Menopause and Chronic Pain: Why Perimenopause Can Make Pain Worse
We often talk about hot flushes, sleep disturbances, and changes in menstrual cycles when discussing perimenopause. But something that receives far less attention is the way women experience pain.
Joint aches, muscle pain, headaches, migraines, and worsening of existing conditions can all become more noticeable during the menopause transition. And there are physiological reasons for this.
Oestrogen does more than regulate your menstrual cycle.
Oestrogen plays an important role in the nervous system, musculoskeletal health, immune regulation and the way our bodies process pain.
Oestrogen receptors are found throughout the brain, spinal cord, muscles and joints. As oestrogen levels become increasingly variable during perimenopause, several processes involved in pain regulation may be affected.
Pain sensitivity: Oestrogen interacts with neurotransmitters and pathways involved in pain processing. Hormonal fluctuations can alter how sensitive the nervous system becomes to painful stimuli.
Inflammation: Oestrogen has complex immunomodulatory effects. Changes in oestrogen signalling may influence inflammatory activity and contribute to musculoskeletal discomfort.
Muscles, joints and connective tissue: Oestrogen contributes to the maintenance of muscle, bone and connective tissue. Declining oestrogen levels may contribute to changes in musculoskeletal health, although the relationship with pain is multifactorial.
Sleep and recovery: Disrupted sleep is common during perimenopause, and poor sleep can increase pain sensitivity. Pain can then further disrupt sleep, creating a difficult cycle.
Did you know? Menopause & Chronic Pain
According to the International Menopause Society's 2026 White Paper:
Women are up to 70% more likely than men to experience chronic pain.
Almost 3 in 4 women experience joint or muscle pain during perimenopause.
Fibromyalgia is approximately three times more common in women than men.
These are significant numbers, particularly when we consider how frequently women's pain is dismissed, normalised, or attributed to ageing.
It's not always just menopause.
While hormonal changes may contribute to pain, they shouldn't become an explanation for every new or worsening symptom.
Iron deficiency, thyroid dysfunction, inflammatory conditions, the microbiome, nutritional inadequacies, sleep disturbances, and existing musculoskeletal conditions may also contribute.
For some women, perimenopause may amplify pain associated with conditions they have lived with for years, including migraine, endometriosis or chronic pain disorders.
This is why individualised assessment matters.
What can we do?
Supporting women through this transition involves looking beyond hormone levels alone.
Adequate nutrition, resistance training, maintaining muscle mass, improving sleep, managing existing health conditions and addressing relevant nutritional deficiencies can all form part of a comprehensive approach.
For some women, menopausal hormone therapy may be an appropriate part of broader menopause management following medical & naturopathic assessment.
