Women's Pain Management Across the Lifespan-A Narrative Review of Hormonal, Physiological, and Psychosocial Perspectives

Abstract

Introduction: Pain perception and management differ by sex, with women frequently experiencing more acute and chronic pain and greater disability than men. Yet, anesthesiology and pain control often overlook the physiological, hormonal, and psychological factors shaping women's pain. Methods: This narrative review explores essential considerations from current literature to optimize pain management in women. We examine evidence about the impact of hormonal changes, reproductive transitions, and psychosocial factors on pain perception and responses to analgesics. By highlighting key insights and practical strategies, we aim to support the development of personalized pain management approaches tailored to women's unique needs. Results: Hormonal changes, including variations in estrogen and progesterone levels, significantly influence pain thresholds and the effectiveness of analgesics and anesthetics. The menstrual cycle, menopausal transitions, and pregnancy each alter pain responses, necessitating personalized approaches to pain management. Postmenopausal women are particularly vulnerable to chronic pain conditions, such as those associated with osteoporosis, which require adjustments in long-term treatment strategies. Furthermore, psychosocial factors like anxiety and emotional distress can intensify pain, highlighting the need for holistic, integrative care. Conclusions: The existing gaps in women's pain management across the lifespan highlight the need to revise both anesthesia and pain management protocols to better account for sex-specific biological and psychosocial factors. Addressing the unique biological and psychosocial factors that influence pain in women can enhance both the effectiveness and equity of care. By tailoring treatment strategies in women, clinicians can not only enhance pain management but also greatly improve their overall quality of life.

Keywords: gender bias; hormonal influence; pain perception; sex differences in pain.

Figure 1

Conceptual overview of key factors influencing women’s pain across the lifespan. Figure legend: Summary of key physiological and psychosocial factors influencing pain perception in women across the lifespan. Hormonal shifts—such as estrogen’s modulation of opioid pathways—affect central pain processing. Psychosocial factors like anxiety and emotional distress can amplify pain. Metabolic differences influence analgesic response, with women more prone to side effects. Pregnancy-related progesterone increases support pain modulation, while estrogen decline during menopause impairs endogenous pain regulation.