The usual causes are the same as at other agesStrong evidence
About 1 in 100 adults aged 45 and over see a GP with a new episode of shoulder pain each year, and rotator cuff problems cause about 70% of the shoulder pain seen in primary care. In a UK survey of working-age adults, shoulder tendon problems were found in 6.1% of women and 4.5% of men.
Frozen shoulder affects 2% to 5% of people, and the UK care pathway from the British Elbow and Shoulder Society (BESS) says it "typically affects women between the ages of 45 and 60, with a peak age of 56"; the American Academy of Orthopaedic Surgeons says it is most common between 40 and 60. Muscle and joint aches in general are reported by 40% of women before the menopause and 57% to 59% around and after it, in surveys that weren't adjusted for age.
Sources 1, 2, 3, 4, 5
Frozen shoulder and the menopause: linked in time, not shown to cause itMixed evidence
NHS inform lists being "Peri-menopausal or menopausal" among the risk factors for frozen shoulder; the NHS frozen shoulder page doesn't mention the menopause. The BESS pathway says hormonal changes "are thought to contribute to the increased prevalence, although a causal link has not been identified", and a review of 48 studies found no "direct relationship between female hormones and FS".
In 310 women seen with shoulder pain at one Korean clinic, frozen shoulder was about as common before the menopause as around it (31.8% and 35.4%). In an international panel of 14 experts, 86% agreed that the menopause is a factor, which is opinion, and a 2025 theory about oestrogen hasn't been tested in people. Men get frozen shoulder too: there were 1.6 women for every man in one cohort of 223 people.
Sources 6, 7, 3, 8, 9, 10, 11, 12
Diabetes and thyroid problems are the clearer linksStrong evidence
In studies comparing people with and without frozen shoulder, people with diabetes had about 4 to 5 times the odds of having it, and 13.4% of people with diabetes had it; in two studies following people over time, the risk was 1.3 to 1.7 times higher. Thyroid disease went with about twice the odds. NHS inform says recovery can be slower with diabetes or thyroid problems, and the NHS asks people with diabetes to keep up their regular check-ups.
Sources 13, 14, 15, 6, 7
Rotator cuff changes are common with age, often without painStrong evidence
Across 30 studies of 6,112 shoulders, rotator cuff changes on scans rose from 9.7% at 20 and under to 62% at 80 and over, whether or not people had symptoms, and in a Japanese village 16.9% of people without symptoms had a full-thickness tear. Calcium deposits in the cuff were found in 42.5% of 485 adults with shoulder pain and 7.8% of 734 without, and were most likely between 30 and 60, a little more in women. In a Taiwan study, calcific tendinitis was commoner after the menopause, but the women with it were older, so age may explain that.
In a Chinese survey, shoulder pain was reported by 20.4% of women past the menopause and 15.5% of women before it, but the first group was 13 years older on average and the comparison wasn't adjusted for age.
Sources 16, 17, 18, 19, 20
The heart, the neck and other causesStrong evidence
The heart can cause pain in the shoulder or arm. The NHS angina page names "sudden pain in your chest, neck, shoulders, jaw or arms", and among its signs to call 999, pain that spreads to your arm, neck, jaw, shoulder, stomach or back. The British Heart Foundation says men and women mostly share the same heart attack symptoms. Across 27 studies of more than a million people having a heart attack or unstable angina, left arm or shoulder pain was reported by 38% of women and 37% of men, and in a US registry, 42.0% of women having a heart attack had no chest pain. The British Heart Foundation says that after the menopause, your risk increases. Most shoulder pain still comes from the shoulder or the neck.
NHS inform says shoulder pain can come from the neck "even when you don't feel pain in your neck", often as pins and needles or a sharp, hot or burning pain; Arthritis UK says tingling in the hand or arm with shoulder pain is likely to come from the neck. Pain spreading below the elbow, and pain that changes with neck movement, point the same way. Polymyalgia rheumatica stiffens both shoulders, often the neck and hips, for more than 45 minutes every morning; it is mostly over 65 and very rare under 50.
Sources 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31
Breast cancer treatment, and broken bonesStrong evidence
In 200 women taking aromatase inhibitors after breast cancer, 47% reported joint pain from the tablets, and the NHS says to call a doctor or NHS 111 now if the joints or tendons in your shoulders or arms feel weak, painful or swollen on anastrozole. Frozen shoulder was a little more common after breast radiotherapy in US records.
A broken top of the arm bone after a fall is commonest in older women: 114 per 100,000 women a year against 47 per 100,000 men in a Finnish town, with the highest rate in women aged 80 to 89 in an earlier series. The NHS says a fracture liaison service can help anyone over 50 who has broken an arm or wrist.
Sources 32, 33, 34, 35, 36, 37
When a scan or test helpsStrong evidence
Frozen shoulder and rotator cuff pain are diagnosed by examination: the UK FROST trial used a loss of turning the arm outwards to less than half of the other side, with a normal X-ray. An X-ray helps to rule out arthritis or a broken bone, or to find calcium. A scan finds tears and tendon changes that are common without pain, so it matters most with sudden weakness after an injury, or before surgery.
Because diabetes and thyroid disease are the clearest links, a GP may check your blood sugar or thyroid with a frozen shoulder (our suggestion). Blood tests for inflammation help when polymyalgia rheumatica is possible. Heart symptoms need the heart checked, not the shoulder.
Sources 38, 18, 16, 7, 15, 31
How it usually goesMixed evidence
A frozen shoulder gets better slowly. The NHS says it "can take months or years to get better. But the pain and stiffness will usually go away eventually"; NHS inform says it "can take more than 2 years"; and NHS Lothian says it can take 2 to 4 years or sometimes longer, though the pain may not last that long. A review found most improvement comes early, with no evidence of set phases ending in full recovery. 4 or more years after it started, 59% of 223 people had normal or near-normal shoulders and 41% had some symptoms, almost all mild. 6% to 17% get it in the other shoulder within 5 years.
With rotator cuff pain, the NHS says it can take 6 months or longer to recover, and in a UK trial of 708 adults, most improved substantially over a year with advice or physiotherapy. No one can promise a timescale.
Sources 7, 6, 39, 12, 40, 3, 41, 1
