Women's Pain Management Across Their Lifespan (Stanford Pain Medicine)
Stanford Health Library has made publicly available this important conversation, “Why Women’s Pain is Different,” with Kristen Mackenzie, MD, which explores the history of how women's pain has been understood by the medical community and societal influences on pain perception.
This hour-long session has many gems — below is a breakdown the most relevant points, section by section, for patients, caregivers, and clinicians who want practical, evidence-informed insight.
The presenter had three clear goals:
Trace how women’s pain has been understood historically
Name how medical training shapes what happens in exam rooms today
Offer practical ways to improve pain care across different life stages
Historical context: why beliefs about women's pain matter today
The talk started with a useful reminder: old ideas still influence modern medicine. Historically, women’s symptoms were sometimes dismissed as "hysteria" or assumed to be inevitable parts of life. That background helps explain why many people — patients and providers — still think some pain is simply "normal" for women.
"Pain is often treated as an unavoidable part of womanhood."
Why this matters: when pain is framed as expected rather than treatable, women wait longer to seek care, and clinicians are more likely to under-investigate, under-treat, or minimize.
When we’re willing to see women’s pain as dynamically shaped by life stage—not a fixed baseline—we can actually apply the tools we already have (education, pelvic PT, multimodal pain care, better procedural pain control) and push research where it’s still (very) thin (and male-dominated).
Life stages: how women’s pain shows up (and gets handled) across the lifespan
One of the strongest parts of this session was the “lifespan” view. Women aren’t dealing with one single pain story—pain can show up in different forms at different chapters, and the care model often fails to adapt.
Menarche and adolescence
Pelvic pain, migraines, and cyclic breast pain can start early.
Expecting a 12–14-year-old to “just manage it” (track cycles, time meds perfectly, self-advocate confidently) is often unrealistic.
Early support matters: severe menstrual pain that’s ignored can be a setup for longer-term pain patterns.
Reproductive years and fertility care
Procedures like IUD insertion and egg retrieval can be extremely painful—yet pain counseling and pain control can be inconsistent.
In fertility contexts, people often feel pressure to endure pain silently because the stakes are so high. The session pointed out the cost of that: patients stop speaking up, and pain becomes normalized as the “price of admission.”
Pregnancy, labor, and postpartum
Pregnancy itself can come with long stretches of back pain, pelvic pain, carpal tunnel symptoms, and more—well before labor begins.
Labor is intense, and choices range from unmedicated to medicated to surgical; what matters is informed consent and real support.
Postpartum care was a standout critique: a single 6-week follow-up can leave a huge gap during a period where pain + sleep deprivation + feeding issues + recovery are all peaking at once.
Caregiving years and perimenopause/menopause
Care roles, chronic stress, and sleep disruption amplify pain and reduce bandwidth for recovery.
Perimenopause and menopause can shift pain: joint pain, pelvic/sexual pain, hot flashes, sleep changes, and mood changes that directly affect pain sensitivity.
Later life
Lower bone density and osteoarthritis increase fracture risk and persistent pain.
Social isolation is not a side note here—less support often means worse outcomes and less access to movement, care, and consistency.
Biology + context: why pain can feel different in women
The session made a point I wish was standard education: differences in women’s pain are not “weakness” and not “drama.” They’re a mix of biology, nervous system patterns, and lived context.
Key themes:
Pain detection thresholds can be different (many women detect pain earlier—this is a data point, not a character flaw).
Hormones matter: puberty, cycle phases, pregnancy, postpartum shifts, and menopause can all change pain sensitivity.
Stress and trauma sensitize the nervous system: adverse experiences can increase risk for overlapping chronic pain conditions (like IBS, pelvic pain syndromes, headaches, widespread pain).
This is where the talk quietly points to something bigger: when women’s lives include higher rates of caregiving strain, chronic stress, and trauma exposure, you can’t separate “biology” from “environment.” The nervous system keeps score.
Medical training and the “scan-and-find” mindset
This part was very honest: clinicians are trained to rule out dangerous causes first. That is lifesaving. But the unintended lesson many patients receive is:
If imaging/labs are normal, the pain must be “psychological,” exaggerated, or not real.
That gap—between “we didn’t find a scary diagnosis” and “you still hurt”—is where so many women get stranded.
A more accurate and compassionate bridge sounds like:
“We ruled out the urgent stuff.”
“Your pain is real.”
“Now we treat pain as a condition that can involve the nervous system, not only tissues on a scan.”
Nociplastic pain: the mechanism that makes chronic pain real (even when scans are clean)
The session discussed nociplastic pain (very similar to central sensitization, often used interchangeably)—pain driven by changes in pain processing in the brain/spinal cord, rather than ongoing tissue damage.
This is the line that changes everything:
Pain does not always mean damage.
Nociplastic pain doesn’t mean “imagined.” It means the nervous system has gotten overprotective—like a smoke alarm that goes off when you toast bread. Still real. Still disruptive. Still treatable.
Practical implications:
This framework helps move people out of the “prove it” trap.
It reduces fear (which lowers threat, which lowers pain over time).
It supports earlier intervention: the longer a system stays sensitized, the more entrenched the pattern can become.
What helped patients: themes from pain psychology that actually translate to real life
The session included patient themes that came up again and again—especially from people who benefitted from pain psychology and education:
Validation through understanding mechanism: learning that a sensitized nervous system can generate real pain made them feel less “crazy” and more empowered.
Less fear, more function: separating “pain” from “damage” helped people return to movement and activity more safely.
Tools for regulation: reframing, emotional skills, and nervous-system strategies gave people a sense of control.
Layered treatment wins: people did best when care wasn’t “one magic thing,” but a steady combo—education, PT, psychology, medications/procedures when appropriate—stacked over time.
Practical takeaways for patients
Here’s what I’d pull forward if you’re living this:
Lead with your headline. Walk into an appointment with 1–2 top priorities and say them first.
Ask for the “why.” If a clinician recommends against an MRI (or recommends one), ask what they’re looking for and what would change the plan.
Treat severe period pain as a real signal. Pain that disrupts school, work, sleep, or life deserves evaluation—not a pep talk.
Consider multimodal care early. PT, pelvic PT, pain education, nervous-system work, targeted meds/procedures when appropriate—this is often a layered approach, not a single lane.
Track patterns without obsessing. Timing, triggers, and what helps are useful data—your pain deserves to be taken seriously and treated strategically.
Practical takeaways for clinicians
If you work with (especially female) patients in pain, a few points from the session feel immediately usable:
Validate first. “I believe you” and “I can see this is impacting your life” changes the entire visit.
Explain normal tests without implying “nothing.” “Normal imaging” can mean “good news” while still acknowledging real pain.
Teach the nervous system in plain language. Short education on nociplastic pain reduces fear and improves buy-in.
Coordinate care. Pelvic pain and chronic pain often overlap across gynecology, GI, urology, PT, pain medicine, and mental health. Patients do better when the system stops bouncing them around.
This session reinforced three truths that deserve to be said plainly:
Women experience pain across predictable life stages, but pain is not “just part of being a woman.”
Nociplastic mechanisms help explain why pain can persist even when scans are clean—and that opens better treatment pathways.
Better outcomes come from validation, clear explanations, early intervention, and coordinated multimodal care.
If you’re in pain: you deserve clinicians who stay curious, take you seriously, and treat pain like the real condition it is. If you’re a clinician: small shifts in language, education, and coordination can change someone’s entire trajectory.