Managing Frozen Shoulder During Perimenopause: Expert Treatment Tips for Women
- Colin O'Banion, DPT
- Mar 21
- 6 min read
Updated: Apr 30
Colin O’Banion, Doctor of Physical Therapy
Colin is a licensed Physical Therapist and founder of Colin O’Banion Physical Therapy in Boulder, Colorado. With over 20 years of experience, he specializes in solving complex and chronic pain cases through a root-cause, integrative approach. Colin combines advanced manual therapy, shockwave therapy, dry needling, and movement re-education to help clients return to the activities they love. His one-on-one practice is dedicated to clients seeking lasting solutions when traditional PT has fallen short.
Frozen shoulder, also known as adhesive capsulitis, is a frustrating and often painful condition that limits your ability to move your arm. It usually develops in three stages: first comes the freezing stage, where pain increases and your range of motion starts to shrink. Then, during the frozen stage, the pain may lessen, but the shoulder becomes stiff and difficult to move. Finally, in the thawing stage, mobility slowly begins to return.
For many active women, frozen shoulder can feel like it comes out of nowhere. One day you’re enjoying a yoga class or swimming, and the next, you’re struggling to lift your arm without sharp pain.
Sometimes frozen shoulder develops after an injury, such as a repetitive strain or a fall. Other times, it’s insidious—meaning it occurs without an obvious cause.
The truth is, while the condition might seem sudden for many, there are clear links between hormonal shifts during perimenopause—particularly a decline in estradiol—and the onset of frozen shoulder. And this can occur at any stage of perimenopause, even if you aren't experiencing other perimenopausal symptoms.
Diagnosis of frozen shoulder is typically made through a physical exam, where a healthcare provider assesses your shoulder’s range of motion and asks about your symptoms. Imaging tests like MRI or ultrasound aren’t usually necessary unless there’s concern about another condition, such as a rotator cuff tear. This straightforward process helps identify frozen shoulder early, so treatment can begin right away.
The good news is that you don’t have to wait it out. With a proactive, hands-on approach, it’s possible to improve shoulder mobility, reduce pain, and get back to doing what you love.
Why Perimenopausal Women Are at Greater Risk for Frozen Shoulder
Perimenopause is a time of major hormonal transition, and one of the most significant changes is the decline in estradiol, a form of estrogen. While most people think of estrogen in terms of reproductive health, it also plays a critical role in maintaining healthy connective tissues, joint mobility, and reducing inflammation throughout the body.
A recent study by Han Li and colleagues in 2024 found a clear connection between lower estradiol levels and an increased risk of frozen shoulder. When estrogen levels drop, the connective tissues that surround the shoulder joint—called the joint capsule—can become inflamed and stiff. Over time, this leads to the thickening and tightening of the capsule, which restricts movement and creates the hallmark pain and stiffness of frozen shoulder.
While frozen shoulder isn’t exclusive to women in perimenopause, this group faces a higher risk because of these hormonal shifts. Other factors, like diabetes, thyroid disorders, and prolonged shoulder immobility after injury or surgery, can add to the likelihood of developing the condition. But for many women navigating this life stage, hormones are often the driving force.
At Colin O’Banion Physical Therapy, I understand how frustrating it is to be told there’s nothing you can do but wait it out. My approach is different. By addressing the underlying inflammation and stiffness early on—with targeted, hands-on care—I help restore mobility and relieve pain, even during the so-called “frozen” stage.
How Frozen Shoulder Impacts Active Women
For active women, frozen shoulder can feel especially limiting. Frozen shoulder can make your favorite activities like rock climbing, swimming, and yoga extremely painful—or impossible.
One of the most frustrating parts of frozen shoulder is the loss of independence it creates in daily life. Simple things, like reaching overhead to grab something from a shelf, reaching back to fasten a seatbelt, or even getting dressed, can become difficult or painful.
Many women are told to just “wait it out” while the shoulder goes through its stages. Unfortunately, this often leads to months—or even years—of pain, frustration, and lost activity.
I believe you shouldn’t have to put your life on hold. My proactive, hands-on approach helps you work through each stage of frozen shoulder, so you can stay as active and engaged as possible.
What a Frozen Shoulder Physical Therapy Session Looks Like
Each session is designed to help you reclaim your range of motion and reduce pain—one step at a time. Here’s what a typical visit looks like when you work with me at Colin O'Banion Physical Therapy:
Heat Therapy to Prepare Your ShoulderWe’ll begin by applying heat to your shoulder to increase circulation, relax tight muscles, and prepare the joint for movement. I often also incorporate red light therapy at this stage to promote tissue healing and reduce inflammation at the cellular level.
Hands-On Joint MobilizationsOnce your shoulder is warm, I use targeted joint mobilizations to gently stretch and move the shoulder capsule. These techniques are designed to “unlock” stiffness, even during the frozen stage. Each session builds on the last, progressing at a pace that works for your body.
Additional Modalities When Indicated If and when it’s appropriate, I may incorporate other advanced modalities such as dry needling to release muscular tension or shockwave therapy to stimulate healing and promote tissue regeneration. These techniques can be highly effective for reducing pain and improving mobility—when tolerated and tailored to your needs.
Guided Movement and Exercises After the manual therapy work, I’ll guide you through specific exercises tailored to your shoulder’s current stage and your personal goals. These exercises help reinforce the progress we make in the session and give you movements you can practice at home to maintain and build on that mobility.
Education and At-Home Plan Last, I’ll walk you through your customized at-home exercise plan and offer strategies to manage pain between visits. We’ll also talk about how and when to use heat—whether it’s a sauna, hot tub, or heating pad—to support your shoulder mobility and comfort.
Every session is one-on-one with me, giving you personalized attention and a treatment plan that’s focused on your specific needs. My goal is to help you restore your shoulder function and get back to doing what you love.
At-Home Strategies to Support Your Frozen Shoulder Recovery
What you do outside of your session is just as important as the work we do together. To make steady progress with frozen shoulder, consistent movement and care at home are key. Here’s what I typically recommend to my clients between visits:
Daily Rehab Exercises I’ll provide you with a simple, tailored set of exercises to do throughout the day. These movements help maintain the mobility we’ve worked on during our session and prevent the shoulder from stiffening back up. You don’t need fancy equipment—just consistency and gentle movement.
Use Heat to Loosen the Shoulder Before Stretching Applying heat before you do your home exercises can make a huge difference. Whether it’s time in a sauna, a soak in a hot tub, or simply using a heating pad, warming up the shoulder before movement helps reduce stiffness and increase your range of motion. This is a great at-home heating pad.
Gentle Movement Throughout the Day Frozen shoulder responds best to consistent, gentle motion. I encourage my clients to move their shoulder frequently—small movements done regularly tend to work better than long, strenuous sessions. The goal is to keep the shoulder from settling back into stiffness.
Managing Frozen Shoulder Pain, Especially at Night Pain often flares up in the evening or while you’re trying to sleep. Here are a few strategies that can help:
Supportive Sleeping Positions: Try lying on your back with a pillow under your elbow, or on your non-painful side while hugging a pillow to support the shoulder.
Evening Heat and Gentle Mobility: Use heat before bed and do a few gentle movements to calm things down before sleeping.
Breath work: Practicing slow, deep breathing can help relax your nervous system and reduce pain sensitivity.
Sleep Hygiene: Good sleep habits—like limiting screen time and caffeine in the evening—can improve your rest, which is essential for recovery.
By combining these at-home strategies with our in-office work, you’ll give yourself the best chance of restoring your shoulder mobility and reducing pain.
This consistent, two-part strategy—focused care in session and consistent movement at home—creates real change over time. Many of my clients start noticing improvements in pain, function, and sleep within a few weeks of starting treatment.
My goal is to help you stay active and engaged in your life without constant shoulder pain.
Ready to Get Your Shoulder Moving Again?
If you’re struggling with frozen shoulder and tired of being told to “just wait it out,” I’d love to help. At my physical therapy practice in Boulder, CO I focus on hands-on, root-cause treatment tailored specifically to you. Whether you’re in the early stages of frozen shoulder or have been dealing with it for months, we can work together to restore your mobility, reduce your pain, and get you back to the activities you love.
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