The Gender Pain Gap in Midlife: Why Women’s Pain Is Still Doubted, Delayed and Dismissed
Many women arrive at midlife already carrying a suspicion that their pain has not been taken as seriously as it should have been, and that suspicion is now supported by evidence, because women's pain is more often doubted, more often delayed and more often dismissed, each of those has been measured. This is not only a question of biology; it is also a question of whose symptoms are believed, which questions get asked, which conditions get researched and how quickly good care is offered.
Persistent pain is common across Australia, with Deloitte estimating that 3.24 million Australians were living with chronic pain and that women made up 53.8 per cent of them, more recent reviews add that women carry a disproportionate share of severe pain, of pain that interferes with daily life and of pain-related disability.[3][4]
Biological pathways can genuinely differ between women and men, but at the same time gendered assumptions can shape whose pain is read as credible, whose is read as emotional and whose is treated as urgent.
What the experimental research shows
In a controlled 2021 study, people watched videos of male and female patients displaying the same level of pain behaviour and rated the women's pain lower on average, a difference of around two and a half points on a hundred-point scale that was tied to beliefs that women express pain more readily and men are more stoic.[1] The difference is small, and the study cannot tell us that every clinician discounts every woman, but it shows that perception can be biased before a single diagnostic or treatment decision has been made, and a bias this widely shared works despite good intentions, which is part of why it has persisted.
Delayed and under-treated: what the healthcare data shows
A frequently cited American study of emergency care for acute abdominal pain found that women waited longer for pain relief than men, a median of 65 minutes against 49 minutes, and were less likely to receive any analgesia at all despite reporting similar pain.[2] It was a single-centre study published in 2008, and the gap was clearest in younger women, so it should not be read as a universal law that every woman waits longer for every kind of pain.
Dismissed: the Australian picture
The most direct evidence here is Australian and recent. When the national Senate inquiry into menopause and perimenopause invited women to describe their care, more than 70 per cent of those who made submissions reported that their symptoms had been dismissed, and the inquiry documented cases where antidepressants were offered in place of proper investigation.[5] These figures come from inquiry submissions rather than a population survey, so they describe the experiences of women who chose to come forward rather than a representative national rate, yet they are powerful as testimony to a pattern rather than as a prevalence statistic. Victoria's 2025 Inquiry into Women's Pain heard from more than 13,000 contributors, of whom 90 per cent reported pain lasting longer than a year and 54 per cent reported daily pain, and the same caveat applies: participation was voluntary and women with difficult experiences were especially likely to respond, rather than a count of how often those things happen across the whole population.[6]
Women make up about 53.8 per cent of people living with chronic pain, with rates climbing through the menopause years to roughly one in five women aged 45 to 54 and nearly one in four aged 55 to 64.[3]
Why midlife symptoms are so easily misread
Perimenopause often brings a shifting mix of sleep disruption, migraine, joint or muscle pain, palpitations, cognitive change, pelvic and genitourinary symptoms and altered mood, and it is worth saying that many women's periods stay completely unchanged through all of this, so a regular cycle does not rule menopause out. When symptoms fluctuate like this it is easy for a clinician to attribute everything to stress, weight, ageing or menopause, and any of those may genuinely contribute, but accepting the first plausible explanation and ending the diagnostic process there can miss a co-existing condition. The reverse also happens, where a woman is sent for scan after scan and test after test while nobody addresses her insomnia, her hot flushes, her work strain or her sensitisation, when the honest answer is that a structural diagnosis and menopause-related contributors can sit together.
What better pain care looks like
The history is heard without interruption to establish the pattern, the timeline and the impact.
Menstrual and menopause stage are considered where relevant, without menopause being used as a diagnosis of exclusion.
The clinician explains their working diagnosis, the reasonable alternatives, why tests are or are not indicated, and what would trigger a review.
Pain relief and function are addressed while investigation continues; a woman should not have to earn symptom relief by first proving a cause.
Treatments are reviewed against agreed outcomes, so a lack of benefit prompts reassessment rather than blame.
Preparing for the appointment
Clear notes can make a short consultation more efficient, and a few things genuinely help.
Lead with the change: this began six months ago and is now limiting stairs and sleep.
Describe pattern and function: where it is, what it feels like, when it comes, what triggers it, whether it wakes you and what you can no longer do.
List associated symptoms and their timing: cycle change, hot flushes, an infection, an injury, a new medication or new neurological symptoms.
Ask the three questions: what is your working diagnosis, what else are you considering, and what is the plan if this does not improve.
Closing the gender pain gap does not mean asking for more than men receive, it means comparable curiosity, comparable diagnostic rigour, comparable symptom relief and comparable follow-up, and it importantly means funding research capable of detecting the sex and gender differences that matter.
In simple terms
The gender pain gap is documented: women's pain is more often doubted, delayed and dismissed.
Observers underestimate women's pain, and most women who made submissions to an Australian inquiry said their symptoms had been dismissed.
The verified figure is that about 53.8 per cent of Australians with chronic pain are women, rising through the menopause years.
In midlife the gap shows up as pain attributed to menopause and then left uninvestigated.
Your pain is real, menopause may be part of the explanation, but it should never be used to stop looking for the full explanation.
Medical terms,
Sex: biological attributes that may influence disease and treatment response.
Gender: social roles, identities and expectations that may influence exposure, communication and care.
Premature closure: ending diagnostic reasoning after the first plausible explanation.
Pain interference: how much pain disrupts sleep, movement, work, relationships or daily activity.
References
[1] Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD. Gender biases in estimation of others’ pain. J Pain. 2021;22(9):1048–1059.
[2] Chen EH, Shofer FS, Dean AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med. 2008;15(5):414–418. (US single-centre study; gap present under 50, absent over 50; not universal across pain types.)
[3] Deloitte Access Economics. The cost of pain in Australia. Painaustralia; 2019. (Women 53.8% of people living with chronic pain.)
[4] 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.
[5] Senate Community Affairs References Committee. Issues related to menopause and perimenopause. Parliament of Australia; 2024. (“More than 70%” derived from inquiry submissions, not a population survey.)
[6] Victorian Department of Health. Inquiry into Women’s Pain: Bridging the gender pain gap. Victorian Government; 2025. (More than 13,000 contributors; consultation, not population prevalence.)
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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