What Are We Missing When We Talk About Menopause and Pain?

World Menopause Day | October 18, 2026

When we talk about perimenopause and menopause, we often hear about hot flashes, night sweats, disrupted sleep, and changes in menstrual cycles.

We don't always hear about pain.

The woman who wakes up with aching joints. The one whose shoulder becomes increasingly stiff and painful. The woman who has always been active but now avoids activities she once enjoyed.

I know, because I was one of those women.

I experienced frozen shoulder twice during a period of significant hormonal changes in midlife. Because I'd had a hysterectomy years earlier, with my ovaries left intact, I didn't have menstrual changes to help me recognize where I was in the menopause transition.

The first time, I had no idea that the hormonal changes happening in my body might even be worth discussing alongside my shoulder pain.

It wasn't until later, when additional hormone testing revealed very low estrogen levels, that I began asking different questions. My labs a year earlier had looked normal.

I can't say that menopause caused my frozen shoulders. But I wish someone had been curious sooner about whether those changes belonged in the same conversation.

Chronic Pain at Midlife: A Conversation Worth Having

October 18 is World Menopause Day, and the International Menopause Society's 2026 theme is Chronic Pain at Midlife.

Estrogen influences multiple systems throughout the body, including those involved in musculoskeletal health and pain processing. Research has explored associations between menopause and symptoms such as joint pain and stiffness, as well as possible relationships with conditions such as frozen shoulder. But association does not establish causation.

Not every new ache or pain is related to menopause, and persistent or unexplained symptoms deserve appropriate medical evaluation. At the same time, hormonal changes shouldn't automatically be excluded from the conversation. Sometimes we need to look beyond one symptom, one laboratory result, or one appointment.

Pain Affects More Than the Body

As a psychotherapist, I'm particularly interested in what happens beyond the physical symptoms. Chronic pain can affect sleep, concentration, relationships, work, and the activities that help us feel connected to ourselves. It can also bring frustration, anxiety, grief, and uncertainty. Someone who has always been independent may suddenly need help with everyday tasks. Someone accustomed to caring for others may struggle to ask for help.

And when pain persists without a clear explanation, there can be another layer of distress.

Am I missing something?

Why isn't this getting better?

Is this just what getting older feels like?

Meanwhile, life continues.

The jobs, relationships, caregiving responsibilities, financial pressures, and sometimes significant losses happen alongside the physical symptoms.

Pain doesn't arrive in isolation.

Neither does menopause.

Where Does Psychotherapy Fit?

Psychotherapy doesn't diagnose the medical cause of pain or replace appropriate medical treatment. But it can play a meaningful role in helping people navigate the emotional and psychological effects of living with pain.

Cognitive behavioral approaches to chronic pain can help people recognize patterns that contribute to distress, develop coping strategies, and find practical ways to improve daily functioning. UK clinical guidelines from the National Institute for Health and Care Excellence (NICE) recommend considering cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for chronic primary pain as part of an individualized approach to care.

In practice, that support might involve addressing sleep-related worries, learning stress-management strategies, communicating needs, adjusting expectations, or making room for the grief that can accompany changes. Sometimes it's about learning how to respond to a body that no longer feels as predictable as it once did. Other times, it's about recognizing how much someone is already managing before suggesting one more thing they should be doing. The goal isn't to convince someone that their pain is psychological.

Pain is real. So is its emotional impact.

Both deserve attention.

What Would a More Complete Conversation Look Like?

I believe we need to remain curious.

Not every symptom has one explanation. Not every treatment works for every person. And what someone needs may change depending on what else is happening in their life.

Alongside a thorough medical assessment, we can ask questions that help us understand the whole person:

• What else has changed in your health?

• How are you sleeping?

• How is pain affecting your daily life?

• What activities have become more difficult?

• What other responsibilities or stressors are you managing?

• What kind of support would be helpful right now?

  
  

Looking Beyond the Familiar Symptoms

World Menopause Day gives us a reason to broaden the conversation.

We don't need to attribute every symptom to menopause.

But we shouldn't overlook it, either.

And the person living with those symptoms deserves more than a shrug.

Sometimes better support begins with asking what else might be connected.

Kristin Gurney, LICSW

Klea Therapy Co. | Vancouver, Washington