Menopause Linked to Chronic Pain

By Pat Anson, PNN Editor

It’s no secret that middle-aged women are far more likely than men to have chronic pain and to feel its effects more severely. A large new study tells us some of the reasons why.

VA researchers analyzed the health data of over 200,000 female veterans between the ages of 45 and 64 and found that women with menopause symptoms were nearly twice as likely to have chronic pain and multiple chronic pain diagnoses.

"Changing levels of hormones around menopause have complex interactions with pain modulation and pain sensitivity, which may be associated with vulnerability to either the development or exacerbation of pain conditions," says JoAnn Pinkerton, MD, Executive Director of the North American Menopause Society (NAMS). "This study suggests that menopause symptom burden may also be related to chronic pain experience."

Hormonal change alone wasn’t the only thing many of the women had in common. Those who were overweight, obese or had a mental health diagnosis were also more likely to have chronic pain. Eighteen percent of the female veterans had been diagnosed with post-traumatic stress disorder (PTSD), 13 percent suffered from depression and 15 percent had anxiety.

Common changes related to menopause and aging include weight gain, decreased physical activity, impaired sleep and negative mood, which can contribute to chronic pain and are also known to affect pain sensitivity and tolerance.

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“Both chronic pain and menopause symptoms are strongly and consistently associated with psychosocial factors and health risk behaviors prevalent in and after the menopause transition,” said lead author Carolyn Gibson, PhD, San Francisco VA Health Care System. “Consideration should be given to integrated approaches to comprehensive care for midlife and older women with chronic pain, such as targeted cognitive behavioral therapy coordinated with interdisciplinary care providers.”    

The study findings are published in the journal Menopause.

A large 2018 study also found a strong association between menopause and symptoms of rheumatoid arthritis (RA). Researchers at the University of Nebraska Medical Center found that post-menopausal women with RA had a significant increase in functional physical decline. Menopause was also associated with worsening progression of the disease.  

Why Does Menopause Worsen Rheumatoid Arthritis?

By Pat Anson, Editor

A large new study is confirming what many women with rheumatoid arthritis (RA) already know – menopause and hormonal changes can significantly worsen their pain and other symptoms. But it's not clear why that happens.

Researchers at the University of Nebraska Medical Center enrolled over 8,000 women with RA – both young and old -- in their observational study. They found that post-menopausal women with RA had a significant increase in the level and rate of functional physical decline. Menopause was also associated with a worsening progression of the disease.

RA is a chronic and disabling autoimmune disease in which the body’s own defenses attack joint tissues, causing pain, inflammation and joint erosion. Women experience RA at a rate three times greater than men, have more severe symptoms and increased disability.

Previous studies have shown that women with RA experience changes in their disease during reproductive and hormonal changes. During pregnancy, women are less likely to develop RA, yet the disease is more likely to progress and flare during the post-partum period. Similarly, women who experience early menopause are more likely to develop RA compared to those who experience normal or late menopause.

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Hormone levels of estrogen increase during pregnancy and decline during menopause – but the association with RA is not fully understood.

"Further study is needed as to why women with rheumatoid arthritis are suffering a greater decline in function after menopause," said the study's lead author, Elizabeth Mollard, PhD, an assistant professor in the College of Nursing at the University of Nebraska Medical Center.

"Not only is this decline causing suffering for women, it is costly to both individuals and the healthcare system as a whole. Research is specifically needed on the mechanism connecting these variables with the eventual goal of identifying interventions that can maintain or improve function in postmenopausal women with rheumatoid arthritis."

The study is published in the journal Rheumatology.

RA affects about 1.3 million Americans and about one percent of the global population. Until the late 1990s, one in three RA patients were permanently disabled within five years of disease onset.

Although there are still no cures for RA, in recent years there has been significant improvement in treatment, with disease control now possible for many patients who receive biologic drugs. Those treatments are expensive, with some biologic therapies costing $25,000 a year.