On October 1, 2026, Science published a review examining why women experience chronic pain at roughly twice the rate of men. The review links the disparity to biological systems, including sex hormones, which may shape pain sensitivity and immune activity while influencing nervous-system processing.
The gap starts early, appearing even among younger patients, and extends well beyond conditions affecting reproductive organs.
Women have higher rates of osteoarthritis and irritable bowel syndrome, as well as fibromyalgia and neuropathic pain. Endometriosis and menstrual migraine are also part of the picture. Chronic pain affects about 20% of the general population, so women carry a disproportionately large share of a condition that can be hard to explain and treat.
Archana Venkataram, a professor at the University of California San Francisco, led the review, which appeared in a Science special issue on women's health.
The authors bring together research on visceral and somatic pain, examining how sex hormones interact with the immune and nervous systems. They also consider the gut microbiota and the body's own pain-relief circuits. The biological mechanisms are not confined to one organ.
Javier Rivera, director of the Rheumatology and Fibromyalgia Unit at Instituto Nacional del Dolor, connects hormonal changes with pain and its progression through central sensitisation. In women, oestrogen can raise visceral sensitivity through specific receptors in internal organs.
The hormone may also affect the intestinal microbiome, promoting metabolic products linked to greater pain sensitivity.
Oestrogen also affects pain processing in several parts of the nervous system. Rivera says it can shape neuroimmune responses to painful stimuli by activating immune cells that differ between women and men. The same stimulus may so produce a different response depending on biological sex.
For primary chronic pain syndromes such as fibromyalgia or headaches, as well as chronic osteoarthritis pain, the exact pathophysiological mechanisms remain less clear. The review still points to hormonal differences as one likely part of the explanation. These conditions should not be treated as isolated complaints with unrelated causes.
Sex is only one part of the picture. Carlos Goicoechea García, professor of Pharmacology at the Faculty of Health Sciences of Universidad Rey Juan Carlos de Madrid, separates sensory differences from emotional ones.
Men generally have higher pain-response thresholds and greater pain tolerance. Gender-related experiences can also shape the emotional side of pain through the role women occupy in society.
That affects treatment decisions. Goicoechea says care should not rely on a generic model of pain. Decisions about medication and physiotherapy should account for sex, while psychological care should account for gender.
He also describes every pain experience as unique: sensation passes through emotion, and no two cases are fully identical.
The review's basic point is clear: women's symptoms need to be taken seriously. Its authors say many women are desperate for concrete answers after repeatedly hearing that their illness is "all in your head".
The evidence does not support one universal explanation for every chronic pain condition. It does support moving away from a generic approach.
Hormones and immune activity may intersect differently in each patient, with the microbiota shaping that response. Nervous-system processing also matters, as does social experience. Recognising those differences is necessary for more credible diagnosis and care.
