Chronic Pain and Menopause: Why Does Everything Suddenly Hurt?
Have you ever stood up from the sofa and made a noise that you are fairly certain did not come from the television? Or woken up wondering what on earth you did yesterday to make your hips, knees or shoulders feel as though they had completed a marathon without telling you? Sometimes it can feel as though you have turned 90 overnight!
Aches and pains come up in almost every menopause conversation I have. For some women, it is new joint stiffness or muscle pain. For others, an existing condition such as migraine, pelvic pain, irritable bowel syndrome or fibromyalgia suddenly becomes more difficult to manage.
The theme for World Menopause Day 2026 is Chronic Pain at Midlife, and the International Menopause Society (IMS) has published a new White Paper examining the relationship between menopause and chronic pain.
This is an important topic because women’s pain has been overlooked and dismissed for far too long. Women have often been told that pain is emotional, caused by stress or simply something they must learn to live with. Stress, sleep and emotional wellbeing can certainly influence how we experience pain, but that does not make the pain imaginary or any less deserving of proper investigation and treatment.
What is chronic pain?
Chronic pain is generally defined as pain that persists or keeps returning for more than three months.
According to the IMS White Paper:
Women are approximately 50–70% more likely than men to experience chronic pain.
Around half of women at midlife may be living with chronic pain.
Musculoskeletal pain is particularly common during the menopause transition, with research suggesting it affects approximately 71% of perimenopausal women.
Pain conditions frequently overlap. Someone may experience joint pain alongside migraine, or pelvic pain alongside bowel symptoms, fatigue and poor sleep.
Fluctuating and declining oestrogen may influence our joints, muscles, bones and nervous system, as well as the way the brain processes pain signals. However, hormones are only one part of a much bigger picture. It is really important that we remember this.
Ageing, previous injuries, loss of muscle strength, changes in bone health, osteoarthritis, poor sleep, stress, mood, lifestyle and other health conditions may all contribute.
Menopause does love to keep us guessing, but we still need to be careful about blaming every new ache and pain on our hormones.
What types of pain may be experienced at midlife?
The White Paper looks at five main areas of pain that may become more difficult to manage during menopause.
1. Joint and muscle pain
This is the most commonly reported type of pain at midlife. It can affect the hands, knees, hips, shoulders, neck or back and be accompanied by stiffness, particularly first thing in the morning.
The term musculoskeletal syndrome of menopause has been used to describe a collection of changes that may occur as oestrogen declines alongside the ageing process. These can include:
joint pain and stiffness
reduced muscle mass and strength
changes in bone density
problems affecting tendons and ligaments
changes in cartilage
However, joint and muscle pain may also be caused by osteoarthritis, inflammatory conditions, injuries and other health problems.
Persistent or worsening pain deserves a proper assessment rather than being added to the ever-growing “sure, it’s probably menopause” list.
2. Migraine
For some women, migraines becomes more frequent and severe during perimenopause. This is often connected with fluctuating hormone levels rather than simply having low oestrogen.
My experience has also been that many women experience migraines but describe them as bad headaches. It is important to understand that a migraine can occur without aura and may include symptoms such as nausea and sensitivity to light, sound or smell.
Some women find that migraines improve after natural menopause when hormone levels become more stable. Unfortunately, menopause does not issue guarantees, so this is not everyone’s experience.
3. Chronic pelvic and sexual pain
Pelvic pain is not one condition. It may be connected with:
endometriosis
bladder pain syndrome
vulvodynia, or pain around the vulva and vaginal opening
pain during sex
pelvic-floor muscle tension
ongoing period-type pain, even after periods have stopped
Pelvic pain should not automatically be put down to menopause, recurrent urinary infections or ageing. It is common, but that does not mean women should simply put up with it. Let’s move on from this suffering-in-silence lark, please!
4. Gastrointestinal pain and irritable bowel syndrome
Abdominal pain, bloating and irritable bowel syndrome may become more troublesome during the menopause transition.
Hormonal changes may play a part, but sleep, stress, medication, diet and communication between the gut and nervous system may also contribute. The gut, as many of us know, is not shy about letting us know when it is unhappy.
This is one of the reasons I am always harping on about fibre, but if you have IBS, you may need a more careful and individual approach.
5. Widespread pain, fatigue and fibromyalgia
Some women experience pain across several areas of the body alongside fatigue, poor sleep and difficulty concentrating. This pattern may be associated with fibromyalgia.
Fibromyalgia and menopause
Fibromyalgia is around three times more common in women than in men. It can cause widespread pain or tenderness, but it is much more than simply feeling a bit achy.
Symptoms may include:
widespread muscle and joint pain
significant fatigue
sleep that does not feel refreshing
difficulty concentrating or “fibro fog”
headaches or migraine
increased sensitivity to touch, temperature, light, noise or smells
digestive symptoms, including irritable bowel syndrome
Fibromyalgia can involve changes in how the nervous system processes pain. You can almost think of the nervous system’s volume control as being turned up too high. Signals that might not normally feel very painful can become amplified, and pain may continue even when there is no ongoing injury or obvious tissue damage.
This is sometimes described as central sensitisation. It is a real physical change in the way pain signals are processed. It does not mean that the pain is imagined, exaggerated or “all in someone’s head”.
Fibromyalgia can overlap with migraine, irritable bowel syndrome, pelvic pain and bladder pain.
Sleep is particularly important because pain can make it harder to sleep, while disrupted sleep can increase pain sensitivity and fatigue. It can become a very frustrating circle: you cannot sleep because you are in pain, and the pain feels worse because you cannot sleep.
Some women notice fibromyalgia symptoms becoming more troublesome during perimenopause, when hormonal fluctuations, poor sleep, hot flushes, mood changes, brain fog and fatigue can all pile on top of one another. It can feel as though the symptoms have started their own group chat and everyone is contributing at once!
However, menopause does not necessarily cause fibromyalgia, and HRT should not be presented as a treatment for fibromyalgia itself.
Treating troublesome menopause symptoms may improve sleep and overall wellbeing, which could make pain easier to manage, but fibromyalgia still needs its own individual care plan.
There is no single approach that works for everyone. Support may include:
gentle, appropriately paced movement
strength work
physiotherapy
pain education
support with sleep
stress-management strategies
psychological support
medication where appropriate
The White Paper also discusses CBT and other psychological approaches. These are not suggested because the pain is psychological, but because they may help someone manage the very real impact that persistent pain can have on sleep, relationships and everyday life.
What can you do to help yourself?
There is rarely one magic solution, despite what may pop up on social media! It comes back to trying many of the practical things that you can do to support yourself during what can be a challenging time in your life.
