Chronic pain 'under-recognised' in half of midlife women, report finds

The IMS report highlights chronic pain, defined as pain persisting for more than three months or recurring, as a highly prevalent but neglected issue in midlife women. Rossella Nappi, the society's president and an obstetrician-gynaecologist at the University of Pavia, says the report aims to empower women and health workers to talk about the condition. "Chronic pain in midlife is a very important subject and highly neglected," she says. "Sometimes the pain becomes widespread and it's present in every day of their life."

Why women are at higher risk is not fully understood. Jane Chalmers, a senior lecturer in pain science at Adelaide University, calls it one of the “hardest questions to answer” in her field. “Trying to understand why certain people or certain groups are more vulnerable to others is often multi-factorial and very layered,” she says, noting that psychology, sociology and biology cannot be separated. Some research suggests women may be more likely than men to experience central sensitisation, a process that makes the brain more likely to produce pain signals.

Hormonal changes during menopause play a role: declining oestrogen can lead to joint pain, stiffness and muscle weakness. Nearly three in four women experience joint or muscle pain during perimenopause. Sharon Vasey, a GP and chair of the Royal Australian College of General Practitioners menopause health subgroup, notes that fluctuating hormone levels can also lead to migraines. Lifestyle factors also play a key role. Professor Nappi says a lack of exercise, poor diet and inactivity can make pain an issue, while sleep disturbances and mood changes can affect the experience of pain.

The IMS report concentrates on three common symptoms: musculoskeletal pain, migraine and pelvic pain. Chronic Pain Australia's 2026 National Pain Report, based on a survey of more than 6,000 Australians, adds further nuance: women reported an average of 4.6 different types of chronic pain, including back, nerve and pelvic pain. Nicollette Ellis, the group's chair and a pharmacist, says it is important not to treat each type in a “silo” but to consider the whole body. She also highlights social factors, saying that women often manage the majority of caregiving responsibilities, which may contribute to stress, and stress may worsen pain intensity for some people. Many patients, she says, feel dismissed.

Dr Vasey says the first step for women experiencing pain symptoms is to speak to their GP. She recommends getting enough sleep, staying active and eating well. Menopausal hormone therapy can help ease the severity of some symptoms for some women, but medication is not the only option; it may also be helpful to see allied health workers such as physiotherapists. “There's lots of things that can be done, women don't have to put up with chronic pain,” she says. At a broader level, Monash University professor Karen Walker-Bone says more needs to be done to support women approaching midlife, including ensuring financial stability so women can retire when they want and ensuring emotional household labour is shared equitably.