Hormone Therapy May Help Ease Shoulder Pain During Menopause

Experts say many women going through menopause develop adhesive capsulitis, also known as “frozen shoulder.” Antonio Diaz/Getty Images

• Researchers say hormone replacement therapy may help ease the pain from “frozen shoulder” for women going through menopause.
• Experts note that hormone therapy is beneficial for a number of ailments, but the research is too preliminary on its impact on shoulder pain.
• There have been concerns over hormone therapy and breast cancer risk, but experts say the risks are low.

It is sometimes called frozen shoulder, even “menopause shoulder.”

Doctors say the condition, known as adhesive capsulitis, causes stiffness and pain in the shoulder joint. Little is definitively known about the cause.

The ailment more commonly occurs in women over the age of 40. Having diabetes, thyroid disease, heart disease, or Parkinson’s disease can also put you at higher risk.

In a new study, researchers decided to hone in on the demographic most affected by adhesive capsulitis –menopausal women.

The Duke University team conducted the first known study evaluating whether hormone therapy might reduce the risk of adhesive capsulitis in menopausal women.

The team evaluated medical records from a single institution for nearly 2,000 menopausal women ages 45 to 60.  In the group, 152 of the women were receiving hormone replacement therapy (HRT).

While acknowledging the small sample size, the researchers concluded that “those not receiving hormone replacement therapy had 99% greater odds of adhesive capsulitis compared to those receiving HRT.”

The findings are being presented this week at the North American Menopause Society annual meeting in Atlanta, Georgia. The results have not been published yet in a peer-reviewed journal.

Dr. Anne Cunanan Ford, NCMP, an associate professor of obstetrics and gynecology at the Duke University Medical Center in North Carolina, is the study’s lead author.

“Our study draws attention to estrogen’s potential benefit apart from the FDA (Food and Drug Administration) approved indications – vasomotor symptoms, bone protection, and vulvovaginal atrophy,” she told Healthline. 

“We know that estrogen plays an important role in the musculoskeletal system, stimulating new bone formation, promoting muscle growth and repair, maintaining connective tissue integrity, and reducing inflammation” Ford explained. 

“If borne out by future prospective studies, the use of systemic hormone therapy may be protective in minimizing adhesive capsulitis” she added. “It’s a condition that causes significant pain, reduction in range of motion, and decreased quality of life in peri and post-menopausal women.”

Reaction to the study

Experts who spoke to Healthline agreed that there needs to be more research.

“This pilot study provides preliminary data that will guide future studies further investigating a potential link between menopause and hormone therapy use or non-use, and risk of adhesive capsulitis,” said Dr. Stephanie Faubion, the director of the Mayo Clinic’s Center for Women’s Health in Minnesota and Medical Director of the North American Menopause Society.

“No conclusions can be made based on these data,” she told Healthline.

“It’s a small study… so something like this has to be looked at in bigger numbers,” added Dr. G. Thomas Ruiz, the lead OB-GYN at MemorialCare Orange Coast Medical Center in California.

“I think it’s an interesting study in that we know that estrogen receptors are found throughout a woman’s body,” he told Healthline. “So it’s not surprising that there would also be an interaction between joint function ligaments and tendons with estrogen.”

“So the menopausal state in the absence of estrogen is probably going to change” he added. “We know with bone, for example, in the absence of estrogen, women will start to lose calcium at a more rapid rate. That puts them at risk of osteoporosis and osteopenia, at an increased risk for hip fractures. So looking at this study… I don’t necessarily find it too surprising… but it’s also too small a number to make a definitive statement.”

Going forward, Ford said: “Our data is preliminary and due to the small sample size, this association did not reach statistical significance. Larger prospective studies are needed to evaluate and confirm our findings.”

Using hormone replacement therapy

Would hormone therapy work to treat adhesive capsulitis? 

“We have no idea. There is no data. Hormone therapy does appear to be associated with less joint pain. But the mechanism behind this effect is unknown” Faubion said.

“Hormone therapy is effective for management of hot flashes, night sweats, sleep disturbance associated with menopause, prevention of osteoporosis, fractures and the treatment of genitourinary syndrome of menopause” she explained. “It also appears to help with depressive symptoms in the menopause transition.”

“The benefits of hormone therapy typically outweigh the risks for symptomatic women who are under the age of 60 and within 10 years of the onset of menopause,” she added.

Still, many women have questions about the safety of hormone treatment because of previous studies linking some forms of hormone treatment to an increased breast cancer risk.

The American Cancer Society states that estrogen-only HRT is not linked to a higher risk of breast cancer. The Women’s Health Initiative studies also found no increase in breast cancer risk in women using systemic estrogen-only HRT.

But organization officials note that in women who have a uterus, using systemic estrogen-only HRT has been shown to increase the risk of endometrial cancer.

Other studies have found a link between systemic estrogen-only HRT and a higher risk of ovarian cancer.

Ruiz says there’s an increase in the use of bioidentical hormones that replicate those your body produces and methods of delivering the hormones that bypass the liver. 

“Keep in mind the medications that were used – Premarin and Provera – were taken orally and metabolized through the liver,” he said. “Physiologically that causes a lot of activity in the breast tissue.”  

“Bioidentical hormones are more like your ovaries made… that’s the definition” he added. “Then the estrogen can even be given in cream or patch… that’s absorbed directly… So these medications are not metabolized in the liver to make them active.”

Ruiz says hormone replacement doses are much lower now and that perhaps new studies need to be done.

Hormone Therapy May Help Ease Shoulder Pain During Menopause
Source: Pinoy Lang Sakalam

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