Menopause is a natural process that signals the end of a woman’s reproductive years. It occurs when the ovaries stop producing eggs and hormones, such as estrogen and progesterone. Menopause usually happens between the ages of 45 and 55, but it can vary depending on individual factors. In the United States, the average age of menopause is 51.

Menopause can cause various physical and emotional changes, such as hot flashes, night sweats, vaginal dryness, mood swings, insomnia, and reduced libido. These changes can affect a woman’s quality of life and well-being. Some of these changes can also increase the risk of certain health conditions, such as osteoporosis, heart disease, and diabetes.

One of the potential conditions that can arise in correlation with menopause is frozen shoulder. Frozen shoulder, also known as adhesive capsulitis, is a painful and debilitating condition that limits the movement of your shoulder joint. Frozen shoulder affects about 2% to 5% of the general population, but it is more common among women in their 40s and 50s. In fact, some studies have suggested that menopause may be a risk factor for developing frozen shoulder.

In this article, we will explore the link between menopause and frozen shoulder, and how to manage and prevent this condition. We will also provide some tips and resources to help you cope with menopause and maintain your joint health.

Understanding Menopause

Menopause is the stage of life when a woman’s menstrual periods stop permanently and she can no longer become pregnant. It is a natural biological process that signals the end of the reproductive years. Menopause usually occurs between the ages of 45 and 55, but it can vary depending on individual factors, such as genetics, lifestyle, and health conditions.

Stages Of Menopause

Stages Of Menopause

Menopause does not happen overnight. It is a gradual transition that involves three stages: pre-menopause, perimenopause, and post-menopause.

Pre-menopause: Pre-menopause is the time before menopause when a woman still has regular menstrual cycles and normal hormone levels. She can still conceive and bear children during this stage.

Perimenopause: Perimenopause is the time leading up to menopause when a woman’s hormone levels begin to fluctuate and her menstrual cycles become irregular. Lasting up to 7 years, this phase marks the gradual decrease in estrogen leading to menopause. She may experience some symptoms of menopause, such as hot flashes, night sweats, mood swings, vaginal dryness, and sleep problems. She can still get pregnant during this stage, but her fertility declines significantly.

Post-menopause: Post menopause is the time after menopause when a woman has not had a menstrual period for 12 consecutive months and her hormone levels have reached a low and stable point. She can no longer get pregnant during this stage. She may still experience some symptoms of menopause, but they usually become less severe and less frequent over time.

Changes in Hormones During Menopause

Changes in Hormones During Menopause

The major hormonal changes that occur during menopause are the decline in estrogen and progesterone, which are the two main female sex hormones. The ovaries generate the hormones estrogen and progesterone, which govern the menstrual cycle, pregnancy, and other aspects of female health and development.

Estrogen: Essential for female reproductive processes, estrogen levels decline during menopause, affecting various body functions.Estrogen is responsible for maintaining the growth and development of the breasts, uterus, vagina, and other female reproductive organs. It also affects the bones, skin, hair, heart, blood vessels, brain, and mood. Estrogen helps prevent osteoporosis, cardiovascular disease, dementia, and depression.

Progesterone: Produced in the ovaries following ovulation, its production ceases in the absence of ovulation during and post menopause. Progesterone is responsible for preparing the uterus for pregnancy and supporting the development of the fetus. It also affects the breasts, cervix, immune system, nervous system, and metabolism. Progesterone helps balance estrogen levels, regulate blood sugar levels, reduce inflammation, and promote sleep.

Effects of Estrogen and Progesterone Deficiency

Effects of Estrogen and Progesterone Deficiency

During menopause, the ovaries gradually produce less estrogen and progesterone until they eventually stop functioning. This causes the menstrual cycle to become irregular and eventually cease. The reduced levels of estrogen and progesterone also affect other parts of the body and cause various physical and emotional changes.

Some of these changes are:

Hot flashes: Sudden sensations of heat that spread throughout the body, especially the face, neck, and chest. They can last from a few seconds to several minutes and may be accompanied by sweating, flushing, palpitations, or chills.

Night sweats: Hot flashes that occur at night and interfere with sleep. They can cause insomnia, fatigue, irritability, or anxiety.

Vaginal dryness: Decreased lubrication and elasticity of the vaginal tissues due to lower estrogen levels. This can cause discomfort, itching, burning, or pain during sexual intercourse or urination.

Urinary problems: Increased frequency or urgency of urination due to weaker bladder muscles and lower estrogen levels. This can also increase the risk of urinary tract infections or incontinence.

Mood swings: Changes in mood or emotions due to hormonal fluctuations and life stressors. They can range from mild to severe and include feelings of sadness, anger, anxiety, or irritability. Possibly due to estrogen’s effect on mood-regulating neurotransmitters.

Cognitive changes: Difficulties with memory or concentration due to lower estrogen levels and sleep deprivation. They can affect work performance or daily activities.

Weight gain: Increased fat accumulation around the abdomen due to lower metabolism and higher cortisol levels. Often resulting from age and lifestyle, but hormonal changes might play a role. This can increase the risk of diabetes or cardiovascular disease.

Hair loss: Thinning or loss of hair on the scalp or other parts of the body due to lower estrogen levels. Linked to reduced estrogen and an increase in androgens. This can affect self-esteem or confidence.

Skin changes: Dryness or wrinkling of the skin due to lower collagen production and hydration. This can also affect wound healing or elasticity.

Bone loss: Decreased bone density or mass due to lower calcium absorption and higher bone resorption. This can increase the risk of osteoporosis or fractures.

Irritability: Estrogen and progesterone have an influence on the production and regulation of neurotransmitters, such as serotonin, dopamine, and norepinephrine. These neurotransmitters are responsible for mood, motivation, and cognition. When estrogen and progesterone levels drop, the balance of these neurotransmitters can be disrupted, leading to irritability, anxiety, depression, and mood swings.

Fatigue: Estrogen and progesterone also affect the quality and quantity of sleep. Estrogen helps maintain the circadian rhythm, which is the natural cycle of sleeping and waking. Progesterone has a sedative effect that aids in the onset of sleep. When estrogen and progesterone levels decrease, the circadian rhythm can be disturbed, causing insomnia, difficulty falling asleep, or frequent awakenings. Lack of sleep can result in fatigue, low energy, poor concentration, and impaired memory.

Sleep problems: In addition to affecting the circadian rhythm, estrogen and progesterone also influence the regulation of body temperature. Estrogen helps dilate blood vessels and promote heat loss, while progesterone helps increase body temperature. When estrogen and progesterone levels fluctuate or decline, the body’s ability to regulate temperature can be impaired, causing hot flashes and night sweats. These symptoms can interfere with sleep quality and comfort.

Headaches: Estrogen and progesterone also play a role in modulating pain perception and inflammation. Estrogen has an analgesic effect that reduces pain sensitivity, while progesterone has an anti-inflammatory effect that reduces swelling and inflammation. When estrogen and progesterone levels fluctuate or fall, the pain threshold is lowered and the inflammatory response is heightened, resulting in headaches or migraines.

Increased risk of heart disease: Estrogen has a protective effect on the cardiovascular system. It helps lower blood pressure, cholesterol, and triglycerides. It also helps prevent blood clots and plaque formation in the arteries. When estrogen levels decline, these benefits are lost or reduced, increasing the risk of hypertension, dyslipidemia, atherosclerosis, coronary artery disease, and stroke.

Increased risk of stroke: Estrogen also has a neuroprotective effect on the brain. It helps maintain blood flow, oxygen supply, glucose metabolism, and neuronal survival in the brain. It also helps modulate the expression of genes involved in neurogenesis, synaptic plasticity, and neuroinflammation. When estrogen levels drop, these effects are diminished or reversed, increasing the risk of ischemic or hemorrhagic stroke.

These hormonal changes can have a significant impact on a woman’s health and well-being during menopause. Therefore, it is important to understand how they affect different parts of the body and what steps can be taken to manage them effectively.

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Frozen Shoulder: A Quick Overview

Frozen Shoulder: A Quick Overview

Definition

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint, limiting its range of motion. It can affect one or both shoulders, and it can last from months to years.

Causes

Frozen shoulder’s specific cause is unknown, but it is thought to be caused by inflammation and scarring of the capsule that surrounds the shoulder joint. The capsule is a thin layer of tissue that encloses the head of the upper arm bone (humerus) and the socket of the shoulder blade. It helps keep the joint stable and lubricated.

However, it is thought to be caused by a combination of factors, including:

Injury to the shoulder: An injury to the shoulder, such as a rotator cuff tear, can increase the risk of developing frozen shoulder. Trauma or surgical procedures can lead to immobilization and subsequent onset of frozen shoulder.

Hormonal changes: Frozen shoulder is more common in women, especially during menopause. This is because the decline in estrogen levels during menopause can weaken the tendons and ligaments in the shoulder, making them more susceptible to injury.

Medical conditions: Other medical conditions, such as diabetes, thyroid problems, tuberculosis, Parkinson’s and rheumatoid arthritis, can increase the risk of developing frozen shoulder.

Idiopathic: In some cases, frozen shoulder may be idiopathic, meaning that there is no identifiable cause.

Symptoms and Pathology

When the capsule becomes inflamed, it thickens and tightens, reducing the space for the shoulder joint to move. This causes pain and stiffness in the shoulder, especially when trying to lift the arm above the head, reach behind the back, or perform other daily activities. The inflammation can also trigger the formation of scar tissue (adhesions) inside the capsule, further restricting the movement of the joint.

Some of the common symptoms of frozen shoulder are:

  • Dull or agonizing pain in the outer shoulder area
  • Inability to move the shoulder (limited motion)
  • Pain during any form of shoulder movement
  • Pain in the shoulder at night that interferes with sleep

Stages of Frozen shoulder

Stages of Frozen shoulder

Frozen shoulder normally occurs in three stages: freezing, freezing, and thawing.

Freezing stage: This is the initial stage when the pain and stiffness begin to develop. The pain is usually worse at night and may interfere with sleep. The range of motion of the shoulder gradually decreases as the capsule tightens. This stage might span anywhere between six weeks and nine months.

Frozen stage: This is the stage when the pain subsides but the stiffness persists. The range of motion of the shoulder reaches its lowest point and becomes very limited. The shoulder may feel frozen or locked in place. This stage can last from four to twelve months.

Thawing stage: This is the final stage when the stiffness begins to improve and the range of motion of the shoulder gradually increases, often taking 6 months to 2 years for normal functionality. The shoulder may still feel sore or achy, but it becomes easier to move and perform daily activities. This stage can last from six months to two years.

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Diagnosis

Diagnosis

Frozen shoulder can be diagnosed by a physical examination and medical history. The doctor may ask about the onset, duration, and severity of the symptoms, as well as any previous shoulder injuries or conditions. The doctor may also perform some tests to assess the range of motion and strength of the shoulder, such as asking the patient to raise the arm, rotate the arm, or touch the opposite shoulder.

In some cases, imaging tests such as X-rays, ultrasound, or magnetic resonance imaging (MRI) may be ordered to rule out other possible causes of shoulder pain and stiffness, such as arthritis, bursitis, tendinitis, or rotator cuff tear (1).

Treatment

Frozen shoulder can be treated with a combination of conservative and invasive methods, depending on the stage and severity of the condition. Among these techniques are:

Medication: Over-the-counter or prescription medication can help reduce inflammation and pain in the shoulder. Some common medications for frozen shoulder are nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, corticosteroids, such as prednisone or methylprednisolone, or muscle relaxants, such as cyclobenzaprine or baclofen.

Physical therapy

Physical therapy: A physical therapist can design a customized exercise program to help restore the flexibility, mobility and strength of the shoulder joint (2). The exercises may include stretching, strengthening, mobilization, or manipulation techniques. The therapist may also use heat, ice, ultrasound, electrical stimulation, or massage to help relieve pain and stiffness.

Injection: A doctor may inject a corticosteroid or a local anesthetic into the shoulder joint to help reduce inflammation and pain (3). This can also improve the range of motion and facilitate physical therapy.

Surgery: If conservative treatments fail to improve frozen shoulder after six months or more, surgery may be considered as a last resort (4). Surgery involves cutting or releasing some of the tight or scarred capsule tissue to allow more movement in the joint. There are two main types of surgery for frozen shoulder: arthroscopic capsular release and open capsular release.

  1. Arthroscopic capsular release is a minimally invasive method that involves inserting a small camera (arthroscope) and tiny equipment through small skin incisions. The surgeon uses these tools to cut or remove some of the capsule tissue while viewing it on a monitor.
  2. Open capsular release is a more invasive procedure that involves making a larger incision in the skin and opening up the shoulder joint. The surgeon then cuts or removes some of the capsule tissue manually.

Both types of surgery are usually followed by physical therapy to help regain full function of the shoulder.

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Connecting the Dots: Hormones and Joint Health

Hormones are chemical messengers that regulate various functions and processes in the body, such as growth, metabolism, reproduction, and mood. Hormones also play a role in joint health, as they affect the production and maintenance of the connective tissues that form the joint structures.

Effects of Hormones on Joint Health

One of the most important hormones for joint health is estrogen, which is the main female sex hormone. Estrogen has several effects on the joints, such as:

  • Stimulating the synthesis of collagen, which is the main protein that provides strength and flexibility to the ligaments, tendons, cartilage, and bone.
  • Enhancing the lubrication of the synovial fluid, which is the liquid that fills the joint space and reduces friction and wear.
  • Modulating the activity of the immune system, which can influence inflammation and healing in the joint tissues.
  • Regulating the balance of calcium and phosphorus, which are essential minerals for bone health.

During menopause, estrogen levels drop significantly, which can have negative consequences for joint health. Some of these implications are as follows:

  • Decreased collagen production and quality, which can lead to weakening and stiffening of the joint tissues. This can increase the risk of injury or degeneration in the joints.
  • Reduced synovial fluid lubrication, which can cause dryness and friction in the joint space. This can result in pain and stiffness in the joints.
  • Altered immune system activity, which can trigger or worsen inflammation and scarring in the joint tissues. This can impair the function and movement of the joints.
  • Imbalanced calcium and phosphorus levels, which can cause bone loss or osteoporosis. This can weaken the bones and make them more prone to fracture.

These hormonal changes can explain why women who are going through menopause or have recently completed it are more likely to develop frozen shoulder than men or younger women. Frozen shoulder is a disorder that causes discomfort and stiffness in the shoulder by inflaming and damaging the capsule that surrounds the joint. As estrogen levels decline, collagen production decreases, synovial fluid dries up, immune system becomes overactive, and bone density drops. These factors can contribute to the development and progression of frozen shoulder.

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Effects of Other Hormones

Estrogen is not the only hormone that affects joint health during menopause. Other hormones that may have an impact are:

Progesterone: This is another female sex hormone that works together with estrogen to regulate the menstrual cycle and pregnancy. Progesterone also helps balance estrogen levels, regulate blood sugar levels, reduce inflammation, and promote sleep. During menopause, progesterone levels also decline, which can exacerbate some of the symptoms of estrogen deficiency, such as mood swings, weight gain, insomnia, or anxiety.

Testosterone: This is a male sex hormone that is also present in small amounts in women. Testosterone helps maintain muscle mass and strength, bone density, libido, energy levels, protects against cartilage damage and has an anti-inflammatory effect. During menopause, testosterone levels may decrease or increase depending on individual factors. Low testosterone levels can lead to muscle loss or weakness, bone loss or osteoporosis, low libido or sexual dysfunction, or fatigue. High testosterone levels can cause acne or hair growth on the face or body.

Relaxin Fluctuation: This hormone, which affects ligament laxity, may see fluctuations during menopause. Altered relaxin levels can impact joint stability, making them prone to overextension or injuries.

Cortisol: This is a stress hormone that is produced by the adrenal glands. Cortisol helps regulate blood pressure, blood sugar levels, inflammation, and immune response. During menopause, cortisol levels may increase due to physical or emotional stressors. High cortisol levels can cause weight gain around the abdomen, high blood pressure or diabetes, increased inflammation or pain in the joints, or impaired memory or concentration.

These hormonal changes can also affect joint health during menopause by influencing muscle mass and strength, bone density and quality, inflammation and pain levels, and mood and sleep quality.

Therefore, hormones play a vital role in joint health during menopause. By understanding how they affect different aspects of joint function and structure, one can take steps to balance their hormone levels and prevent or manage joint problems such as frozen shoulder.

Some Other Factors Compound the Risk of Frozen Shoulder During Menopause

While hormonal fluctuations during menopause play a vital role in musculoskeletal health, it’s essential to recognize that they are not the only contributors. Several other factors, often coinciding with the menopausal transition, can compound the risk of developing joint issues such as frozen shoulder. This section examines these factors and emphasizes the importance of a holistic approach to understanding the risks.

Decreased Physical Activity

Overview: As women age, there might be a natural inclination to reduce physical activity due to fatigue, pain, or other age-related factors. The menopausal transition itself, with its array of symptoms, might also discourage physical engagement.

Impact: Reduced physical activity can lead to joint stiffness and muscle weakness. Regular movement helps maintain joint flexibility and muscle strength, both vital in preventing conditions like frozen shoulder.

Bone Density Loss

Overview: Menopause brings a rapid decline in bone density due to the drop in estrogen levels. This phase sees the highest rate of bone loss in a woman’s life.

Impact: Weak bones might alter joint mechanics, leading to conditions like frozen shoulder. Joint issues might arise due to the bones’ compromised structural support, increasing vulnerability to injuries and other orthopedic conditions.

Weight Gain

Overview: It’s not uncommon for women to experience weight gain during menopause. Changes in metabolism, hormone levels, and lifestyle can contribute to this increase.

Impact: Excess weight can put added strain on joints, particularly those in the weight-bearing areas like the hips and knees. This strain can lead to increased wear and tear, reduced flexibility, and a heightened risk of joint-related conditions.

It is important to distinguish between the direct hormonal impact of menopause and these other factors when determining risk for frozen shoulder. While menopause can lead to decreased estrogen levels, which can weaken the tendons and ligaments in the shoulder, it is also possible that other factors, such as decreased physical activity, bone density loss, or weight gain, may play a role in increasing the risk of frozen shoulder during menopause.

Studies and Evidence

Presentation of Studies Linking Menopause to Frozen Shoulder or General Joint Issues

Hormonal Levels and Joint Pain: A study by Sowers et al. (2003) found that hormonal fluctuations, particularly declines in estradiol levels, were linked to an increased risk of joint pain and stiffness in peri-menopausal and post-menopausal women (5). The study highlights the potential for hormonal fluctuations, common during menopause, to contribute to conditions like frozen shoulder.

Frozen Shoulder and Menopause: Research by Hand et al. (2008) concluded that the prevalence of frozen shoulder was higher in women around the age of menopause. This suggests a potential relationship between the decline in reproductive hormones and the onset of adhesive capsulitis (6).

Collagen and Estrogen Connection: Castelo-Branco et al. (1992) illustrated the role of estrogen in collagen content regulation. The study indicated that postmenopausal women had reduced skin collagen compared to premenopausal women, and this was attributed to the decline in estrogen levels (7. As collagen plays a significant role in the shoulder capsule’s make-up, the decrease in estrogen could influence adhesive capsulitis onset.

Comparative Analysis of Frozen Shoulder Incidence in Different Menopausal Stages

Pre-menopausal Women: While there’s no direct comparative study exclusively analyzing the incidence rate among these categories, general medical consensus and clinical observations suggest that pre-menopausal women are at a lower risk for developing frozen shoulder compared to their peri-menopausal and post-menopausal counterparts (8).

Peri-menopausal Women: The transitional stage between a woman’s reproductive years and menopause, peri-menopause witnesses hormonal fluctuations that can lead to joint pain and conditions like frozen shoulder. Per the study by Sowers et al., peri-menopausal women experience increased joint pain and stiffness, potentially contributing to higher incidences of frozen shoulder in this group (5).

Post-menopausal Women: The post-menopausal period sees a significant decline in estrogen levels. As highlighted by Hand et al., this stage poses an increased risk for frozen shoulder (hand). The decline in collagen content, as observed in the study by Castelo-Branco et al., can further exacerbate the risk (7).

Management & Prevention

Management

The challenges to joint health that accompany menopause, as discussed in earlier sections, might seem daunting. However, there are several measures women can adopt to manage and even prevent some of these challenges. From medical interventions to lifestyle adjustments and alternative therapies, various strategies can help maintain joint health during this transitional phase.

Hormone replacement therapy (HRT): HRT can help replenish your estrogen levels and reduce menopausal symptoms, including joint pain. HRT can also help prevent bone loss and osteoporosis, which can affect your joint health. There is some evidence suggesting that HRT may also help in reducing the risk or severity of frozen shoulder in postmenopausal women (9). However, HRT is not suitable for everyone and has some risks and side effects that need to be discussed with your doctor. HRT should be used at the lowest effective dose and for the shortest possible time.

Regular exercise: Exercise can help maintain your joint mobility, flexibility, and strength. It can also help prevent weight gain, a potential risk factor for frozen shoulder. Exercise can also improve your mood, sleep quality, and overall well-being. Aim for at least 150 minutes of moderate aerobic activity and two sessions of strength training per week. Choose low-impact exercises that do not strain your joints, such as walking, swimming, cycling, or yoga. Warm up before you exercise and stretch afterward to avoid injury.

Physiotherapy: Physiotherapy can help you manage joint pain and stiffness by providing personalized exercises, massage, heat or cold therapy, ultrasound, or electrical stimulation. Physiotherapy can also help you improve your posture, balance, and coordination. A physiotherapist can assess your condition and design a treatment plan that suits your needs and goals. Studies have shown that physiotherapy can significantly improve outcomes for frozen shoulder patients (10).

Dietary changes: Eating a balanced diet that is rich in anti-inflammatory foods can help reduce joint inflammation and pain. Some of the foods that have anti-inflammatory properties are omega-3 fatty acids (found in fish, nuts, seeds, and oils), fruits and vegetables (especially berries, cherries, citrus fruits, leafy greens, broccoli, and tomatoes), spices (such as turmeric, ginger, garlic, and cinnamon), and tea (especially green tea) (11). Avoid foods that can trigger inflammation, such as processed meats, fried foods, refined carbohydrates, sugar, alcohol, and dairy products. Drink plenty of water to keep your joints hydrated and lubricated.

Alternative therapies: Some alternative therapies may help relieve joint pain and stiffness during menopause. However, the evidence for their effectiveness is limited or mixed. Some of the alternative therapies that may have some benefits are acupuncture (which involves inserting thin needles into specific points on your body to stimulate nerve endings and release endorphins) (12), massage therapy (which involves applying pressure and movement to your muscles and soft tissues to improve blood circulation and relaxation), aromatherapy (which involves inhaling or applying essential oils to your skin to enhance your mood and well-being), and herbal remedies (such as black cohosh, evening primrose oil, or soy). Before trying any alternative therapy, consult your doctor or a qualified practitioner to ensure its safety and suitability for you.

Prevention

Therefore, to prevent or reduce the effects of menopause on your health, you need to consider both the hormonal changes and the other contributing factors. You can take the following steps:

  • Eat a balanced diet that is rich in calcium, protein, fiber, fruits, and vegetables. Avoid foods that are high in fat, sugar, salt, and calories.
  • Get adequate vitamin D through sunlight or supplements. Vitamin D enhances bone health by assisting calcium absorption. Aim to get 1,200 milligrams of calcium and 800 international units of vitamin D per day.
  • Regular physical activity, especially shoulder-specific exercises, can help maintain shoulder mobility and prevent the onset of frozen shoulder. Exercise regularly to maintain your muscle mass, metabolism, and bone density. Aim for at least 150 minutes of moderate aerobic activity and two sessions of strength training per week.
  • Quit smoking and limit alcohol intake. Smoking and alcohol can interfere with your hormone levels and increase your risk of osteoporosis and other diseases.
  • Manage stress. Stress can contribute to inflammation. Find healthy stress-management techniques, such as yoga, meditation, or spending time in nature.
  • Talk to your doctor about hormone replacement therapy (HRT) or other medications that can help ease menopausal symptoms and protect your bones. HRT can be effective for reducing hot flashes, vaginal dryness, mood swings, and bone loss. However, it also has some risks and side effects that need to be weighed carefully with your doctor.
  • Get enough sleep and manage stress. Lack of sleep and chronic stress can affect your hormone levels and increase your appetite. They can also impair your immune system and mental health.
  • Diabetes and thyroid conditions have been associated with frozen shoulder. Proper management of these conditions can reduce the risk.

Conclusion

Menopause is a natural occurrence that affects each woman differently. However, one of the common effects of menopause is the increased risk of frozen shoulder, a painful and debilitating condition that limits the movement of your shoulder joint. Frozen shoulder is caused by inflammation and thickening of the capsule that surrounds your shoulder joint, which can be triggered or worsened by hormonal changes during menopause. Estrogen, the main female hormone, plays a key role in regulating inflammation and maintaining the health of your connective tissues. When estrogen levels drop during menopause, your joints may become more susceptible to inflammation, stiffness, and damage.

Therefore, it is important to be proactive and aware of your joint health during and after menopause. By taking preventive measures, such as hormone replacement therapy (if suitable), regular exercise, physiotherapy, dietary changes, and alternative therapies, you can reduce the risk of developing frozen shoulder or ease its symptoms if you already have it. You can also consult your doctor or a qualified health professional for more advice and treatment options. Remember, menopause does not have to mean the end of your mobility and quality of life. You can still enjoy an active and fulfilling lifestyle with healthy joints.

References

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https://journals.sagepub.com/doi/abs/10.1177/0363546509348048

2. Page, M.J., Green, S., Kramer, S., Johnston, R.V., McBain, B., Chau, M., Buchbinder, R. and Cochrane Musculoskeletal Group, 1996. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews, 2014(8).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011275/abstract

3. Buchbinder, R., Green, S., Youd, J.M. and Cochrane Musculoskeletal Group, 1996. Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews, 2010(1).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004016/abstract

4. Uppal, H.S., Evans, J.P. and Smith, C., 2015. Frozen shoulder: a systematic review of therapeutic options. World journal of orthopedics, 6(2), p.263.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363808/

5. Sowers, M., Zheng, H., Tomey, K., Karvonen-Gutierrez, C., Jannausch, M., Li, X., Yosef, M. and Symons, J., 2007. Changes in body composition in women over six years at midlife: ovarian and chronological aging. The Journal of Clinical Endocrinology & Metabolism, 92(3), pp.895-901.
https://academic.oup.com/jcem/article-abstract/92/3/895/2597229

6. Hand, C., Clipsham, K., Rees, J.L. and Carr, A.J., 2008. Long-term outcome of frozen shoulder. Journal of shoulder and elbow surgery, 17(2), pp.231-236.
https://www.sciencedirect.com/science/article/pii/S1058274607004867

7. Castelo-Branco, C., Pons, F., Gratacós, E., Fortuny, A., Vanrell, J.A. and González-Merlo, J., 1994. Relationship between skin collagen and bone changes during aging. Maturitas, 18(3), pp.199-206.
https://www.sciencedirect.com/science/article/pii/0378512294901260

8. Codman, E.A., 1934. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. (No Title).
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9. Lethaby, A., Hogervorst, E., Richards, M., Yesufu, A. and Yaffe, K., 2008. Hormone replacement therapy for cognitive function in postmenopausal women. Cochrane Database of Systematic Reviews, (1).
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10. Kelley, M.J., Mcclure, P.W. and Leggin, B.G., 2009. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of orthopaedic & sports physical therapy, 39(2), pp.135-148.
https://www.jospt.org/doi/abs/10.2519/jospt.2009.2916

11. Hill, C.L., March, L.M., Aitken, D., Lester, S.E., Battersby, R., Hynes, K., Fedorova, T., Proudman, S.M., James, M., Cleland, L.G. and Jones, G., 2016. Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. Annals of the rheumatic diseases, 75(1), pp.23-29.
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12. Tough, E.A., White, A.R., Cummings, T.M., Richards, S.H. and Campbell, J.L., 2009. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. European Journal of Pain, 13(1), pp.3-10.
https://www.sciencedirect.com/science/article/pii/S1090380108000554

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