Menopause and Chronic Pain: What the Research Shows, and Where the Gaps Remain
The International Menopause Society chose chronic pain at midlife as its 2026 World Menopause Day theme.[1]
Observational evidence
The strongest recent synthesis pooled 37 studies from 22 countries and 93,021 women, and found reported muscle or joint pain rising from around 40 per cent before menopause to 57 per cent through perimenopause and 59 per cent afterwards.[2]
Specific diagnoses such as tendinopathy, inflammatory arthritis or neuropathy were often not separated out, so the review supports an association across menopause stages without being able to establish the cause of any one woman's symptoms.
Mechanistic evidence: the biology
Oestrogen signalling interacts with the central and peripheral nervous systems, with immune pathways, and with bone, skeletal muscle, tendon and cartilage. Sex-related differences have been described in how pain is modulated, in neuroimmune signalling and in susceptibility to several painful conditions.[3]
Intervention evidence: the MHT results are mixed
A systematic review published across late 2025 and the 2026 volume included 57 studies and almost four million participants, and for generalised musculoskeletal pain the pooled results showed no significant overall difference between women who had ever used menopausal hormone therapy and those who never had, with the randomised-trial-only sensitivity analysis also neutral and the findings for osteoarthritis and rheumatoid arthritis inconsistent.[4] Despite the very large participant count only a small minority of those studies were randomised trials, so they were not testing MHT head to head against a placebo for pain. This does not prove that no individual woman can feel better on MHT; it means the available studies do not support a predictable, general pain-relieving effect, particularly when formulation, route, timing, diagnosis and the way pain was measured all varied so much between studies.
General pain evidence: useful, but not menopause-specific
Many of the treatments used for midlife pain were studied in mixed-age or condition-specific groups rather than in women stratified by menopause stage, so exercise, cognitive behavioural approaches, sleep treatment and multidisciplinary rehabilitation can each help selected chronic pain presentations, but the average effects are usually modest and depend heavily on the diagnosis and on how the treatment is delivered. Pain neuroscience education is a useful example, because it can reduce fear and give people a coherent explanation of their pain, yet systematic reviews do not support education as a stand-alone cure, and a large trial found that a short intensive education programme did not prevent chronic low back pain, which is why education is best used to support active, diagnosis-appropriate care rather than as a substitute for it.[5][6]
Why are the gaps so persistent?
Part of the answer is historical; women were under-represented in clinical research for decades, and many studies that now include women still do not report their outcomes by sex or by menopause stage, which means a study can contain thousands of women and still be unable to answer a menopause-specific question if cycle stage, symptoms, hormone therapy and reproductive history were never measured.
Funding is part of it too. An analysis of United States National Institutes of Health funding measured against disease burden found that, among conditions predominantly affecting one sex, close to three-quarters of the funding disparities favoured male-dominant conditions, and it is evidence that research investment does not reliably track the burden a condition places on the population.[7]
What the next generation of studies should do
Define reproductive stage prospectively rather than inferring menopause from age alone.
Separate pain diagnoses and mechanisms instead of collapsing everything into a single aches-and-pains outcome.
Record MHT formulation, dose, route, timing and adherence.
Measure function, sleep, quality of life and adverse effects alongside pain intensity.
Recruit diverse populations and report sex, gender and ethnicity analyses planned in advance.
We have enough evidence to take pain in menopause seriously and to reject the idea that it is simply inevitable ageing, and we do not yet have enough direct evidence to assign all midlife pain to hormonal change or to promise a universal treatment.
In simple terms
A 2026 review of 93,021 women found muscle or joint pain in about 40 per cent before, 57 per cent during and 59 per cent after menopause, with no proof of cause.
The biology is plausible, but plausibility is not the same as a proven treatment effect.
The largest MHT review found no reliable overall effect on general musculoskeletal pain, and its huge participant count was mostly not from randomised trials.
The gaps persist because of historical exclusion, funding misaligned with burden, and pain being treated as one disease when it is many.
References
[1] International Menopause Society. World Menopause Day 2026: Chronic Pain at Midlife.
[2] Kruse C, et al. Musculoskeletal pain during the menopausal transition: a systematic review and meta-analysis. JBJS Open Access. 2026;11:e25.00254. (37 studies, 22 countries, 93,021 women; 35 of 37 cross-sectional; heterogeneity very high.)
[3] Smith AF, Plumb AN, Berardi G, Sluka KA. Sex differences in pain: from bench to bedside. J Clin Invest. 2025;135(11):e191931. doi:10.1172/JCI191931.
[4] Overton R, Amini P, Chew A, et al. The effect of menopausal hormone therapy on musculoskeletal pain: a systematic review and meta-analysis. Post Reprod Health. 2026;32(1):52–68. (57 studies, ~3.96 million participants but only a minority randomised; no reliable overall effect; I²=90%.)
[5] Cuenca-Martínez F, et al. Pain neuroscience education in chronic musculoskeletal pain: a systematic review and meta-analysis. 2023. (No clinically important advantage over control for pain or disability; low certainty.)
[6] Traeger AC, Lee H, Hübscher M, et al. Effect of intensive patient education vs placebo patient education on outcomes in acute low back pain. JAMA Neurol. 2019;76(2):161–169.
[7] Mirin AA. Gender disparity in the funding of diseases by the U.S. National Institutes of Health. J Womens Health. 2021;30(7):956–963. (US NIH data; burden-adjusted funding; correlational.)
This information is educational only and does not constitute personal medical advice. Always consult a qualified health professional about your individual circumstances.
© Menopause Hub 2026.
Anna Pattison. Former Registered Nurse, Clinical Myotherapist, Menopause Mentor.
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