Feeling a dull ache in the centre of her left shoulder, Emma Mapp thought she had simply tweaked a muscle while working out at the gym.
But within a month that ‘niggle’ had worsened to the point where Emma couldn’t raise her left arm or turn her neck, and she struggled to wash and dress herself.
‘I limited my social life because I was worried that someone might bump into my shoulder and it would be really painful,’ says Emma, 52, a lawyer from Twickenham.
‘If I did go out I’d wear a sling over my coat so people were warned that I was injured and to be careful around me.’
Emma was eventually diagnosed with a frozen shoulder – pain and stiffness often brought on by an injury, which can persist for months (sometimes years) and which make everyday activities difficult.
And in the absence of an injury, the private physiotherapist Emma saw had a surprising explanation for the problem: the menopause.
Emma had around that time started suffering with common menopausal symptoms, such as hot flushes, brain fog and sleeping difficulties, ‘but I never thought that a frozen shoulder might be one of them’, she says.
The link between frozen shoulder and the menopause might seem unlikely but there is some research to support it.
At one point, Emma Mapp couldn’t raise her left arm or turn her neck, and she struggled to wash and dress herself. It also had an impact on her social life because she was worried someone might bump into her shoulder and cause her pain
Frozen shoulder, which causes pain and stiffness often brought on by an injury, can persist for months (sometimes years) and make everyday activities difficult
Frozen shoulder, also known as adhesive capsulitis, affects around a million people a year in the UK and occurs when the capsule of tissue that surrounds the shoulder joint becomes inflamed and thickens.
‘The capsule is usually large enough to allow for a full range of motion in a normal shoulder,’ says Rajeev Sharma, a consultant orthopaedic surgeon in private clinics across London and Hertfordshire, who specialises in shoulder, elbow and hand surgery.
‘With an inflamed condition such as frozen shoulder, the capsule thickens – and as a result the space for movement also reduces, which is the main cause for the stiffness.’
Some people also develop neck pain as the stiffness in the shoulder joint may mean muscles in the neck overcompensate for the lack of motion in the shoulder.
Often caused by injury ‘such as a fall or even a minor stretch such as reaching for something in the back of a car’, Mr Sharma says a frozen shoulder is also more common if you have diabetes. The theory is that persistently high blood sugar can make the surrounding shoulder tissue thicker.
However, he adds it is women in the 40 to 60 age bracket – the age at which most women go through the menopause – who are most at risk of the condition.
The question is, why?
Research has suggested a link to the drop in oestrogen that occurs around menopause to an increased risk of frozen shoulder.
Rajeev Sharma, a consultant orthopaedic surgeon, says that women in their 40s to 60s – the age at which they go through the menopause – are most at risk of suffering from frozen shoulder
A study by Duke University in the US, involving 1,952 women – of which 152 were taking hormone replacement therapy (HRT) normally given to make up for the drop in oestrogen that occurs during menopause – found that patients who were not taking HRT were 99 per cent more likely to develop a frozen shoulder compared to those receiving HRT.
The results, published in the Orthopaedic Journal of Sports Medicine in 2023 make sense, says Dr Elise Dallas, a menopause specialist at The London General Practice, as oestrogen ‘plays several important roles in musculoskeletal health’.
‘Oestrogen has anti-inflammatory properties and supports bone growth, as well as connective tissue health,’ she says.
As oestrogen levels drop during menopause, collagen (an integral part of the connective tissue that forms the muscles, ligaments and tendons) can become stiffer, reducing the flexibility of joints, including the shoulder.
The fall in oestrogen levels also leads to an increase in levels of cytokines, compounds which can trigger 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 to blame.
Mr Sharma says that as women aged 40-60 years account for most frozen shoulder patients, the condition ‘will often get correlated with menopause, even though there is no direct link to the hormonal changes of menopause’.
Currently, as it is 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 hydro-dilatation, where a combination of saline, local anaesthetic and a steroid is injected into the joint capsule.
‘The steroid helps in reducing the symptoms of the pain and the high volume of saline attempts to relax the capsule for increased mobility of the shoulder joint,’ says Mr Sharma.
Physiotherapy and exercise can help maintain shoulder strength – ‘though sometimes exercises and physiotherapy can 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 (small sacks that you heat up in the microwave), massages, a massage gun and ‘every type of painkiller’, which all helped short term, ‘but sometimes the pain was horrendous’.
‘Even sitting to relax and watch TV was painful. I had to prop my left arm on a cushion because I couldn’t let it drop to one side as it was too painful.’
In severe cases patients may need an MRI scan to confirm diagnosis. Then a hydrocortisone injection. Mr Sharma says steroid injections ‘help reduce inflammation and provide pain relief while the condition resolves itself naturally and can make the recovery journey more comfortable’.
But Emma’s GP initially refused to refer her.
Then fate intervened just before Christmas in 2023 when Emma fell, injuring her shoulder. She was given an X-ray and MRI in A&E, which confirmed her frozen shoulder diagnosis.
‘The doctor said they see many women of my age with it.’
Emma was referred a specialist at Kingston Hospital for a hydrocortisone injection.
She had the injection in January last year.
‘I must admit, I’ve never felt pain like it,’ says Emma. ‘It was excruciating.’
But within a week she felt some improvement and over the course of the next couple of months, her shoulder got progressively better.
She went on holiday with her partner Stuart, 57, to Indonesia and Singapore, where as it happens, ‘they refer to frozen shoulder as “50s shoulder” – clearly they have a better awareness of the link to menopause’, says Emma.
A year on, the mobility in Emma’s shoulder has improved dramatically.
‘My shoulder mobility is now around 97 per cent and although I find it too painful to do something like play tennis, which I used to do two or three times a week, I’m mostly back to normal.
‘I’m doing three or four aqua aerobic sessions each week to help it improve further.
‘I just want more women to know that if they start experiencing shoulder pain around this stage of life, it’s worth seeking medical advice sooner rather than later.’
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