You Are Not Imagining It

In 2020 the international body that defines pain rewrote its definition to state that pain need not match any damage a scan can find, and that a person’s report of their pain should be respected [1]. That is important if you have experienced pain no test seems to explain, and come away from appointments being told it is due to stress, or hormones, or your age because being in pain is hard enough without also having to advocate for yourself and describe a pain that is real.

Real pain does not always show on a scan

The belief that pain must correspond to visible damage is out of date, and when the international body governing pain research updated its definition in 2020, it added that pain need not be tied to damage a scan can find, and it stated plainly that a person’s report of their pain should be respected [1]. That last line matters most here: your account of your own pain is treated as evidence.

There is a mechanism behind this, pain can be generated and amplified by a sensitised nervous system even when there is little or nothing left to find in the tissue. The absence of damage on an image is not evidence that nothing is wrong, it is evidence that the problem lies in a system that images were never designed to show.

Why women in particular are so often doubted

Alarmingly, research has shown that when people are shown others in pain, they systematically judge women to be feeling less than they report [2]. In emergency care, women in pain have been found to wait longer for pain relief than men and to be less likely to receive it at all [3]. When Australian women were asked directly, in a national inquiry into menopause and perimenopause, more than seventy per cent said their symptoms had been dismissed, with the inquiry documenting cases where antidepressants were offered in place of investigation [4].

This pattern has a nuanced impact in midlife, where pain is more likely to be attributed to menopause, to stress, or to ageing, and waved through without the full explanation being sought. 

What to do 

There are things that help you hold your ground while the system catches up. It helps to describe your pain precisely rather than apologetically, in terms of where it is, what it feels like, when it comes and how it affects your life, because a clear pattern is harder to dismiss than a tired summary. It helps to write it down and bring it with you. It also helps to know that if you are not taken seriously, that is information about the appointment, not a verdict on you, and that looking for a GP with an interest in menopause is a reasonable response.

 Your pain is real, menopause may be part of the explanation, but it should never be used to stop looking for the full explanation. When you are ready to prepare for the conversation itself, how to talk to your GP about pain sets it out step by step.

In simple terms

• Since 2020 the international definition of pain recognises pain without visible tissue damage, and states your report should be respected.

• Pain from a sensitised nervous system is real and well described, so clear scans do not mean nothing is wrong.

• Women are measurably more likely to be doubted, wait longer for pain relief, and have symptoms dismissed.

• Describing your pain clearly and holding your ground is reasonable, and being doubted is information about the appointment, not about you.

  
  

Your pain is real, menopause may be part of the explanation, but it should never be used to stop looking for the full explanation.

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.

References

[1] Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982.

[2] Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD. Gender biases in estimation of others’ pain. Journal of Pain. 2021;22(9):1048–1059.

[3] Chen EH, Shofer FS, Dean AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine. 2008;15(5):414–418.

[4] Senate Community Affairs References Committee. Issues related to menopause and perimenopause. Parliament of Australia; 2024.