Shoulder Pain in Midlife: Is Menopause Part of the Problem?

Your shoulder starts hurting. You stop doing anything that involves your upper body. A few weeks later, reaching overhead, putting on your coat or sleeping on that side has become difficult.

Shoulder problems are common in midlife, and they can be particularly frustrating if you're trying to stay active.

Frozen shoulder, rotator cuff problems and tendon-related pain are all things I see regularly with women in their 40s and 50s.

So, could menopause be part of the picture?

What does menopause have to do with your shoulders?

We know that hormonal changes during perimenopause and menopause can be associated with a range of musculoskeletal symptoms, including joint and muscle aches, stiffness and some tendon problems.

Oestrogen has effects on tissues including muscle, bone and connective tissue, so changes in hormone levels may influence how those tissues respond to load and recover.

That doesn't mean every shoulder problem in a woman over 40 is caused by menopause. Age, previous injuries, changes in activity, training load, general health and simple bad luck can all play a part.

But if you've suddenly developed a shoulder problem during perimenopause, hormonal changes may be one factor worth considering.

Frozen shoulder isn't the same as a sore shoulder

This is an important distinction.

Frozen shoulder typically involves both pain and a progressive loss of movement. It can be particularly painful at night, and everyday movements such as reaching behind your back, putting on a coat or lifting your arm can become difficult. It commonly affects people between 40 and 60 and is more common in women.

Rotator-cuff-related shoulder pain is different. You may notice pain when lifting your arm, reaching overhead or doing particular movements, sometimes with weakness around the shoulder.

Tendon-related shoulder problems are also common in middle age.

The treatment and exercise approach can be different too.

That's why I wouldn't recommend simply searching for “shoulder exercises” online and throwing a load of movements at a painful shoulder.

Should you stop training?

Usually, no – but you may need to change what you're doing.

With shoulder pain, completely stopping movement isn't generally recommended. The NHS advises keeping the shoulder gently moving, while avoiding activities that aggravate the problem.

That might mean temporarily changing:

• the amount of weight you're lifting

• your range of movement

• how often you're training the shoulder

• overhead pressing or pulling

• exercises that put the shoulder into painful positions

• the volume of upper-body work you're doing.

You can often continue training other areas while your shoulder is being assessed or rehabilitated.

And if you've been given specific exercises by a physiotherapist, those take priority over a generic gym programme.

Don't ignore persistent shoulder pain

A shoulder niggle that isn't settling, is getting worse or is restricting your movement is worth getting assessed.

Frozen shoulder can take months – sometimes considerably longer – to resolve, so getting the right diagnosis and management early can make the process easier.

And if you have sudden severe pain, cannot move your arm, have significant swelling or a change in the shape of the shoulder, or the problem started following an injury, seek medical advice promptly.

Keep training – but train the shoulder you have

One of the advantages of working with someone who understands strength training is that a shoulder problem doesn't automatically mean putting your whole training programme on hold.

We can usually find ways to keep working on your legs, core, cardiovascular fitness and the parts of your upper body that aren't affected, while modifying the movements that are causing problems.

And once the shoulder is ready, strength and capacity can be built back progressively.

That's the approach I take in my Midlife Fit Programme. The aim isn't to avoid lifting because you're getting a few niggles. It's to build strength and fitness while taking account of the changes, injuries and daily niggles that can come with midlife.

If shoulder pain is stopping you doing the things you want to do, don't just stop training. Get it assessed, adapt your programme and keep moving where you can.