Hormonal Imbalance and Pain - Understanding the Connection and Finding Relief

Are hormonal imbalances and pain connected? You betchya!

When our hormones get out of balance, it can have a serious impact on chronic pain symptoms. The endocrine system and the central nervous system are intricately connected.This complex relationship means that fluctuations in your hormone levels can either exacerbate or alleviate pain. But, the good news is, understanding and learning how to regulate your hormones can be a powerful tool in managing your chronic pain. In this article, we’ll explore the key hormones that influence pain and offer strategies to help you relieve hormonal imbalance.

Disclaimer: Always seek medical advice when addressing hormonal imbalances, as everyone's body is unique. In this article we used the term sex as a binary phenomenon referring to women (females) and men (males). We also are basing the information on the available clinical evidence that is largely including cis women and men. We also acknowledge that gender is a spectrum. Transgender, gender-diverse individuals, and men also experience hormonal changes that can affect their experience of pain.

What are hormones?

Hormones are chemical messengers produced by your endocrine system, which includes glands like the thyroid, adrenal glands, ovaries, and testes. These hormones play crucial roles in regulating various bodily functions, including growth, metabolism, mood, and—drum roll please—pain.

Introducing the cast - key hormones and their impact on chronic pain

Let’s take a closer look at some of the hormones that can influence chronic pain:

• Estrogen: This hormone, primarily associated with female reproductive health tends to have a protective effect against pain, which is why some women experience increased pain during times of low estrogen, such as during menstruation or menopause.
• Progesterone: Another key hormone in the menstrual cycle, progesterone can have a calming effect on the nervous system. However, imbalances, such as low progesterone levels, can lead to increased anxiety and sensitivity to pain.
• Testosterone: Often thought of as a male hormone, testosterone plays a role in muscle strength and overall energy levels for all genders. Low testosterone levels can contribute to fatigue and heightened pain sensitivity.
• Thyroid hormones: The thyroid gland regulates metabolism and energy levels. Hypothyroidism, a condition where the thyroid is underactive, can lead to muscle and joint pain, as well as fatigue.
• Cortisol: Known as the stress hormone, cortisol plays a significant role in the body’s response to stress. Chronic stress can lead to cortisol dysregulation, which is often linked to increased inflammation and pain.
• Oxytocin: Often called the “love hormone,” oxytocin is associated with feelings of well-being and pain relief. Low levels of oxytocin have been linked to increased pain sensitivity.

Symptoms of hormonal imbalance

Hormonal imbalances can stem from various causes, including age, stress, illness, and lifestyle factors. These imbalances can significantly affect how the body perceives and processes pain¹.

Estrogen and progesterone: natural fluctuations

For many women, the fluctuations of estrogen and progesterone throughout the menstrual cycle can impact how we feel and also affect pain sensitivity. Here are the three key life stages/times when estrogen and progesterone fluctuations can impact pain:

Menstrual cycle: Many people experience premenstrual syndrome ( PMS) which refers to a group of physical, emotional, and behavioural symptoms in the one to two weeks before their menstrual period. Symptoms can vary from mild to severe, and will generally go away once menstruation begins. During this time, chronic pain and symptoms may also increase, for example, research shows a worsening of fibromyalgia symptoms during the premenstrual period².

Pregnancy: Hormone levels can change during pregnancy to assist with preparation for birth. During pregnancy some people notice an improvement of pain and other symptoms but these can swiftly return postpartum as hormone levels drop. That was certainly my experience with a gradual increase in pain in the first year after my first child was born.

Perimenopause and menopause: Menopause is medically defined as the time when ovarian function declines and there has been an absence of menstruation for at least 12 consecutive months, typically occurring between the ages of 45 and 55 with perimenopause encompassing the 5-10 years preceding menopause. Symptoms that may be present during either of these times include a range of physical, mental, cognitive and metabolic changes including (but not limited to):

• Pain in the joints and muscles
• Fatigue
• Waking unrefreshed
• Hot flushes and night sweats
• Brain fog
• Memory issues
• Attention difficulties
• Low mood
• Headaches

When estrogen levels decline, many women report an increase in chronic pain symptoms³. This period of life can bring new challenges in managing pain, as the protective effect of estrogen wanes.

In my own journey through perimenopause, I noticed a sharp increase in my back pain, which I only realized later may have been linked to my declining estrogen levels. Understanding this connection allowed me to explore hormone replacement options and lifestyle adjustments that made a significant difference in managing my symptoms. Another relief came from being open and sharing my experience with my friends….Ahhh, menopause, it can be a sure-fire conversation starter if you are in that time of life!

Andropause: Men also experience hormonal changes as they age, particularly a gradual decline in testosterone, often referred to as andropause. This decrease can contribute to chronic pain, fatigue, and a decrease in overall well-being. Like women, men can benefit from monitoring their hormone levels and considering treatment options if low testosterone is affecting their quality of life.

Hormonal imbalance and specific pain conditions

Certain chronic pain conditions are closely associated with hormonal imbalances:

• Fibromyalgia: Often linked to central sensitization, dysregulated cortisol levels and hormonal imbalances, fibromyalgia is a condition characterized by widespread pain, fatigue, sleep, concentration and mood issues^4,5.
• Premenstrual Dysphoric Disorder (PMDD): Affecting about 1 in 20 women, PMDD is related to hormonal changes throughout the menstrual cycle and a brain chemical called serotonin may also play a role. Characterized by severe mood swings, depression, and heightened pain sensitivity during the luteal phase of the menstrual cycle.
• Polycystic Ovary Syndrome (PCOS): This condition, which affects about 1 in 10 women, involves imbalances in estrogen, progesterone, and testosterone, often leading to chronic pelvic pain, among other symptoms.
• Endometriosis and pelvic pain: Hormonal imbalances, particularly in estrogen, play a significant role in the development and severity of endometriosis, a condition that causes chronic pelvic pain.

Hormonal imbalance and mental health

While we have been outlining the ways in which hormonal imbalance can impact pain, there are also a number of ways hormones affect how we feel - our mood and risk of depression and anxiety. For many women, the mental health impacts of decreasing estrogen levels through perimenopause and menopause can bring about some really challenging changes - during this time the risk of developing depression (or a relapse of past condition) is increased⁶.

Latest research

Recent studies have explored the connection between hormones and chronic pain, particularly in conditions like fibromyalgia and endometriosis⁷. Research suggests that addressing hormonal imbalances can be an effective way to assist in reducing the symptoms associated with these conditions. This might be done through a trial of menopausal hormone therapy (MHT) and this has been shown to reduce pain (and associated symptoms) for some women going through menopause​. However, most Australian women receive substandard menopause‐related health care because of two decades of widespread dissemination of conflicting, and often frightening, information about menopause treatment, lack of clinician knowledge, poor access to services, negative attitudes, and lagging research⁸.

Understanding the link between hormones and pain could lead to further developments in therapeutic approaches to treat chronic pain. A recent study has shown that artificially activating progesterone receptors may play an important role in pain perception⁹.

How can I regulate hormonal imbalances to improve chronic pain and symptoms?

Addressing hormonal imbalances can be a game-changer in managing chronic pain and symptoms. Here’s how:

• Menopausal Hormone Therapy (MHT): Previously known as hormone replacement therapy (HRT), MHT is a relatively safe and effective treatment to help manage symptoms of menopause¹⁰, including chronic pain. However, it’s important to weigh the benefits against the risks and consult with a healthcare provider to determine if it’s right for you.
• Lifestyle factors: Things like stress, diet and exercise can all impact on our hormone levels. For example, managing stress through mindfulness, meditation, or relaxation techniques can help regulate cortisol levels. An anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids can also support hormone balance¹¹. Regular exercise improves overall health and can help regulate hormones naturally. Research shows poor sleep quality can negatively impact on immune and hormone function¹².
• Cognitive Behavioral Therapy (CBT): Research shows that CBT can be effective in managing symptoms like hot flushes and night sweats, which are often linked to hormonal changes¹³.
• Education and empowerment: Understanding your body and how it responds to hormonal changes can empower you to take control of your health. Armed with this knowledge you may feel more confident advocating for yourself in healthcare settings so you can address hormone imbalances to improve pain and symptoms. Some additional places you can go for information and support:some text
  • Australasian Menopause Society: www.menopause.org.au/
  • International Menopause Society: https://www.imsociety.org
  • Jean Hailes for Women’s Health: https://www.jeanhailes.org.au/

Don't forget to boost the ‘feel-good’ hormones

Another way to tackle the link between hormones and pain is to focus on boosting hormones that promote well-being. In particular you might target:

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• Dopamine - our reward hormone - We get more of this from completing a task, performing a self care activity, eating healthy food, celebrating a win (these are the things we love to share in our Living Well with Fibromyalgia Facebook community!)
• Oxytocin - the Looooove hormone that has many actions associated with feeling good¹⁴. Maybe you can play with a pet, cuddle a baby, holding hands with a friend, try a 20-second hug (my favourite!), give someone a compliment or do a random act of kindness¹⁵!
• Serotonin - a great mood booster and pain modulator¹⁶ - generate it through meditation, going outdoors, feeling the sunshine, aerobic activities like swim or cycling.
• Endorphin - the body’s natural painkiller^17. You can boost it with a good belly laugh (watch a funny cat video), dark chocolate (any excuse is fine with me!) and exercise.

Balance time…

We hope this article has helped you understand the role of hormones can play in managing chronic pain and symptoms. If you’re experiencing chronic pain and suspect hormonal imbalances might be a factor, start by tracking your symptoms and seeking advice from your medical team.

Balancing hormones isn’t a one-size-fits-all solution, but with the right guidance, it can be a real game-changer in how you manage your pain condition. Remember, you’re not alone—there are resources and support available to help you navigate this journey. You may want to explore discussing this with a qualified endocrinologist and gather input and ideas from your medical team.

For more support, check out our recent live expert webinar with Dr Angela Simpson on this topic, or listen to a great podcast here.

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