Frozen Shoulder, Perimenopause and Menopause

Why your shoulder may be telling a bigger story

Frozen shoulder, also called adhesive capsulitis, causes pain, stiffness and reduced movement in the shoulder. It has often been treated as a local shoulder problem, but it may also be linked to wider changes in hormones, inflammation, blood sugar, thyroid function, blood vessel health, stress, sleep and lifestyle. This may be especially relevant for women in perimenopause and menopause.

Why is frozen shoulder more common around menopause?

During perimenopause and menopause, oestrogen levels fluctuate and then decline. Oestrogen does much more than support reproductive health. It also helps regulate inflammation, tissue repair, pain sensitivity, collagen balance, blood vessels and metabolic health. When oestrogen signalling is lower or less effective, the body may become more prone to inflammation, stiffness, pain sensitivity and connective tissue changes.

Frozen shoulder may be more likely or more intense when hormonal change happens alongside other factors such as raised blood sugar, insulin resistance, high cholesterol, thyroid problems, poor sleep, stress, low activity levels and increased inflammation.

Frozen shoulder is often not simply “wear and tear” or just a stiff joint. In some women, it may be a sign that the body is under wider metabolic, hormonal or inflammatory stress. This means there may be several helpful areas to support improvement alongside traditional supports like physiotherapy, chiropractic or medical care.

What may increase risk?

There are several possible drivers including:

• Perimenopause and menopause related oestrogen changes

• Thyroid dysfunction, especially hypothyroidism (low thyroid function)

• Raised blood sugar or HbA1c (blood test of blood sugar over preceding 3 months)

• Insulin resistance

• High LDL cholesterol or triglycerides

• Increased abdominal weight

• Chronic stress and pain sensitisation

• Poor sleep and disrupted circadian rhythm

• Low physical activity

• Highly processed, high sugar or high glycaemic diets

• Environmental hormone disruptors such as BPA, phthalates and some plastics

• Low grade inflammation

Diet Recommendations

Aim for diet that support bold glucose balance and is rich in antioxidants

A Mediterranean style diet fits well. This means building meals around:

• Colourful vegetables and salads

• Beans, lentils and chickpeas

• Wholegrains such as oats, brown rice, quinoa and rye

• Nuts and seeds

• Extra virgin olive oil

• Herbs and spices

• Protein at each meal e.g. oily fish, eggs, poultry, lean meat, tofu or tempeh

• Berries and lower sugar fruits

• Fermented foods if tolerated, such as live yoghurt, kefir or sauerkraut

Try to balance your plate, aiming for:

• Half plate vegetables and/or salad

• Quarter plate protein (at every meal)

• Quarter plate high fibre carbohydrate e.g. sweet potatoes, brown rice

• Add healthy fats such as olive oil, avocado, olives, nuts or seeds

This helps support steadier blood sugar, better insulin signalling and lower inflammatory load.

Reduce advanced glycation end products

Advanced glycation end products, also called AGEs are compounds that can increase when blood sugar is high, and are created in our foods when they are cooked at very high temperatures, browned, charred or heavily processed. AGEs may make collagen stiffer and contribute to tissue fibrosis and increase inflammation in the body.

Helpful cooking methods include slow cooking, stewing, poaching, braising, and gentle roasting that avoids charring. Soups and casseroles therefore can be good alternatives and using lemon juice, vinegar, herbs and spices as marinades and avoiding marinades with sugar or honey which will accelerate charring and AGE production.

The aim is to try to reduce:

1. Burnt or blackened foods e.g. BBQ foods

2. Deep fried foods

3. Heavily processed meats

4. Frequent pastries, biscuits, cakes and sweets

5. Sugary drinks

6. Large portions of refined carbohydrates

Support thyroid and metabolic health

Because thyroid dysfunction appears to be linked with frozen shoulder risk, it may be helpful to discuss thyroid testing with your GP, especially if you have additional symptoms like fatigue, cold intolerance, constipation, weight gain, hair thinning, low mood or a family history of thyroid disease.

Nutrients that support thyroid and metabolic health include:

• Protein

• Selenium from Brazil nuts, fish, eggs and meat

• Iodine from white fish, dairy, eggs or seaweed in sensible amounts

• Zinc from seafood, meat, pumpkin seeds and legumes

• Iron from meat, fish, beans, lentils and leafy greens

• B vitamins from wholegrains, eggs, meat, fish, legumes and leafy greens

It is important not take iodine or thyroid supplements without professional advice, especially if you have thyroid disease. In general, dietary sources should be sought.

Lifestyle recommendations

1. Keep moving, but pace it

Frozen shoulder often needs physiotherapy support. Movement should be regular, gentle and progressive. NHS Inform has gentle exercises for shoulder mobility problems that may be helpful particularly if you notice early signs like stiffness overnight. Exercises for shoulder muscle and joint problems | NHS inform. Chiropractic support for better alignment and support of sleep and stress resilience and may be helpful too.

Helpful options may include:

• Daily shoulder mobility exercises from a physiotherapist

• Gentle walking• Strength training two to three times weekly when appropriate

• Avoiding long periods of sitting

• Movement snacks through the day

• Pacing activity to avoid flare ups

2. Protect sleep and circadian rhythm

Sleep disruption can worsen inflammation, pain sensitivity, blood sugar regulation and hormone signalling. Sleep and circadian rhythm is important factors in frozen shoulder. Sleep can be disrupted by perimenoapsue or menopause as progesterone levels fall.

Try:

• A regular wake time

• Morning daylight exposure

• Dimming lights in the evening

• Reducing digital screens before bed

• Keeping the bedroom cool and dark

• Avoiding caffeine after midday or early afternoon

• Alcohol reduction, as it can fragment sleep

• Gentle stretching, breathing or relaxation before bed

• Warm bath and Epsom salts

3. Reduce stress load

Chronic stress can increase pain sensitivity, affect cortisol rhythm, disturb sleep and contribute to low grade inflammation. Hormonal changes can disrupt our stress resilience and upset the hypothalamic-pituitary-adrenal axis meaning we can find it harder to cope with stress and return to a calm baseline after stress exposure.

Helpful practices include:

• Slow breathing

• Mindfulness

• Yoga or Pilates adapted to ability

• Time outdoors/in nature

• Journaling

• Social connection

• Counselling, CBT or pain education if fear of movement is high

  
  

4. Support blood vessel health

There may be a link between endothelial health (the blood vessel lining) and frozen shoulder mechanisms. Poor diet, AGEs, oxidative stress, raised blood sugar and inflammation may affect blood flow and tissue repair.

Aforementioned supportive steps often help and include:

• Walking most days

• Eating oily fish or other omega 3 rich foods

• Eating colourful plants daily

• Using extra virgin olive oil

• Reducing smoking exposure

• Managing blood pressure, cholesterol and blood sugar

• Reducing ultra processed foods and burnt or charred foods

5. Reduce unnecessary hormone disrupting exposures

Environmental exposures may interfere with hormone signalling especially when we are hormonally more vulnerable like in perimenopause or menopause.

Endocrine disrupting chemicals are found in everyday items, cosmetics and household cleaning products. You do not need to become fearful or perfect. Small swaps can reduce overall exposure.

Simple swaps include:

• Use glass or stainless steel instead of plastic for hot food and drinks

• Avoid microwaving food in plastic

• Choose fragrance free or low fragrance products where possible

• Use simple cleaning products

• Ventilate your home daily

• Wash fruit and vegetables well

• Consider organic for higher pesticide produce when affordable

• Avoid handling till receipts (BPA), often we can opt for electronic versions or wash your hands after handling

When to speak to your GP

If you are in perimenopause, menopause or pregant or postnatal and experiencing frozen shoulder, it may be worth discussing the following tests with your GP:

• HbA1c and fasting glucose and ideally fasting insulin to check for insulin resistance

• Lipid profile (cholesterol and triglycerides)

• Thyroid function, including TSH and free T4 and T3

• Thyroid antibodies if autoimmune thyroid disease is suspected

• Vitamin D

• Blood pressure

• Weight, waist circumference and metabolic risk

If also having menopause symptoms, HRT may be worth discussing with a GP or menopause specialist, but it is not suitable for everyone and should be individualised.

Also seek medical advice if shoulder pain follows injury, is severe, or is associated with chest pain, breathlessness, unexplained weight loss, fever, night sweats, arm weakness, numbness, swelling, redness, or if pain is not improving.

Summary

Frozen shoulder espacially around menopause may reflect more than a shoulder joint problem. Hormone changes, blood sugar balance, thyroid function (which can be trigered by preganacy), inflammation, stress, sleep, movement and diet may all be driving your symptoms.

The best approach is usually combined care. This includes support to reduce pain and increase mobility through options like physiotherapy, chiropractic and/or medical assessment and support to address underlying drivers to reduce the possibility of recurrence.

Practical nutrition and lifestyle support through self-help or 1:1 personalised nutritional therapy can help address why frozen shoulder has occurred and reduce the risk of recurrence.

References:

Santiago Navarro-Ledesma, S. (2025).  Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications  https://www.mdpi.com/2077-0383/14/20/7315

Wise et al. (2026). Adhesive Capsulitis in a Postmenopausal WomanWith Thyroid Dysfunction [PDF] Adhesive Capsulitis in a Postmenopausal Woman With Thyroid Dysfunction | Semantic Scholar