Women’s Pain Management Across Their Lifespan

For centuries, women have been told that pain is simply part of being female — from menstrual cramps and childbirth to the discomforts of menopause. But modern pain science shows that pain is not something women should be expected to tolerate at every stage of life.

Dr. Kristen MacKenzie, clinical assistant professor and co-director of the Stanford Pelvic Pain Program, emphasizes that women’s pain must be understood as a lifelong issue — influenced by biology, hormones, social expectations, and medical systems. When pain is identified and treated early, short-term discomfort is less likely to evolve into chronic pain later in life.

Pain Throughout a Woman’s Life

Adolescence

Menstrual pain often begins early. The average age of menstruation onset in the U.S. is around 12, and up to 90% of girls experience cramps, headaches, or back pain during their periods. Severe or persistent symptoms can signal conditions such as endometriosis, yet young girls are often told this pain is “normal.” Early care — whether through medication, physical therapy, or other options — can prevent the nervous system from becoming sensitized and reduce the risk of future chronic pain.

Reproductive

During the reproductive years, pain may accompany fertility treatments, pregnancy, and childbirth. Painful procedures like IUD insertions or egg retrievals have historically been performed with minimal pain management. Even pregnancy itself can bring significant back and pelvic pain. After childbirth, recovery from vaginal tearing, C-sections, or breastfeeding challenges is frequently under-treated. Social messages to “push through it” or “this is normal” leave many women to manage pain in silence, even when help is available.

Midlife and Menopause

Hormonal changes during perimenopause and menopause can lead to hot flashes, sleep disruption, joint pain, and painful intercourse. These symptoms are often misdiagnosed or minimized, yet they can dramatically affect quality of life. In later years, women are at greater risk for bone loss and fractures due to declining estrogen, as well as arthritis and other joint pain. Addressing these issues early helps maintain activity, social engagement, and independence.

Why Women Experience Pain Differently

Women’s pain sensitivity is shaped by both biology and experience. Hormones like estrogen and progesterone influence how the brain processes pain. Research shows that women detect pain at lower thresholds than men — not because they are weaker, but because their bodies are tuned to respond quickly to potential danger, a trait that may have been evolutionarily protective for caregiving and survival.

However, repeated or unaddressed pain can “train” the nervous system to stay on high alert — a process called sensitization. Over time, this can lead to nociplastic pain, where the brain continues to send pain signals even after the body has healed. Conditions like fibromyalgia, chronic pelvic pain, and irritable bowel syndrome often fall into this category. Recognizing these mechanisms helps move care away from outdated assumptions that pain must always correspond to visible injury.

How Culture and Medicine Shape Pain Care

The roots of women’s pain dismissal run deep. Ancient Greek physicians believed the uterus could “wander” through the body, causing illness — a notion that led to centuries of treating women’s suffering as emotional rather than physical. Modern versions of that mindset persist today.

Research shows that women wait longer in emergency departments for pain medication and are more likely to receive sedatives or anti-anxiety drugs instead of diagnostic tests. These disparities delay care and can erode trust in the medical system. Dr. MacKenzie notes that part of the solution lies in how physicians are trained: medical education often emphasizes finding tissue damage to explain pain, leaving doctors uncertain about how to respond when no clear injury is visible.

Understanding that pain is both sensory and emotional — and that the nervous system itself can become dysregulated — is critical for providing appropriate and compassionate care.

Comprehensive Pain Management for Women

Because pain involves both the body and the brain, the most effective management uses more than one approach. Dr. MacKenzie highlights several key strategies that can be tailored throughout a woman’s life:

• Medication: NSAIDs like ibuprofen or naproxen reduce menstrual and joint pain; other medications may help calm nerve sensitivity.
• Physical therapy: Especially pelvic floor or orthopedic therapy, which can retrain muscles and reduce pain sensitivity.
• Pain psychology: Approaches such as cognitive behavioral therapy (CBT) and Stanford’s Empowered Relief class teach mind-body tools to lower stress and reframe pain.
• Lifestyle support: Movement, stress reduction, and restorative sleep all help regulate the nervous system.
• Social connection: Pain can be isolating; community support is a vital part of recovery.

Relief often comes through consistency — combining multiple strategies and giving the body and brain time to adapt.

What Needs to Change

Improving outcomes for women requires systemic change:

• Medical education must teach future doctors how to recognize and manage pain that isn’t tied to tissue damage.
• Research must include more women, especially in dose-finding studies for medications.
• Clinical care must validate women’s pain experiences, offering clear explanations even when imaging or lab tests appear normal.
• Patient education should start early — even in high school — teaching girls how to advocate for themselves and communicate effectively with healthcare providers.

“When women’s pain is acknowledged and studied, care improves for everyone.”

The Path Forward

Pain touches nearly every stage of a woman’s life, but it does not have to define it. Recognizing the biological, cultural, and social influences on women’s pain — and providing early, compassionate, and comprehensive care — allows women to live fuller, healthier lives at every age.

As Dr. MacKenzie says, “The old idea that pain is simply part of womanhood is being replaced with compassion, curiosity, and science. When women’s pain is acknowledged and studied, care improves for everyone.”