Pain during menopause

Chronic pain at midlife is the theme for World Menopause Month. We went looking at what has been published on it in Maturitas, found four studies worth reading, and asked the authors to write about their own findings.

Musculoskeletal pain, migraine and vulvovaginal pain all rise during the menopausal transition, and are usually treated separately from it.

Natalie H. Strand, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, United States

Menopause is usually discussed in terms of hot flashes, mood changes and hormonal shifts. Pain is a frequent part of the experience too, and it is often overlooked and under-addressed. Around 1.3 million women in the United States begin menopause each year, and close to 60% experience urogenital symptoms, including dyspareunia.

What the pain looks like

It takes three main forms: musculoskeletal pain, headaches and migraines, and vulvovaginal pain.

The causes involve hormonal fluctuation, psychosocial factors and genetic predisposition. Changes in estrogen and progesterone levels play a significant part in musculoskeletal pain and joint stiffness, and increase susceptibility to conditions such as osteoarthritis. Mood disorders, stress and sleep disturbance can worsen the perception of pain.

Gender norms, changes in reproductive capacity and societal attitudes to ageing can also affect the self-esteem of women going through menopause. These sit alongside the physical symptoms.

Working out the cause

Pain during this period has a wide range of possible causes. History, physical examination, laboratory tests and imaging all have a part in establishing what is behind it and deciding on treatment. Our review examined the factors contributing to pain during menopause, the effects of hormones on it, and the management strategies available, both pharmacological and non-pharmacological.

More research is needed on how these factors interact, so that treatment can be better matched to the individual woman.

Part of the clinical picture

Menopause remains underdiagnosed and undertreated, and its potential contribution to chronic pain in midlife women is too often overlooked. Raising awareness of this connection is essential so that clinicians consider menopause as part of the clinical picture, helping more women receive an accurate diagnosis and timely, individualized treatment. By recognizing the role hormonal changes may play in pain, we can better serve this often-overlooked patient population and improve both quality of life and clinical outcomes.

Read the review

Strand NH, D’Souza RS, Gomez DA, et al. Pain during menopause. Maturitas. 2025;191:108135.