Chronic Pain in Midlife • World Menopause Day • October 18, 2026

Maybe it is the new or increasing stiffness when you first get out of bed, a regular walk that now leaves you aching, or migraines that have become harder to manage. It might be that pain has been part of your life for years and midlife has brought another layer of change. It can be unsettling to feel less at ease in your own body, especially when you are already navigating disrupted sleep, shifting energy and the many demands of this season of life.

On October 18, World Menopause Day, the International Menopause Society (IMS) is bringing attention to a concern that deserves a much larger place in our conversations about women's health: chronic pain at midlife. 

The IMS 2026 White Paper estimates that approximately half of midlife women experience chronic pain. That is a lot of women adjusting their days around what hurts, missing activities they enjoy, or wondering whether this is the new normal and something they have to learn to live with long term. Many still face delayed diagnoses or symptoms attributed to stress or getting older.

Women carry a greater burden of chronic pain than men. A systematic review focussed specifically on midlife, found chronic pain was about 16% more common in women than men. The difference varies by condition and population; for fibromyalgia, the same review found women were approximately three times as likely to be affected. 

If any of this feels familiar, your symptom experience deserves time, curiosity and care. Understanding how menopause may contribute can help make sense of what you are experiencing and open up more possibilities for support. 

How menopause and pain can intersect

Chronic pain is pain that persists or recurs for more than three months. It may arise from a condition such as osteoarthritis, from nerve injury, from changes in pain processing, or from several mechanisms simultaneously. 

During the menopause transition, fluctuating and eventually declining estrogen levels interact with the nervous system, immune function and musculoskeletal tissues. These changes may influence pain sensitivity and contribute to new symptoms or changes in an existing pain condition.

Hormones are one part of that picture. Aging, previous injuries, medical conditions, disrupted sleep, emotional health and the demands of daily life also matter. The paper emphasizes how these influences interact, rather than identifying a single cause.

This is why new pain deserves a thoughtful assessment, even when it begins around perimenopause. Recognizing a possible hormonal connection should broaden the conversation while keeping other causes in view.

The nervous system is part of the story

With persistent pain, the pathways that process signals in the spinal cord and brain can become more sensitive. This is sometimes called central sensitization. Pain may persist after an injury has healed or become more widespread than the original problem would suggest.

These are real biological changes. If you have ever been told that your pain is 'just stress,' it is understandable that a conversation about the nervous system might feel uncomfortable. Looking at how sleep, stress and mood affect pain is a way to understand more of what your body is carrying, and to identify additional ways to help.

Why symptoms often overlap

The White Paper explores fibromyalgia, migraine and chronic pelvic pain, including vulvar pain and bladder pain syndrome. Joint and muscle pain are also common around the menopause transition. Some women experience several pain conditions at once.

Fibromyalgia, for example, can involve widespread pain alongside fatigue, non-restorative sleep and difficulty concentrating. Migraine may become more frequent or severe during perimenopause as hormones fluctuate. Pelvic pain can involve pelvic floor muscle tension, changes in vulvovaginal tissues, bladder symptoms or other conditions that need specific assessment.

Pain can interrupt sleep, while poor sleep can increase pain sensitivity. Fatigue and mood symptoms can add to the burden. Treating each symptom in isolation may miss opportunities to address what is keeping that cycle going.

What more complete care can look like

The central message of this year’s paper is the need for individualized, multidisciplinary care. Depending on your symptoms, that might involve primary care, a menopause clinician, a physiotherapist, a pelvic health physiotherapist, a psychologist or a pain specialist. Neurology, rheumatology or gynecology may also have a role.

A useful plan begins with being heard. Alongside learning where and when the pain occurs, questions like 'What has changed?', 'What do you miss being able to do?', 'What would make your daily quality of life feel more manageable?' can help shape care around what would work best for you. Treatment can then address the pain condition alongside menopausal symptoms and other contributing concerns.

Appropriately paced movement, strength training and rehabilitation can improve function and help with several chronic pain conditions. Sleep support, adequate nutrition and psychological approaches such as cognitive behavioural therapy may also help. These supports work alongside medical treatment, with goals and activities adapted to your capacity. They should never become another reason to blame someone for being in pain.

How menopause hormone therapy may support some women

Menopause hormone therapy (MHT) may be a helpful part of care for some women. When hot flashes and night sweats repeatedly interrupt sleep, treating those symptoms may support improved capacity and overall well-being for people living with pain. The White Paper recognizes these potential indirect benefits, particularly when several menopausal symptoms are contributing to a reduced sense of well-being.

Some studies have also found improvements in joint and muscle symptoms with MHT. A large randomized trial of estrogen alone in women who had undergone hysterectomy found a modest reduction in joint pain. This gives us reason to consider possible benefits for individuals, while recognizing that the response is variable and findings from one treatment or population do not apply to everyone. 

The broader research remains mixed. A recent systematic review found no significant overall effect of MHT on generalized musculoskeletal pain, and evidence for treating established chronic pain is limited. MHT may have a place as part of a comprehensive treatment plan without being the 'magic bean' that fixes everything.  

For selected women with new pain associated with menopause, the paper supports considering a cautious, individualized trial after discussing the limited evidence, potential benefits and personal risks. This is a conversation to have with a clinician who can consider your symptoms and health history, then follow up on what is actually helping. 

Starting the conversation

You do not need to have the explanation figured out before asking for help. If pain is changing your daily life, some questions to consider asking: Could perimenopause be contributing? What other causes should we assess? Are there overlapping conditions? How can we address sleep, function and pain together? Would a referral help?

You can also bring the IMS White Paper to your appointment. Or visit IMS World Menopause Day for additional resources that may support you.

I hope we can make more room for women to speak openly about pain and for care that responds with understanding and practical support.