Actresses Olivia Wilde, 42, & Penelope Cruz, 52, Say ‘Shoulder Stiffness’ Is a Subtle Symptom Women In Their 40s May Experience as Perimenopause Takes Hold

“I see this condition quite often in our practice. In general, musculoskeletal symptoms in midlife women remain underrecognized as part of the menopausal transition,”  Dr. Sarah Richina, board-certified OB/GYN and Director, UPMC Magee-Womens Midlife Health Center, tells SurvivorNet.

“Frozen shoulder is one of several musculoskeletal conditions that appear to disproportionately affect women, with an increased incidence during the menopausal transition when estrogen levels are fluctuating and ultimately declining,” Dr. Richina adds.

When it comes to the changes that accompany menopause and perimenopause, Dr. Stephanie McNally, Medical Director for Katz Institute of Health at Northwell Health, says the impact can touch “everything.”

“The average age in the United States is about 51 to 52, when your periods will stop,” Dr. McNally explains to SurvivorNet. “So it’s the full year without a period equals menopause. Menopause is anything happening after, and perimenopause is the time leading up to that last period.”

Perimenopause is the natural transition before menopause, marked by fluctuating hormones, irregular periods, and the early onset of menopausal symptoms.

This phase typically lasts “around four or five years,” Dr. Sara L. Stockman of the Magee-Womens Department of Obstetrics, Gynecology and Reproductive Sciences tells SurvivorNet. “But we do know that there is a subset of women who can be in a perimenopausal period for 10 or more years,” she adds.

Cruz recalls being warned about the long road ahead: “I remember when I was 41, and my doctor told me, ‘Your hormones are going to be doing this crazy dance for the next 10 or 12 years.’ I thought it was a really bad joke…I thought it was not possible to handle that.”

During perimenopause, women may experience hot flashes, night sweats, mood changes, sleep disruptions, and irregular menstrual cycles.

Cruz and Wilde also highlight a lesser-discussed but well‑documented symptom associated with this stage of life.

“Now I just think about frozen shoulder all the time. I’m just waiting for my shoulder to freeze,” Wilde told entertainment outlet “Allure.”

A 2025 study published in the peer‑reviewed “Journal of Clinical Medicine” notes: “Given the predominance of frozen shoulder in women, especially around perimenopause and menopause—a period marked by a sharp decline in estrogen levels—the female sex hormonal axis emerges as a promising and under-investigated component in the etiological framework of frozen shoulder.”

The researchers further explain that: “Estrogens are known to exert anti-inflammatory, neuroprotective, and immunomodulatory effects, and their decline may create a systemic environment that favors fibrotic, inflammatory, and pain-sensitized states. This hormonal transition may intersect with other metabolic and lifestyle factors (e.g., diet, stress, physical inactivity), contributing to the onset and progression of Frozen Shoulder.”

Dr. Richina says, “Estrogen plays an important role in joint health, and the growing recognition of frozen shoulder in midlife women highlights the broader need to better understand and address the musculoskeletal manifestations of menopause.”

What to Expect: Signs of Menopause and Perimenopause

Dr. McNally explains that symptoms often begin “at the head,” showing up as shifts in mood, energy, cognition, and episodes of brain fog.

Many women notice slower word recall or reduced mental quickness during the perimenopausal transition — a pattern well documented in research. Sleep disruptions, changes in libido, difficulty coping with stress, and hot flashes (a vasomotor symptom) are also common, all of which originate from hormonal signaling in the brain.

“As estrogen declines, it becomes erratic,” she says. “Your brain is craving estrogen, and your ovaries are essentially saying, ‘I’m done.’”

Perimenopause can last anywhere from two to ten years, and its duration and intensity vary widely. Research shows differences across ethnic backgrounds, medical histories, and other individual factors, making the experience highly personal. Dr. McNally adds that:

• Premature menopause occurs before age 40
• Early menopause occurs between the ages of 40 and 45
• After age 45 is considered the typical range
• The average age of menopause is 51

Symptoms can begin as early as a woman’s early 30s, particularly for those who may be on track for an earlier transition.

Understanding the Signs

Early and common perimenopause symptoms may include:

• Breast tenderness
• Headaches
• Menstrual cycle changes
• Mood changes

Other physical, metabolic, and weight‑related changes may include:

• Skin changes or itchiness (including itchy ears)
• Hair changes
• Shifts in breast density
• Slower metabolism
• Belly weight gain despite healthy habits

Pelvic, urinary, and broader body changes may include:

• Urinary leakage or incontinence
• Vaginal dryness
• General pelvic health changes
• Joint discomfort

Dr. McNally emphasizes that symptoms can appear “from head to toe” because estrogen receptors exist throughout the body. As hormone levels fluctuate, any body system can be affected — and each person’s experience is unique.

She reiterates that predicting exactly how perimenopause or menopause will unfold is difficult, as factors such as ethnic background, medications, and overall health shape the transition.

“The menopausal state is really a depletion of our sex hormones — estrogen, progesterone, and part of our testosterone,” she explains.

While testosterone is produced in both the ovaries and adrenal glands, levels of these key sex steroid hormones drop significantly during menopause. “That’s the difference,” she says. “Erratic in perimenopause, and then absent in the menopausal state.”

Women Going Through Menopause Should Protect Their Mental Health

Dr. McNally validates the emotional symptoms many women experience as they enter menopause and adds that they aren’t imagined or exaggerated.

“There’s very good data to show that there is an increase in depression and anxiety diagnoses in the perimenopausal transition,” Dr. McNally says.

WATCH: Coping With Early Menopause

The reasons are both biological and situational:

• Shifts in estrogen and progesterone
• Life stressors are common in midlife, which may include caring for aging parents, career pressures, caregiving, or relationship changes.
• Elevated stress hormones like epinephrine and cortisol

These forces interact in ways that can destabilize mood, energy, and sleep.

The Triangle: Sleep, Mood, and Energy

Dr. McNally describes these symptoms as a tightly linked system:

“If you break it down into a physiological hormonal perspective… these stress hormones could negatively impact many other factors of your life,” Dr. McNally explains.

“If you’re not sleeping as a root, your other mood function fatigue is all connected. Think of it as a triangle. Sleep, mood, and energy are very, very connected.”

When one corner of the triangle falters, the others often follow.

Learn more about SurvivorNet's rigorous medical review process.

---