Menopause-associated pain: a decade review of patterns, determinants, and research priorities.

Abstract

Importance and objective: Menopause-associated pain is increasingly recognized as a multidimensional symptom influenced by endocrine change, comorbidity, and psychosocial context. However, the evidence base remains fragmented across pain types, and study designs limit clinical clarity. To examine research trends in menopause-associated pain published between 2014 and 2024, identify major pain categories, severity modifiers, and management approaches across the menopause transition.

Methods: A structured search of PubMed and Scopus identified peer-reviewed, English-language studies using the terms "menopause" and "pain." After screening and full-text assessment, 115 studies were included. Data were synthesized descriptively by pain domain, study design, context, and geographical origin.

Discussion and conclusion: Five major pain categories were identified: musculoskeletal, urogenital, gastrointestinal, oral/orofacial, and multisite or unspecified pain. Musculoskeletal and urogenital pain were most frequently studied. Pain severity was commonly reported to peak during early menopause and declined postmenopause, although trajectories vary by pain type and comorbidity. Across domains, psychological distress, sleep disturbance, body mass index, and social determinants of health consistently modified pain perception and functional impact. Evidence for management strategies was uneven; however, exercise-based interventions demonstrated the most consistent functional benefits. Evidence for hormone therapy and complementary approaches was heterogeneous and phenotype-dependent. Although research has become more phenotype-specific and biopsychosocial in orientation, methodological heterogeneity and geographic concentration limit generalizability. Harmonized measurement, longitudinal designs, and inclusive, rigorously conducted trials are needed to support equitable, patient-centered menopause pain management.