Menopausal Hormone Therapy Decreases the Odds of Developing Soft‐Tissue Disorders of the Shoulder in Perimenopausal Women

Purpose To determine whether perimenopausal women receiving menopausal hormone therapy (MHT) have decreased odds of developing soft‐tissue shoulder disorders compared with women without an active MHT prescription, specifically adhesive capsulitis, bursitis, bicipital tendinitis, calcific tendinitis, atraumatic rotator cuff tear/rupture, and shoulder impingement syndrome and to quantify the impact of differing formulations and administration route. Methods The TriNetX US Collaborative Research Network, a deidentified database of over 180 million patients, was queried on June 11, 2026. Women aged 40 to 60 years in a menopausal state were identified by International Classification of Diseases code N95.1 and primary ovarian insufficiency by International Classification of Diseases code E28.3. Patients were grouped by MHT prescription status. Patients were one‐to‐one propensity‐matched on age, race, ethnicity, and metabolic disease status, with standardized mean difference less than 0.1. The odds of developing soft‐tissue shoulder disorders were studied, with P values less than .05 considered statistically significant. Results A total of 296,992 patients were included. The index the mean age was 49.1 years, 74.5% to 74.6% were White, 6% were Hispanic/Latino, 9% were African American, and 4.1% were Asian. Women prescribed any form of systemic MHT showed significantly lower odds of developing adhesive capsulitis (odds ratio [OR] 0.875, 95% confidence interval [CI] 0.786‐0.973; P = .014), bicipital tendinitis (OR 0.775, 95% CI 0.669‐0.898; P = .001), calcific tendinitis (OR 0.829, 95% CI 0.706‐0.974; P = .023), shoulder impingement syndrome (OR 0.873, 95% CI 0.792‐0.962; P = .006), and rotator cuff tear/rupture (OR 0.892, 95% CI 0.804‐0.991; P = .032). Topical estrogen specifically was associated with decreased odds of developing adhesive capsulitis, bursitis, bicipital tendinitis, shoulder impingement syndrome, and rotator cuff tear/rupture. Conclusions In peri‐ and postmenopausal women, MHT use was associated with decreased odds of soft‐tissue shoulder disorders compared with individuals not using MHT. Topical estrogen was more closely associated with reduced odds of soft‐tissue shoulder disorders compared with oral estrogen and oral combined formulations. Level of Evidence Level III, therapeutic retrospective comparative study.