic issues, unresolved trauma – isn’t going anywhere if you don’t make some changes.
And that’s why it’s probably wise to start treating frozen shoulder as the whole-body yellow-alert “signal symptom” it is, rather than just another weird perimenopause symptom contained to one of our parts.
Ann Marie McQueen is the founder of Hotflash inc, a global platform to inform, inspire and entertain people in peri/menopause while bridging the gap between mainstream medicine and holistic care.