Menopause IS linked to Shoulder Pain. But the exact mechanisms are still unclear.
There are usually two major presentations that I have seen in the clinic with relation to menopause: Frozen Shoulder & Rotator Cuff Related Pain.
Firstly, let’s distinguish the two pathologies:
Frozen Shoulder
Frozen shoulder (or adhesive capsulitis) is a condition whereby the tissue surrounding the shoulder joint becomes thickened and inflamed, leading to marked stiffness, as well as some pain. The exact trigger for Frozen Shoulder is unknown, although it is known that Diabetes, Menopause and Thyroid conditions are risk factors for developing Frozen Shoulder.
Rotator Cuff Related Pain (RCRP)
RCRP is a common condition involving one or multiple of the rotator cuff muscles/tendons, with or without irritation of the bursa. As the bursa can’t be distinguished in-clinic from the rotator cuff component, these are grouped together as Rotator Cuff Related Pain. On an ultrasound or MRI, the report might read something like “full width tear of the supraspinatus tendon”.
Menopause is more than a hot flushes!
If you think menopause is just a middle-aged women having to wear a singlet in the depth of Bendigo winter, think again! Menopause is one of the major shifts in a female’s life.
The process of menopause is best thought of as a continuum which spans across many years. It can be broken down into stages (peri-menopause/menopause transition, menopause & post-menopause), each with varying symptom presentation.
There are lots of moving components to the menopause process, however, notably I like to focus on the reduction in Estrogen. There are receptors for estrogen all over our body including our brain, heart, muscles, bone, tendon, cartilage and other tissues.
Collagen, a product that is not only in our skin, but also our tendons, responds to the decrease in estrogen by reducing the turnover of collagen in the body. This means we get reduced tensile strength and increased tendon stiffness and injury risk.
Can Hormone Replacement Therapy (HRT) be used to treat Shoulder Pain in Menopausal women?
The big ticket question.
From my clinical experience, I have seen many females have mild to moderate positive effects from the use of HRT on their shoulder pain and other joint pain problems, however, the results are few and far between. The research does not yet approve the use of HRT as a standalone treatment of shoulder pain during menopause, although research is constantly developing. Early studies have begun looking at potential uses for HRT in reducing likelihood of developing Frozen Shoulder.
What does Physiotherapy do for Menopause-related Shoulder Pain?
My clinical treatment is tailored to the individual, and includes a multidisciplinary approach with an informed GP, manual therapy to provide symptomatic relief, and exercises to help maintain or improved shoulder range of motion and strength.
