A Science review examines why chronic pain affects women at roughly twice the rate of men. Hormones may shape pain sensitivity, immune responses and pain processing across the body.
On October 1, 2026, Science published a review linking women's higher rate of chronic pain to several biological systems. The review says sex hormones may affect pain sensitivity, immune activity and the way the nervous system handles pain.
The gap appears even among younger patients. It extends well beyond conditions affecting reproductive organs.
Women have higher rates of osteoarthritis, irritable bowel syndrome, 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.
The gap starts early.
Pain in women has historically been studied less thoroughly than pain in men. The latest evidence strengthens the case for treating sex as a biological variable in both pain research and clinical care.
Archana Venkataram, a professor at the University of California San Francisco, led the review. It appeared in a Science special issue on women's health.
The authors bring together research on visceral and somatic pain. They examine the links between sex hormones, the immune and nervous systems, 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. That can promote metabolic products linked to greater pain sensitivity.
The Science special issue places chronic pain alongside wider gaps in women's health research, including continuing questions about menopause. This broader context suggests that pain disparities are part of a wider pattern in which conditions affecting women have received insufficient scientific attention.
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 therefore produce a different response depending on biological sex.
For primary chronic pain syndromes such as fibromyalgia, headaches and 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 changes treatment decisions. Goicoechea says care should not rely on a generic model of pain. Pharmacological and physiotherapy decisions 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 makes a simple point. 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, immune activity, microbiota, nervous-system processing and social experience may intersect differently in each patient. Recognising those differences is necessary for more credible diagnosis and care.
