Midlife shouldn’t hurt: Answering the IMS call on chronic pain this World Menopause Day
Saturday 18 October marks World Menopause Day, and this year the International Menopause Society (IMS) is shining a spotlight on a symptom that is often overlooked: chronic pain in midlife.
Saturday 18 October marks World Menopause Day, and this year the International Menopause Society (IMS) is shining a spotlight on a symptom that is often overlooked: chronic pain in midlife.
While many women recognise menopause through symptoms such as hot flushes, night sweats and mood changes, persistent aches and pains are far less widely discussed. Yet for many women, joint pain, muscle aches, headaches and worsening chronic pain can have a significant impact on daily life, work, and wellbeing.
Dr Bismeen Jadoon, Consultant Obstetrician, Gynaecologist, and Menopause Specialist, explains why chronic pain deserves greater attention during menopause. As a British Menopause Society-accredited specialist running complex menopause clinics, she regularly sees women who are surprised to learn that their pain may be linked to hormonal changes. In fact, a UK survey found that one-third of women said pain was the menopausal symptom they least expected. Research also shows that women experiencing menopausal symptoms are significantly more likely to live with chronic pain, highlighting the important connection between hormonal health and physical wellbeing during midlife.
Why menopause hurts
Falling oestrogen changes how the body processes pain and weakens the protection around joints, muscles and vaginal tissues. Clinicians now call this cluster the musculoskeletal syndrome of menopause, and more than 70% of women in perimenopause report musculoskeletal pain. Because pain, poor sleep, and low mood feed each other, the answer is rarely a single tablet.
Six pillars, one pain plan
That is why I always start with the six pillars of lifestyle medicine, which double as a pain-management plan. The IMS 2025 White Paper reviewed 25 years of research, from 2000 to 2024, and concluded that these pillars should be the foundation of menopause care.
Healthy eating and a healthy weight ease the load on joints, and the IMS advises 700 to 1,200 mg of calcium and 400 to 1,000 IU of vitamin D a day after menopause.
The White Paper names the Mediterranean diet, rich in vegetables, fruit, whole grains, pulses, oily fish, nuts and olive oil, as the eating pattern with the strongest evidence for menopausal health, and its anti-inflammatory foods may also help ease joint pain.
Physical activity, especially strength training, is one of the best treatments for joint pain. Restorative sleep lowers pain sensitivity.
Stress management, including CBT, reduces how much pain takes over daily life. Avoiding smoking and excess alcohol cuts inflammation. And positive social connection reminds women they are not alone.
In a UK study of more than 500,000 people, loneliness was linked to almost double the rate of chronic pain.
When lifestyle is not enough
Lifestyle is the foundation, but many women also need treatment. For most women under 60, or within ten years of their last period, the benefits of HRT outweigh the risks. It remains the most effective treatment for hot flushes and night sweats, protects against osteoporosis and fractures, and can ease joint and muscle aches, poor sleep and low mood.
Body-identical HRT, with oestrogen through the skin as a patch, gel or spray, does not raise the risk of blood clots the way tablets can, and micronised progesterone protects the womb with a lower breast risk than older progestogens. Any change in breast cancer risk is small and depends on the type and length of treatment, which is why every prescription should be tailored and reviewed each year.
Testosterone can help some women with low libido, and low-dose vaginal oestrogen is very effective for painful sex and bladder symptoms. For women who cannot or prefer not to take hormones, NK3 receptor antagonists for hot flushes, certain antidepressants, gabapentin and CBT are real alternatives. What I steer women away from is long-term reliance on strong painkillers.
After breast cancer and before surgery
This matters most for women with a history of breast cancer or planning risk-reducing surgery. Aromatase inhibitors commonly cause joint pain, and systemic HRT is usually avoided, so non-hormonal treatment, exercise and physiotherapy come first. Removing the ovaries brings an immediate menopause, so planning before surgery makes a real difference.
We have many non-hormonal, alternative options including the new NK3 receptor antagonist for women who are unable to take HRT.
Menopause care at Cromwell Hospital
At Cromwell Hospital, we understand that menopause affects every woman differently. Our experienced women's health specialists provide personalised care and support for symptoms ranging from hot flushes and sleep disturbances to mood changes and concerns about long-term health. We take the time to understand your individual needs, offering evidence-based treatments, lifestyle advice and tailored management plans to help you navigate perimenopause and menopause with confidence, comfort and continuity of care.
About the author
Dr Bismeen Jadoon is a Consultant Obstetrician, Gynaecologist and British Menopause Society-accredited Menopause Specialist with more than 20 years' experience in women's health. She runs complex menopause clinics and specialises in the diagnosis and treatment of a wide range of gynaecological conditions, including fibroids, endometriosis, PMOS, adenomyosis and heavy menstrual bleeding. Alongside her clinical work, Dr Jadoon leads quality improvement and postnatal care initiatives, helping to improve outcomes and experiences for women across their healthcare journey.
