I own an app on my phone that, after logging in with an iCloud account and social media accounts, will show you pictures you have taken or things you have posted on that day any year prior. Now, I don’t actively use social media, but I love to look at the pictures I have taken over the years on each day. It is so nostalgic and helps remind me to connect with old friends. But the other day when I was looking back on pictures from my junior year of high school, all I could remember was that it was my year of migraines.
Thankfully, I no longer suffer so regularly from migraines, but this reminder got me thinking about how chronic pain affects women. According to the U.S. Centers for Disease Control and Prevention (CDC), anywhere from 11 percent to 40 percent of adults in the country suffer from chronic pain. And 70 percent of chronic pain sufferers are women.
Why is that? Let’s dig in.
Yale Medicine defines chronic pain as "discomfort that persists or progresses over a long period of time." It might be “on” and “off,” or it might be continuous. Chronic pain may last for months or even years. Some major categories of chronic pain include musculoskeletal pain, abdominal or pelvic pain, and headaches and migraines.
Most commonly considered to be arthritic pain, musculoskeletal pain also includes back pain, whole body pain, and bone fractures. A study of health care workers found that 24 percent of women suffered from upper-limb musculoskeletal pain compared to 11 percent of men. The researchers attributed a possible cause for this difference to women taking on higher domestic workloads with demanding physical tasks. Women also have a greater prevalence of osteoporosis and bone fractures, contributing to the greater female incidence of musculoskeletal pain (See my previous blog post: “To: Why Didn’t I Know This? Re: Menopause”.)
One clear source of abdominal pain that disproportionately affects women is related to the reproductive system and includes pain related to menstruation, pregnancy, childbirth, and post-childbirth. Another very common abdominal pain condition is irritable bowel syndrome (IBS). Globally, women experience a 67 percent greater incidence of IBS than men up until their 70s, at which point the prevalence of IBS is similar in women and men. Women are also more susceptible to developing non-erosive reflux disease (NERD), a subset of the highly common gastroesophageal reflux disease (GERD).
In terms of urinary diseases, urological chronic pelvic pain syndrome in women carries increased risk of many other conditions, such as chronic fatigue syndrome (affecting 14 percent of women and only 2 percent of men) or diabetes (20 percent of women and 4 percent of men). In one study, 58 percent of women reported pain in the pubic and bladder area as compared to only 34 percent of men. Another form of pelvic pain often relates to gynecological disorders and conditions, but reproductive system-related pain is also often attributed to intimate partner violence. One in five women have experienced intimate partner violence according to the CDC, both physically and sexually (compared to one in seven and one in 12 men, respectively). Those who have experienced domestic violence often reported more pelvic and abdominal pain.
Headaches and Migraines
Women experience severe headaches or migraines twice as often as men, including about 20 percent of women surveyed. One contributor may be fluctuating levels of estrogen experienced by women. But other headache triggers could include anxiety, noise, medications, and posture. For example, women are twice as likely to have an anxiety disorders than men from the ages between puberty and their mid-50s.
So why? This long list of statistics makes it seem as though chronic pain is an unavoidable part of a woman’s life.
Researchers have established that women largely have increased pain sensitivities. This may be due to the production of sex hormones in the body because testosterone, the primary male sex hormone, is considered to be more protective against pain. And estrogen, the primary female hormone, can increase the risk of chronic pain conditions.
Researchers are starting to attribute some of this difference to the layered levels of stress a woman experiences. Women are more likely than men to report experiencing severe stress (28 percent compared to 20 percent of men), likely due to the unique acute and chronic stressful circumstances in the lives of women. The social determinants of health and the biological determinants of health are both responsible for the resulting diagnosis or medical condition that we see. There is emerging evidence about the overlap between physical and social pain, and how clinicians’ compassion in responding to patients’ pain may improve treatment outcomes.
These types of investigations can help us to better understand how domestic burdens, historical trends, social norms, and increased trauma and stress in personal and professional life can contribute to the burden of chronic pain. We must continue to explore the causes of these sex-and-gender differences. Then, equipped with knowledge and compassion, we will be better able to care for women suffering from chronic pain.
Gillian is a junior at Timothy Dwight College studying Molecular, Cellular, and Developmental Biology and Anthropology. Read more from Gillian on WHRY's blog: "Why Didn't I Know This?