Women bear a disproportionate and often unseen burden of chronic pain, with their suffering frequently minimized or misdiagnosed. While chronic pain afflicts millions globally, women represent a striking 70 percent of patients, yet historically face significant disparities in evaluation and treatment. The critical question of how can we better understand and address this disparity is now being answered through groundbreaking scientific discoveries and a growing emphasis on holistic, personalized care. By recognizing fundamental sex differences in pain biology and empowering women to advocate for themselves, we can forge a path toward more effective, compassionate, and validating pain management.
The Unseen Burden: Why Women Experience More Pain
Caro Morales de Valencia’s ordeal began at the tender age of 13. With the onset of her first period, she was plunged into days of debilitating abdominal pain, accompanied by overwhelming fatigue, dizziness, and nausea. As a teenager, the intensity of her symptoms was so severe that she would sometimes collapse to the floor. Despite numerous doctor’s visits and hospital stays, first in Panama and later in California, the consistent verdict was that her pain was merely a normal part of being a woman. “I was constantly told that my pain was normal. So I thought it was normal,” Morales de Valencia recounts, highlighting a pervasive issue.
By her late twenties, Morales de Valencia’s distressing symptoms had intensified dramatically. She grappled with persistent pain, nausea, exhaustion, and gastrointestinal problems, leading her to routinely cancel social engagements and take time off from her demanding work teaching students with disabilities. She vividly recalls, “I was in pain 20 to 30 days a month,” illustrating the profound impact on her quality of life.
Chronic pain, defined as pain lasting longer than three months, affects nearly one in four American adults, equating to approximately 85 million individuals, according to a 2023 report from the Centers for Disease Control and Prevention (CDC). This pervasive condition disproportionately impacts women, who constitute roughly 70 percent of all chronic pain patients. Conditions such as migraine and fibromyalgia see an even higher female prevalence, with around 75 percent of sufferers being women (Journal of Women's Health, 2024).
Beyond prevalence, women often experience unique challenges. They tend to be under-evaluated and under-treated for their pain, receiving less relief from certain analgesics than men. Furthermore, women contend with specific pain conditions, including endometriosis and vulvodynia, which are often misunderstood or dismissed. As Frank Porreca, a distinguished professor at the University of Arizona College of Medicine, notes, “It’s fair to say most of the world’s pain patients are women.”
Biological, Psychological, and Sociological Factors
The intricate nature of pain involves a complex interplay of biological, psychological, and sociological elements. Hormonal influences play a significant role, with sex differences in pain perception becoming more pronounced in postpubertal adolescents compared to children. Estrogen and progesterone, key female hormones, influence myriad biological processes, including how medications are circulated, metabolized, and ultimately operate within the body. Women also navigate unique biological stressors and demands throughout their lives, particularly during pregnancy, childbirth, and postmenopause (NIH, 2024).
The immune system also appears to be a crucial player, according to psychiatrist Traci Speed of Johns Hopkins University School of Medicine. Women exhibit a greater propensity for diffuse pain conditions like fibromyalgia, which may be linked to immune dysregulation. Generally, women’s immune systems mount stronger reactions to pathogens and other stimuli than men’s, which, while beneficial for fighting infection, can also lead to increased inflammation. This heightened inflammatory response may contribute to the reduced effectiveness of common anti-inflammatories, such as ibuprofen, aspirin, and cortisone, in women compared to men (Journal of Immunology, 2023).
Moreover, there are well-established bidirectional links between chronic pain and mental health conditions. A comprehensive 2025 meta-analysis revealed that the prevalence of anxiety and depression among adults with chronic pain reached 40 percent. Given that women experience these mental health conditions more frequently than men, this connection further exacerbates their pain burden (World Health Organization, 2025).
Societal conditioning also plays a powerful, often detrimental, role. Boys and men are frequently taught to suppress their emotions and “be tough,” hiding their pain, while girls and women are often socialized to be agreeable and avoid “bothering” others with their discomfort. When women do express pain, they are frequently met with dismissive labels, being told they are emotional, hysterical, or that their pain is “all in their head.” Such invalidation can be tremendously damaging, echoing the experiences of people of color and other marginalized individuals (American Sociological Review, 2024).
The persistent bias against women in pain treatment was highlighted in a seminal 2001 article by scholars Diane Hoffmann and Anita Tarzian, titled “The Girl Who Cried Pain.” Two decades later, their follow-up study found some improvements, but significant disparities endure. Research continues to show that healthcare providers are more likely to prescribe psychotropic treatments to women than to men, even when both present with identical pain symptoms. The authors’ concluding hope remains poignant: “We sincerely hope that the next 20 years will witness far greater progress in treating women’s pain than we have seen in the last two decades.”
Unlocking the Biological Blueprint: Sex Differences in Pain
A significant part of the solution to understanding how can we better treat women's pain lies in unraveling the fundamental sex differences in the biology of pain itself. For too long, women were largely excluded from medical research; the mandate to include women in clinical studies only took effect in the U.S. in 1993, and the requirement to analyze sex as a biological variable in research became standard practice only in 2016. Since these policy changes, a torrent of new findings has begun to emerge, initially slowly, but now at an accelerating pace.
Jeffrey Mogil, a distinguished professor at McGill University, describes this period as an “opening of Pandora’s box,” with new studies revealing qualitative sex differences in the pain system almost weekly. One such pivotal study, published in December 2024, examined tissue samples from mice, monkeys, and humans. Researchers discovered that nociceptors, the nerve cells responsible for producing pain, responded remarkably differently to identical stimuli in male and female samples. This suggests that pain cells themselves vary between sexes, and consequently, respond (or not) to different treatments. “The basic machinery that produces pain is different in men and women,” states study co-author Porreca, calling it a “conceptual advance” (Nature Neuroscience, 2024).
Another significant study, published in October 2024, found that naloxone, a medication commonly used to reverse opioid effects, inhibited pain relief in males but had no such effect in females. “Males and females may be using different systems to reduce pain,” explains study co-author Fadel Zeidan, a professor at the University of California, San Diego. This insight underscores the urgent need to be more sophisticated and personalized in our approaches to pain management (Science Translational Medicine, 2024).
These emerging differences are crucial for shaping more effective, personalized treatments. This knowledge is key to determining how can we better optimize existing drugs that might have failed to reach statistical significance in general clinical trials but could be highly effective for women or men when data is analyzed by sex. Such cases are already coming to light. Porreca’s re-analysis of FDA data on a class of migraine drugs, for instance, revealed strong efficacy in women, with no evidence of efficacy in men. This profound insight could revolutionize treatment for the millions of women who suffer from migraine (Journal of Headache and Pain, 2025).
Roger Fillingim, director of the University of Florida Pain Research & Intervention Center of Excellence, emphasizes that “Migraine is one of the pain conditions that has the highest female-to-male ratio. Baked into migraine is some kind of sex difference, and these drugs are one of the relatively few successes in new pain therapies.” Beyond migraines, other breakthroughs are also on the horizon. The FDA recently approved suzetrigine, the first nonopioid pain medication in two decades. This novel drug targets sodium channels to block pain signals, offering an alternative to opioids that merely dampen the signal. Approved for acute pain, future research will explore its potential for chronic pain. “It’s extremely exciting that a new medication, a non-opioid, is approved for pain,” says Speed. “There are similar drugs in the pipeline, in clinical trials. In another decade or two, I think there will be more variety of pain medications that won’t be addictive.”
Beyond Painkillers: Sex-Specific Responses in Mental Health Treatments
The impact of sex-specific differences extends beyond pain medications to psychotropic drugs, highlighting the broader need for personalized medicine. Among antidepressants, for example, studies consistently show that men tend to respond more favorably to tricyclic antidepressants, while women often find greater relief from selective serotonin reuptake inhibitors (SSRIs). This distinction is particularly vital given the widespread prevalence of depression and the often arduous process patients endure to find an effective treatment regimen (Psychopharmacology, 2023).
These sex-specific variations are likely mediated by a complex interplay of factors, including fluctuating levels of hormones like estrogen, molecular differences at the cellular level, distinct synaptic signaling pathways, and the inherent heterogeneity of depression itself. Tara LeGates, a neuroscientist at the University of Maryland, Baltimore County, and author of a review on sex differences in antidepressants, asserts, “If we understand the differences between men and women, we can better treat people with what currently exists, and we can develop better drugs in the future.”
Research into mood stabilizers and antipsychotics also suggests potential sex differences, though the findings are less clear-cut. A 2024 review of the literature identified 18 studies showing no sex differences, 16 indicating women had better outcomes but experienced more harmful side effects, and five suggesting men had superior responses. Hypotheses for these observed differences mirror those in antidepressant research: variations in hormone levels and environmental factors. For instance, estrogen and progesterone can influence how medications are processed by the body, potentially inhibiting the enzymes responsible for drug metabolism in the liver. Mete Ercis, a postdoctoral research fellow at the Mayo Clinic and the review’s author, explains, “Higher estrogen means higher levels of some drugs. That can increase the efficacy and increase the side effects” (Journal of Clinical Psychiatry, 2024).
Understanding these fundamental sex differences represents one of the most basic building blocks of personalized medicine, a long-standing aspiration in healthcare. It is absolutely critical to grasp these distinctions not only for effectively treating pain and psychiatric disorders but also for enhancing overall healthcare provision across the board. The journey to discovering how can we better manage chronic pain and mental health conditions for all patients is intrinsically linked to recognizing and acting upon these sex-specific insights.
Navigating the Path to Relief: Holistic Strategies for Chronic Pain
Until more personalized medications become widely available, the immediate answer to how can we better treat chronic pain for women, and all patients, lies in a holistic approach. This strategy acknowledges and integrates all the biological, psychological, and societal elements that contribute to the pain experience. It’s a comprehensive journey that requires patience, persistence, and a multi-faceted plan.
Prioritizing Self-Care and Finding Support
From the outset, women must prioritize their own health, as advised by Traci Speed. Women often assume primary caretaker roles within their families, balancing numerous responsibilities, which can inadvertently lead to their own health suffering. Ensuring adequate sleep, regular exercise, balanced nutrition, consistent medical care, and robust social support are fundamental pillars of effective pain management. These foundational elements create a resilient base from which to address chronic pain.
Given that women’s pain is still frequently dismissed or ignored, finding a supportive and empathetic doctor is paramount. Patients must advocate for themselves by seeking out different opinions and asking friends or members of support groups for recommendations. A healthcare provider who truly listens and validates a patient’s experience can make an immense difference in their healing journey.
Multimodal Treatment Approaches
Effective treatment for chronic pain typically involves a multimodal strategy, integrating medication, various forms of therapy, physical activity, targeted nutrition, consistent sleep hygiene, and mental health care. In some cases, surgical interventions may also play a role. Patients should expect to experiment with different interventions and combinations over time, as what works for one individual may not work for another. This iterative process is crucial for discovering a personalized recipe for relief.
For instance, Sarah, a 42-year-old marketing executive, suffered from chronic pelvic pain for years, dismissed as “stress.” After finding a specialist, she embarked on a regimen combining a low-dose muscle relaxant, weekly pelvic floor physical therapy, and acupuncture. Within six months, her pain significantly decreased, allowing her to resume her favorite hobbies and improve her work productivity. Her journey exemplifies the power of a combined approach.
Therapeutic interventions offer powerful tools for managing chronic pain. Approaches such as cognitive behavioral therapy for chronic pain (CBT-CP), mindfulness-based stress reduction (MBSR), biofeedback, pain reprocessing therapy, and emotional awareness and expression therapy have all demonstrated efficacy. These therapies equip individuals with coping mechanisms and strategies to alter their relationship with pain.
Mindfulness-based stress reduction (MBSR) helps individuals cultivate awareness of their thoughts, emotions, and bodily sensations without judgment. This heightened awareness can create a crucial distance between the pain experience and one’s reactive response, thereby changing how people relate to their pain and reducing overall suffering. MBSR is particularly effective in alleviating stress, anxiety, and muscle tension, all of which can exacerbate the experience of pain. Rachel Zoffness, an assistant clinical professor at the University of California, San Francisco, School of Medicine and author of *The Pain Management Workbook*, states, “Mindfulness-based stress reduction is phenomenal for chronic pain.”
Another important evidence-based approach is cognitive behavioral therapy for chronic pain (CBT-CP). This therapy incorporates a suite of tools, including pain education, practical management techniques, behavior modifications, relaxation exercises, coping skills development, and lifestyle adjustments. The goal is to manage symptoms and significantly improve quality of life. CBT-CP works by helping to rewire the troublesome neural pathways that can become entrenched in chronic pain. A key tool within this approach is pacing, which involves gradually increasing activity and stimulation. Zoffness explains that just as a marathon runner doesn’t start by running 26 miles, a pain patient, in collaboration with their doctor, identifies a starting point and a realistic end goal, whether it’s returning to work, resuming a cherished hobby, or simply being able to play with their children.
Consider Maria, a 55-year-old retired teacher with fibromyalgia. She found profound relief by integrating gentle aquatic therapy, a specialized pain therapist who guided her through CBT-CP, and a carefully managed low-inflammation diet. Her therapist helped her identify triggers and develop coping strategies, while the aquatic exercises provided pain-free movement, collectively reducing her daily pain scores by over 50%. This comprehensive strategy highlights the individualized nature of effective pain management.
“There’s no single therapy for effectively treating pain. There’s a recipe of ingredients for each individual,” Zoffness concludes. “Chronic pain is treatable.”
Empowering Your Journey: Advocacy and Validation
A few years ago, Caro Morales de Valencia made a resolute decision to focus on healing her body and finally addressing the chronic pain she had endured for nearly two decades. She had long suspected she might have endometriosis, a condition that ran in her family, affecting a cousin and an aunt who had both undergone multiple surgeries. This personal history fueled her renewed determination to seek a definitive diagnosis.
Morales de Valencia consulted a gynecologist, who recommended a specialist and a pelvic floor therapist. Despite initial insurance challenges that caused a lapse in care, she diligently resumed her search for a diagnosis the following year with different providers. In December 2024, she had an appointment with a new specialist who utilized an online survey to assess patients’ likelihood of endometriosis prior to their visit. She completed the test, and the results flashed back: Over 90 percent probability. This moment marked a turning point.
When the doctor entered the room, his first words were, “You have endometriosis. Your pain is real. Everything you’re feeling is real. I’m sorry you’ve had to suffer for so long.” Morales de Valencia teared up recalling this pivotal moment. “It was amazing,” she says, underscoring the immense power of validation after years of dismissal. They then approached her treatment from multiple angles, including surgery, which successfully removed 16 adhesions and a cyst. She also embraced lifestyle changes, incorporating sound baths and yin yoga, which she finds deeply restorative. With this comprehensive treatment, she has found significant relief from her pain. While it hasn’t entirely disappeared, it has substantially decreased, a victory she gratefully accepts. The validation and unwavering support she now receives from her medical team are invaluable. “It’s exciting to have the support of my doctor,” she shares. “My brain had begun lying to me, telling me it wasn’t real. But this was real. I’m grateful to have learned to advocate for myself.”
Another powerful example comes from Elena, a 30-year-old graphic designer who experienced severe, unexplained abdominal pain for years. Repeated visits to doctors yielded no answers, often attributing her symptoms to anxiety. Frustrated but determined, Elena started meticulously documenting her symptoms, including pain intensity, location, duration, and associated factors, in a detailed journal. She also researched specialists in her area, specifically looking for those with expertise in gastrointestinal and women’s health issues. Armed with her comprehensive data, she presented her case to a new gastroenterologist who, impressed by her detailed records, ordered further specialized tests. This led to a diagnosis of adenomyosis, a condition often confused with endometriosis, after years of being dismissed. Elena’s proactive data collection was key to her diagnosis and subsequent treatment plan.
How to Advocate for Yourself
Gwen Getchell, a preschool teacher in Portland, Oregon, who grappled with severe abdominal pain and bloating, faced similar dismissal from doctors before finally being diagnosed with endometriosis. Her experience served as an invaluable crash course in self-advocacy. “You know your body best. No one else can be inside your body and feel what you feel,” she emphasizes. “Write down your symptoms over time and bring that list to the doctor. It’s harder to be dismissed when you have concrete data. And if someone isn’t listening, find someone else who’ll work with you instead of against you.”
Here are actionable ways to be proactive in your healthcare journey:
- Collect detailed data on your pain ahead of time: Keep a pain journal noting intensity, triggers, duration, and accompanying symptoms.
- Seek out specialists for your specific pain or problem: General practitioners may not have the expertise needed for complex chronic conditions.
- Prepare questions for your doctor: Write them down to ensure all your concerns are addressed during the appointment.
- Be assertive and push back when necessary: Don’t be afraid to voice your concerns or challenge a diagnosis if it doesn’t feel right.
- Bring a trusted friend or family member: They can offer emotional support, help remember information, and advocate on your behalf if needed.
- Seek out different opinions and doctors: If you feel unheard or unsatisfied with your care, don’t hesitate to get a second or third opinion.
- Practice self-compassion: The process of diagnosis and treatment for chronic pain can be long and challenging; remember you are doing your best.
The journey to understanding and effectively treating women’s pain is evolving. By recognizing the unique biological, psychological, and sociological factors at play, embracing scientific breakthroughs, and empowering individuals through self-advocacy, we are collectively moving towards a future where chronic pain is met with understanding, validation, and personalized, world-class care. This pursuit of how can we better support individuals in pain is not just a medical challenge, but a fundamental human right.
