Women experience more pain than men across virtually every region of the body, yet their symptoms remain systematically under-recognized, delayed in diagnosis, and undertreated. A landmark 2026 global analysis published in Nature Medicine, which was drawing on self-reported data from more than 6.1 million people across 118 countries, confirmed that women report higher pain prevalence at all 11 anatomical sites examined, including the head, face, neck/shoulder, back, abdomen, hips, and knees. The largest sex differences appeared in headache, facial pain, and abdominal pain. Pain prevalence rose most steeply before age 55, spanning the years of highest occupational, caregiving, and reproductive demands.
These findings are not isolated. They align with longstanding clinical observations and smaller-scale studies showing that women wait longer in emergency departments, have pain scores documented less frequently, and receive less analgesia than men reporting comparable intensity. The disparity persists even when controlling for presenting complaint, suggesting that gendered assumptions about pain expression continue to shape clinical decision-making.
Biological and psychosocial contributors
Sex differences in pain arise from multiple interacting mechanisms. Hormonal fluctuations influence visceral sensitivity and central sensitization. Immune-neural interactions, gut microbiota differences, and endogenous analgesic circuits also vary by sex. Psychosocial factors compound these biological realities: Higher rates of trauma exposure, caregiving burden, depression, and anxiety among women interact with systemic delays in diagnosis and treatment. The result is a higher lifetime burden of both acute and chronic pain.
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Specific conditions where the gap is most evident
Endometriosis and chronic pelvic pain
Endometriosis affects approximately one in ten reproductive-age women and frequently produces severe dysmenorrhea, non-menstrual pelvic pain, and dyspareunia. Despite its prevalence, diagnostic delays of several years remain common. Superior hypogastric plexus (SHP) block is a preferred interventional injection performed by pain specialists for endometriosis-related chronic pelvic pain, particularly when the pain is deep, central, visceral, and poorly localized (with features such as severe dysmenorrhea and dyspareunia). By targeting the autonomic nerve network that transmits pain signals from the pelvic organs, this image-guided procedure (typically under fluoroscopy) using local anesthetic with or without steroid can provide meaningful relief; a prospective pilot study in patients with refractory endometriosis demonstrated significant improvements in pain scores, dysmenorrhea, dyspareunia, and quality of life that were sustained through 24 weeks with no serious adverse events, while broader chronic pelvic pain literature reports lasting benefit in roughly 50 to 70 percent of appropriately selected patients.
Emerging non-hormonal approaches and multidisciplinary pain-management programs that incorporate pelvic-floor physiotherapy, cognitive-behavioral strategies, and optimized medication regimens are also under evaluation. Importantly, experts increasingly emphasize that treatment success should be measured by improvements in quality of life (sleep, work capacity, relationships, and daily function) rather than pain scores alone.
Menstrual migraine
Menstrual migraine represents a distinct and often severe phenotype. Phase 3 data on the calcitonin gene-related peptide (CGRP) receptor antagonist atogepant have shown significant reductions in perimenstrual migraine days when used in a short, cycle-timed regimen, offering a targeted option that avoids continuous daily prophylaxis for many patients. Greater occipital nerve (GON) block is a practical interventional pain procedure that can be used for menstrual migraine.
It involves injecting local anesthetic (sometimes with steroid) near the greater occipital nerves at the back of the head, typically timed to the perimenstrual window. This modulates pain transmission at the trigeminocervical complex and can reduce the frequency, severity, and duration of menstrual migraine attacks. Prospective studies in pure menstrual migraine and menstrually related migraine have shown significant improvements in pain scores, headache frequency, disability measures (HIT-6, MIDAS), and quality of life, with benefits lasting into follow-up periods after a short series of injections.
Fibromyalgia
Women constitute the large majority of patients with fibromyalgia. Recent observational data on repeated ketamine infusions in predominantly female cohorts report clinically meaningful and sustained reductions in pain intensity for responders, with median scores falling from 8/10 to 5/10 at 3 months and durable benefit lasting up to 24 months in a substantial subset. These findings add to the growing evidence base for multimodal, mechanism-informed approaches beyond traditional pharmacotherapy. For fibromyalgia, an interventional pain approach remains adjunctive rather than primary, focusing on targeted trigger-point injections with local anesthetic (with or without corticosteroid) to address myofascial contributors, selective peripheral or sympathetic nerve blocks when regional pain phenotypes predominate, and, in highly refractory cases, short-course intravenous ketamine infusions or consideration of neuromodulation such as spinal cord or peripheral nerve stimulation after exhaustive multimodal non-interventional care has failed, always integrated within a broader strategy that prioritizes education, graded exercise, sleep optimization, and centrally acting medications.
Midlife and menopause-related pain
The International Menopause Society designated chronic pain at midlife as the focus of World Menopause Day 2026, releasing a white paper that challenges the assumption that joint pain, pelvic discomfort, or escalating migraines are simply “normal aging.” The guidance stresses that unexplained pain at this life stage warrants thorough evaluation rather than resignation. Midlife and menopause-related pain, which is mainly driven by estrogen decline that affects joint lubrication, collagen, inflammation, and pain processing, commonly presents as knee osteoarthritis (OA), axial low back pain, and other musculoskeletal symptoms; the most relevant interventional options include genicular nerve radiofrequency ablation (after a positive diagnostic block) for chronic knee OA pain refractory to conservative care, providing 6 to 24 months of relief; basivertebral nerve ablation (Intracept) for vertebrogenic low back pain with Modic changes that has failed at least 6 months of conservative treatment, offering durable improvements in pain and function, all typically sequenced after optimized non-interventional care and confirmatory diagnostic injections.
Procedural pain in gynecologic care
Interventional options for gynecological pain are selected according to the dominant phenotype. For deep visceral pain (endometriosis, adenomyosis, dysmenorrhea-type), the superior hypogastric plexus block is a primary choice, with inferior hypogastric plexus or ganglion impar blocks used for lower pelvic or perineal visceral pain. For somatic or neuropathic pain (burning, sitting-aggravated, vulvodynia, or nerve entrapment), pudendal, iliohypogastric, or genitofemoral nerve blocks are commonly employed. Myofascial contributors are addressed with pelvic floor trigger-point injections or botulinum toxin into the levator ani and related muscles when spasm persists despite physical therapy.
Caudal epidural steroid injections can also be useful when there is a sacral radicular or mixed nociceptive component. These procedures are typically image-guided, often start as diagnostic blocks, and are most effective when combined with pelvic floor physiotherapy and multimodal medical care rather than used in isolation.
In 2025, the American College of Obstetricians and Gynecologists issued formal consensus guidance recommending that clinicians routinely discuss and offer evidence-based options, including topical lidocaine, lidocaine-prilocaine cream, paracervical block, and NSAIDs, and engage patients in trauma-informed shared decision-making. This represents an important institutional acknowledgment that procedural pain has been minimized for too long.
The role of social media and lived experience
From a pain specialist’s perspective, analyses of high-engagement TikTok content about women’s pain reveal that approximately two-thirds of dominant narratives center on negative clinical encounters emphasizing visual depictions of uncontrolled suffering, clinician minimization or gaslighting, ineffective or purely symptomatic treatment, incomplete diagnostic workups, and the reflexive attribution of symptoms to menstruation, motherhood, or psychiatric causes, therefore highlighting a persistent gap that interventionalists are uniquely positioned to address; thorough, mechanism-based evaluation and targeted procedural interventions, rather than dismissal, are warranted.
Clinical and systemic implications
Closing the gender pain gap requires more than awareness campaigns. Practical steps include:
- Routine, sex-disaggregated documentation of pain scores and functional outcomes
- Explicit training to counteract the tendency to interpret women’s pain through an interventional vs. hormonal or psychological lens before thorough evaluation
- Expanded access to multidisciplinary care pathways for pelvic pain, migraine, and nociplastic conditions
- Continued investment in sex-specific research so that mechanisms and treatment responses are no longer extrapolated primarily from male data
- Quality metrics that track time to analgesia, diagnostic intervals, and patient-reported function rather than process measures alone
Women are not exaggerating their pain. Large-scale epidemiology, mechanistic research, and clinical outcome data converge on the same conclusion: Women experience a higher burden of pain and receive systematically less adequate care. Addressing this disparity is both a scientific and an ethical obligation.
Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.
Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.
Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.
