10/19/2025
Exploring female s*x-specific biological and psychosocial determinants of pain
The literature reports numerous s*x-specific biological mechanisms that underlie pain at both physiological and pathological levels, and these insights underscore the necessity for s*x-specific management of musculoskeletal conditions.
The Influence of S*x Hormones on Pain
S*x hormones significantly modulate pain perception and inflammation. Oestradiol, in particular, demonstrates complex dual roles. At high concentrations, it enhances descending inhibitory pain pathways (anti-nociceptive), while at low concentrations, it facilitates sensitisation (pro-nociceptive).1 These modulatory effects are especially evident during hormonally dynamic periods such as menstruation, perimenopause, and post-menopause.
Progesterone and testosterone also exhibit antinociceptive properties. Progesterone has been linked to pregnancy-induced analgesia, while testosterone is associated with a lower risk of developing persistent widespread pain.18
Hormonal fluctuations, whether natural or iatrogenic could influence pain thresholds, inflammatory cytokine profiles, and pain sensitivity.5 These mechanisms may help explain why many female patients present with pain that is cyclical, migratory, or resistant to standard musculoskeletal interventions.
Further, hormonal fluctuations are likely to influence not only pain perception but also tissue structure and function. For instance, variations in oestradiol levels may affect collagen synthesis, joint laxity, and tendon health.1
It is important for clinicians to assess whether pain intensifies during specific hormonal phases. Tracking symptoms across the cycle may help identify hormone-sensitive pain presentations and tailor treatment accordingly. For instance, some patients may benefit from modifying exercise loads or incorporating pacing strategies during ovulation or menstruation when symptoms are worse.
Reference: Blog by Sonam Jethwa, Australian Physiotherapist
For full article:
Women in Pain: S*x-Based Gaps in Musculoskeletal Clinical Practice | Find out more
