Menopause symptoms and chronic pain

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Women with menopausal symptoms are nearly twice as likely to experience chronic pain and have multiple chronic pain diagnoses, according to a national sample of midlife women veterans.

“The magnitude of the relationship between menopausal symptoms and chronic pain was significantly larger than the modest associations seen with known risk factors including older age and higher body mass index (BMI), and approached that of mental health comorbidities known to influence both menopause and pain experience,” wrote the investigators from the San Francisco Veterans Administration (VA) Health Care System and the University of California, San Francisco (UCSF).

The cross-sectional analysis in the journal Menopause used national Veterans Health Administration medical and pharmacy records for 200,901 women veterans aged 45 to 64 years (mean age 54.3) who had at least one VA interaction during 2014 and/or 2015.

The women in the sample were mostly white (58%), and either overweight (25%) or obese (41%).

The most prevalent mental health diagnosis was posttraumatic stress disorder (PTSD) (18%), followed by a depressive disorder diagnosis (13%) and an anxiety diagnosis (15%). Less common were documented alcohol use disorder (5%) and substance use disorder (4%). 

Overall, 15% of women had two or more comorbid mental health diagnoses.

Incidences of overweight/obesity and all mental health diagnoses were greater among women with chronic pain and chronic pain multimorbidity compared to women without chronic pain.

In total, 26% of the sample had menopausal symptoms, which was defined as menopause symptom-related diagnoses on at least two VA encounters and/or menopause hormone therapy use.

In addition, 52% of the sample had chronic pain and 22% had at least two distinct chronic pain diagnoses.

Among women with menopause symptoms, the odds ratio for chronic pain was 1.89 (95% CI: 1.85–1.94) and for multiple chronic pain diagnoses 1.86 (95% CI: 1.83–1.90).

Women who were older, black, overweight or obese were more prone to both chronic pain and chronic pain multimorbidity. Similarly, those with mental health comorbidities and substance use disorder were also at higher risk.

However, the correlation between menopausal symptoms (as defined by diagnostic codes) and chronic pain was the same (OR 1.90; 95% CI: 1.82- 1.99), whereas the association between menopause symptoms and chronic pain multimorbidity remained significant but not as prominent (OR 1.33; 95% CI: 1.27-1.40).

Psychosocial factors and health risk behaviors that are widespread during and after the menopause transition, and are strongly and consistently associated with both chronic pain and menopause symptoms, include sleep difficulty, physical and mental health comorbidities, and health risk behaviors like limited physical activity. These factors may underlie or exacerbate both menopause symptoms and chronic pain experience.

Regardless, “The etiology underlying chronic pain risk among women in midlife is not well understood,” the authors wrote. 

Because the temporal relationship between menopause symptoms and chronic pain is unknown, it remains unclear whether menopause symptoms contribute to chronic pain or if chronic pain contributes to menopause symptom burden and/or reporting, or whether shared etiology underlies both experiences.

Nonetheless, the biological and behavioral changes linked to the menopause transition may play a role.

The authors noted that previous studies have shown connections between menopause status and self-reported chronic pain diagnoses/symptoms, thus underscoring the possibility of a menopause-related hormonal change in chronic pain experience.