Pain and sex hormones: a review of current understanding

Written by Maurer AJ, Lissounov A, Knezevic I, Candido KD & Knezevic NN

Multiple epidemiologic studies have demonstrated an increased prevalence for women in several chronic pain disorders. Clinical and experimental investigations have consistently demonstrated sex-specific differences in pain sensitivity and pain threshold. Even though the underlying mechanisms responsible for these differences have not yet been elucidated, the logical possibility of gonadal hormone influence on nociceptive processing has garnered recent attention. In this review, we evaluated the complex literature regarding gonadal hormones and their influence on pain perception. We reviewed the numerous functions of gonadal hormones, discussed the influence of these hormones on several common chronic pain syndromes (migraine, tension and cluster headaches, fibromyalgia, temporomandibular syndrome, rheumatoid arthritis and back pain, among others), and have attempted to draw conclusions from the available data.
The way in which individual patients experience pain is influenced by a variety of factors, including neurobiological, hormonal, psychological factors, as well as social/cultural norms [1–5]. Although patients describe and experience pain in a wide spectrum of presentations, a growing body of evidence has demonstrated that females and males perceive pain differently [2,6–10]. The prevalence of specific clinical pain syndromes (such as migraine headaches and tension headaches, fibromyalgia, irritable bowel syndrome, temporomandibular pain disorder, Raynaud’s syndrome, multiple sclerosis, rheumatoid arthritis and osteoarthritis) is greater in females than in males; however, other conditions such as cluster headaches are more common in males than females [11–14].

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