Chronic Pain in Menopause: Understanding Midlife Symptoms Beyond the Scan

While approximately half of midlife women experience chronic pain, the reason for that pain is not always obvious on a scan or explained by a single diagnosis. This can leave women without clear answers or support, believing persistent pain is simply something they have to live with.

To address this, the International Menopause Society (IMS) has made Chronic Pain at Midlife the focus of World Menopause Day on 18 October, the global awareness day it founded in 2009 to break the stigma surrounding menopause and improve understanding, care and support.

To support more informed clinical conversations and personalised, multidisciplinary care, IMS has worked with ten international experts to produce a new White Paper bringing together the latest evidence on chronic pain at midlife and the complex factors that can influence how it is experienced and managed.

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.”

The White Paper states that “pain severity often correlates poorly with visible disease burden” and explains that nociceptive, neuropathic and nociplastic pain mechanisms may coexist 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. Considering the impact on mobility, work and everyday function can help build a fuller clinical picture and inform appropriate treatment, referral or multidisciplinary support.

Professor 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.”

The message this World Menopause Day is that when tests do not fully explain persistent pain at midlife, that pain should not simply be accepted as “one of those things”. Test results are one part of a wider clinical picture, and recognising the complexity and overlap of symptoms can help women access appropriate care and support.

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