Taking chronic pain in midlife women seriously

The International Menopause Society (IMS) marked World Menopause Day on 18 October by highlighting chronic pain at midlife, which affects approximately half of women in this age group. A new IMS white paper, developed with 10 international experts, explores the complex factors influencing pain during midlife and menopause, emphasising that symptoms may persist even when scans or tests show no clear cause.

The campaign’s central message is that persistent pain should not be accepted as an inevitable part of menopause. Women deserve appropriate assessment, treatment, and support, even when test results do not fully explain their symptoms.

Prof Rossella Nappi, President of the IMS and co-author of the paper, said: “This year’s World Menopause Day is about chronic pain at midlife because it’s a health issue that affects millions of women, and one that deserves to be talked about and taken seriously. Chronic pain is complex and is something we often associate with menstruation.

“However, it does not end with menopause and this message needs to be heard. We want to help women to be able to speak to their doctors openly and find a solution without thinking they are imagining the pain that keeps them up at night and stops them from living life.”

The document states that “pain severity often correlates poorly with visible disease burden” and explains that nociceptive, neuropathic, and nociplastic pain mechanisms may co-exist in the same patient. It also notes that current neuroimaging cannot provide objective proof of the presence or absence of pain.

Healthcare professionals can help by looking for patterns across a woman’s symptoms rather than considering each symptom in isolation. How long the pain has persisted, whether more than one pain condition is present, and whether symptoms such as sleep disturbance, fatigue, mood changes, brain fog, or vasomotor symptoms are contributing to the overall picture can all be important.

Prof Nappi added: “Women’s pain has too often been dismissed through gendered stereotypes, and labelled ‘emotional’ rather than properly investigated and treated. Chronic pain at midlife should be recognised as a key component of menopause care, requiring gender-sensitive, individualised, and multidisciplinary approaches.”

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