593: Is the menopausal symptom-pain link unique to women? A cross-sectional study of 6,000 adults

Topic: Education, Societal Impact, and Others
Subtopic: Epidemiology

Background and Aims: The prevalence of pain increases during middle age, a period marked by drastic fluctuations in sex hormones. While the relationship between menopausal symptoms and pain is well-documented in women, it remains unclear whether similar associations exist in men, who also experience age-associated hormonal changes. This study aimed to investigate the relationship between menopausal symptoms and pain across both sexes, examining whether the clinical significance of these symptoms—often considered exclusive to women—extends to men in the context of pain management and health-related quality of life (HRQOL).

Methods: This cross-sectional online survey involved 6,000 Japanese adults (30–59 years; 3,000 per sex). Pain was assessed via an 11-point Numerical Rating Scale (NRS) and location mapping. Menopausal symptoms were evaluated using the Simplified Menopausal Index (SMI) for women and the Aging Males' Symptoms (AMS) scale for men; participants were categorized into quartiles by severity. HRQOL was measured using EQ-5D-5L. Statistical analyses included χ2, Mann–Whitney U, and Kruskal–Wallis tests. Spearman’s correlation and multiple regression identified predictors of pain intensity, adjusted for age and BMI. Significance was set at p < 0.01.

Results: Pain prevalence was 14.4% in women and 16.3% in men (p = 0.049), though women reported significantly higher pain intensity (p = 0.002). As menopausal symptoms (SMI/AMS) increased in severity, pain prevalence, intensity, and the number of pain locations significantly rose for both sexes across all age groups. EQ-5D-5L utility values were significantly lower in moderate-to-severe symptom groups. Regression analysis identified somatic and vasomotor symptoms as significant predictors of pain intensity in women, while somatic and psychological symptoms were primary predictors in men.

Conclusions: Midlife pain is more strongly associated with menopausal symptom severity than chronological age. The sex-specific predictors—vasomotor symptoms in women and psychological symptoms in men—reflect distinct hormonal influences on pain modulation. In women, declining estrogen triggers vasomotor instability and exacerbates pain sensitivity [1,2]. In men, testosterone decline disrupts psychological networks and reduces antinociceptive effects, increasing pain vulnerability [3,4]. Consequently, pain management should integrate sex-specific screenings. Interventions such as hormone replacement therapy for women and psychological or hormonal support for men are essential for optimizing quality of life.

References: 1. Athnaiel O, Cantillo S, Paredes S, Knezevic NN. The role of sex hormones in pain-related conditions. Int J Mol Sci 2023;24(3):1866.
2. Deecher DC, Dorries K. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health 2007;10(6):247–57.
3. Wu CY, Yu TJ, Chen MJ. Age related testosterone level changes and male andropause syndrome. Chang Gung Med J 2000;23(6):348–53.
4. Zitzmann M. Testosterone, mood, behaviour and quality of life. Andrology 2020;8(6):1598–605.

Presenting Author: Yukiko Shiro
Submitting Author: Yukiko Shiro

Senior Author: Shinsuke Inoue

IASP 2026 Global Year theme of Neuropathic Pain: No

• Shinsuke Inoue: MD, PhD - Kaguyama Orthopedic Clinic
• Young-Chang Arai: MD, PhD - Department of Pain Medicine, School of Medicine, Aichi Medical University
• Koichi Shinohara: MD, PhD - Department of Obstetrics and Gynecology, School of Medicine, Aichi Medical University
• Tatsunori Ikemoto: MD, PhD - Department of Orthopedics, School of Medicine, Aichi Medical University