Menopause, Frozen Shoulder and the Joint Pain Wake Up Call with Dr. Jo

If you've ever struggled to put on a bra, reach behind your back, or lift your arm without searing pain in your shoulder, you're not alone. Frozen shoulder strikes women in midlife at alarming rates, yet for decades, medicine dismissed it as a mystery condition with no known cause. Orthopedic surgeon Dr. Jocelyn Wittstein saw what others missed: her patients with frozen shoulder were almost all women between forty and sixty, experiencing hot flashes, night sweats, and other symptoms of perimenopause and menopause. What she discovered is changing how we understand the impact of declining estrogen on women's joints, bones, and muscles.

Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University, specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies.

In this conversation, Dr. Mary Claire Haver and Dr. Wittstein explore how declining estrogen during perimenopause and menopause impacts joints, bones, muscles, and connective tissue. They discuss why frozen shoulder disproportionately affects women in midlife, with some Asian cultures having their own term for it that translates to fifty year shoulder. Dr. Wittstein explains the critical window for treatment, why early intervention can be transformative, and how hormone replacement therapy may prevent it, with preliminary data suggesting women using systemic estradiol have half the risk of developing frozen shoulder. She shares why physical therapy during the inflammatory phase can worsen it and how to recognize the early warning signs.

The conversation expands beyond frozen shoulder to address broader musculoskeletal changes during menopause. Dr. Wittstein discusses why women are eight times more likely than men to tear their ACL, her research using real-time hormone measurements and advanced imaging to understand this disparity, and what oral contraceptives might have to do with injury risk. She explains why women over fifty are thirty-five percent more likely to have arthritis than men, a difference that doesn't equalize until age eighty, suggesting these are hormonally influenced processes driven by estrogen loss.

Dr. Wittstein and Dr. Haver dive deep into bone health and osteoporosis prevention. Dr. Wittstein explains why impact matters for bone density, sharing research on jumping exercises and how mechanical load stimulates bone formation. She discusses evidence for strength training, particularly the LIFT More trial that demonstrated significant bone density gains in menopausal women who performed back squats, deadlifts, and overhead presses.

The conversation addresses practical prevention strategies women can implement now. Dr. Wittstein discusses wrist fractures that often happen when women in their fifties fall as an early warning sign of bone health issues and why catching these cases early could prevent hip fractures decades later. They discuss balance training, agility work, and why standing on one leg while brushing your teeth can reduce fall risk. Dr. Wittstein shares her evidence-based perspective on weighted vests.

For women experiencing joint pain, stiffness, or loss of range of motion during perimenopause or menopause, this episode validates that these symptoms aren't in their heads and aren't simply aging. Dr. Wittstein explains why joints hurt more, why injuries take longer to heal, and why frozen shoulder appears out of nowhere during midlife. She emphasizes that while HRT can be one prevention tool, lifestyle interventions like strength training, impact exercise, and balance work are crucial for all women, regardless of whether they choose hormone replacement therapy.

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