Midlife chronic pain isn't all in your head

More frequent migraines, aching joints and pelvic pain are often put down to aging.

But the International Menopause Society (IMS) says chronic pain at midlife should not simply be accepted as part of life, and women should not be left believing they are imagining it when conventional tests fail to provide an obvious answer.

To address this, IMS has made chronic pain at midlife the focus of World Menopause Day on 18 October and published a new White Paper, Chronic Pain at Midlife. Founded by the Society in 2009, World Menopause Day aims to break stigma, raise awareness and improve menopause care and support globally.

Compiled by ten international experts, it brings together current evidence on why pain at this stage of life can be so complex and why there is rarely a one size fits all explanation, while highlighting how chronic pain remains underestimated in research and care.

Conditions including fibromyalgia, migraine and chronic pelvic pain can seriously affect quality of life, yet when investigations do not provide a clear explanation, women can be left without answers and unsure where to turn next. IMS says women should not be left in this position.

Professor Rossella Nappi, President of the IMS and co-author, 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.”

Understanding the Complex Causes of Midlife Pain

The White Paper draws on evidence showing how hormonal changes can interact with the nervous system, immune system, musculoskeletal health, sleep, mood, lifestyle and wider social and cultural factors. Together, these influences help explain why persistent pain can be difficult to untangle and why looking at the whole person, rather than one symptom or test result in isolation, matters.

Breaking the Stigma Around Women’s Health

Women experiencing persistent pain are encouraged not to dismiss it as part of getting older. Keeping a note of when it happens, how long it lasts, what makes it better or worse and the impact it is having on sleep, work, relationships and everyday life can help when speaking to a healthcare professional about what may be contributing to it and what treatment or support options are available.

Professor Nappi added: “Women's pain has too often been dismissed through gendered stereotypes, and labeled '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.”

The message this World Menopause Day is simple: pain that cannot immediately be explained is still pain, and women should not feel they simply have to live with it.

The 2026 IMS White Paper, Chronic Pain at Midlife, plus factsheets and additional resources are downloadable from the International Menopause Society website.