How Estrogen & Progesterone Affect Your Pain

It’s been long-established that pain perception in women and men is quite different—on average, at least, since the datasets are usually somewhat overlapping.

If that last statement is confusing, think of it like height: on average, men are taller than women, but the datasets of “men’s height” and “women’s height” will be overlapping, because indeed some women are taller than some men.

So it is with pain also: women generally have heightened pain sensitivity compared to men, although reporting of that pain can vary a lot depending on the circumstances and experimental methodology.

For example: Gender Differences in Pain Threshold, Unpleasantness, and Descending Pain Modulatory Activation Across the Adult Life Span: A Cross Sectional Study

An additional consideration is that women are overrepresented when it comes to people with chronic pain (i.e., more women have chronic pain than men).

In some cases, this is because a given chronic condition (as for example many autoimmune diseases) predominantly affects women for reasons that are often not well-explored, and in other cases, the reason is more obvious (for example, you will not find many men with endometriosis).

See also: What you need to know about endometriosis

Researchers, namely, Dr. Élora Midavaine et al., have found another common reason for the disparity in pain perception:

From estrogen to opioids

It turns out that the main female sex hormones, estrogen and progesterone, can suppress pain by prompting immune cells near the spinal cord to produce opioids.

The immune cells in question are immune-regulatory T-cells (colloquially called “Tregs” by scientists who don’t want to have to say/write that in full every time), whose main job is usually simply reducing inflammation. In other words, they’re the immune cells that tell your other immune cells to kindly chill a little bit and not overdo it.

In this case, the estrogen and progesterone stimulate the Tregs to produce the opioids (specifically, enkephalin) to block the pain signals before they reach the brain.

You may be thinking: but hang on, wouldn’t this mean that women experience less pain than men?

And the answer is: it depends!

A while back we wrote an article about how Alzheimer’s Sex Differences May Not Be What They Appear, and it’s a similar principle in this case: the female sex hormones are protective… Until they’re not!

In other words: in menopause, for example. And just like Alzheimer’s, chronic pain increasingly affects people the older we get, so the majority of people experiencing it at any time will tend to be postmenopausal. Symptoms get brushed off with “well, you are older now”, and while yes indeed many things may be age-related, in some cases their pathogenesis can be very clearly traced to “this hormone was doing the job for you, and now your levels of that hormone are very low, so you no longer get that protection”.

You can find the paper itself here: Meningeal regulatory T cells inhibit nociception in female mice ← yes, it’s a mouse study, but all the systems exist the same way in humans, so there is no reason to assume it would be different for us. Just, scientists can’t persuade an ethics board to let them knock out humans’ Tregs with toxins and then do nerve damage to measure the pain processing.

Takeaway idea: if you are postmenopausal and suffer chronic pain, then it’s an extra reason you might want to consider bioidentical HRT if you haven’t already.

See also: What You Should Have Been Told About The Menopause Beforehand

Want to learn more?

We’ve written quite a bit about pain management, including:

• Before You Reach For That Tylenol…
• How To Stop Pain Spreading
• How To Dial Down Your Pain
• Managing Chronic Pain (Realistically!)
• Get The Right Help For Your Pain
• The 7 Approaches To Pain Management
• Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)

Take care!