Key Summary
- Chronic pain impacts half of midlife women but is often invisible on standard scans.
- The IMS is urging doctors to stop dismissing persistent midlife pain as merely "emotional".
- Menopause abruptly alters over half of routine bodily health markers, starting years before the final period.
Women experiencing chronic pain at midlife will be highlighted on 18 October as the International Menopause Society (IMS) marks World Menopause Day.
Approximately half of midlife women experience persistent pain, yet symptoms are rarely explained by standard scans or isolated diagnoses. According to the IMS, this leaves millions believing persistent discomfort is an unavoidable part of aging.
Co-authored by ten international experts, a white paper highlights significant epidemiological disparities: globally, women are 50% to 70% more likely than men to develop chronic pain.
During the menopausal transition, musculoskeletal pain alone affects roughly 71% of women.
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.”
She added: “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.
The organisation is urging healthcare professionals to look for patterns across a woman’s symptoms rather than considering individual symptoms in isolation.
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 white paper stresses that 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.
Complementing the focus on multi-system symptoms at midlife, a new study from the Weizmann Institute of Science published in Nature Medicine also reveals that physiological shifts during menopause extend far beyond sex hormones and reproductive function.
Analysing more than 300 million routine laboratory test results from over one million women, researchers identified abrupt changes across 52 of 90 standard biological markers. These disruptions spanned nearly all organ systems, including bone metabolism, liver and kidney function, and lipid profiles.
Notably, the study revealed that these systemic changes were preceded by gradual hormonal shifts beginning more than a decade before the final menstrual period (FMP), several years earlier than previously documented. None of these abrupt changes were detected in age-matched men, pointing to what the authors describe as a "step-like physiological cliff" driven by ovarian decline.
The shifts were found to be less pronounced among women receiving menopausal hormone therapy. Because many of the altered markers are directly tied to cardiometabolic and chronic disease risk, the authors argue that the window for preventive intervention opens much earlier than traditional clinical thresholds suggest.
"Our study extends the window for potential preventive care to almost a decade before menopause," said co-author Professor Uri Alon. "More broadly, the method we developed may help study other major changes in life, such as puberty, pregnancy or the onset of disease."
To bypass the typical challenge of missing menopausal age data in medical registries, the team applied an analytical model inspired by astronomy, mathematically eliminating individual timeline variations to construct a unified chronological picture of female reproductive ageing.
