Chronic Pain in Midlife: World Menopause Day 2026

Dear Rosies,

Today is World Menopause Day. I had two letters in mind. One celebrated midlife, the self-knowledge and freedom of these years, the queens coming home (Malka Russell's vibey song is linked there). The other followed the International Menopause Society, which chose chronic pain at midlife as this year's theme. The second one has good information to share for those of you dealing with pain.

Ten specialists wrote the society's new white paper, published in Climacteric. They estimate that about half of women in midlife live with pain that lasts, or keeps returning, beyond three months. Many carry more than one kind at once.

The research covers:

• Muscles and joints. Estrogen receptors sit in joints, ligaments, tendons and bone. As estradiol falls, many women feel aching, stiffness and fatigue. In 2024, clinicians writing in the same journal named this the musculoskeletal syndrome of menopause.

• Migraine, which can grow more frequent or more severe in perimenopause.

• Fibromyalgia, widespread pain often tangled up with poor sleep.

• Pelvic pain, including vulvodynia and bladder pain syndrome.

The finding that struck me most is that pain can outlast its original cause because the nervous system itself changes. Pain pathways grow more responsive and turn the volume up, a process the researchers call central sensitization. That's why a scan can come back clean, while the pain remains real.

The paper recommends a log of when pain occurs and how long it lasts, what eases or worsens it, and how it affects sleep and daily life. The log then goes to a provider who builds a plan with the patient (from the perspective of how thoughts impact the body, you might want to log the great days, too).

That plan may draw on strength training, sleep, physical therapy, psychological therapies and medication. Hormone therapy helps some menopause symptoms and calls for an individual conversation.

For keeping that log, we recommend Manage My Pain. It was developed with pain clinicians and turns daily entries into a clear report to bring to appointments.

Also, we have an encyclopedic amount of resources in the Rose Woman library on perimenopause and menopause, and a free guide to Conscious Menopause available for download, and our 2025 book The Nine Lives of Woman covers the 3 stages of life after menopause.

One source of midlife discomfort responds to daily care at home. As estrogen declines, vulvar and vaginal tissue becomes thinner and drier, and friction from walking, cycling or sex can cause discomfort. A fingertip of Honor smoothed over the outer and inner lips each morning after the shower keeps that thin skin moisturized and supple, and eases dryness-related discomfort.

All the best to you, in all stages of life,

Christine Marie Mason, Founder, Rosebud Woman

Burning, rawness or pain at the vulva that persists deserves a provider's eye. Vulvodynia and other pelvic pain respond to specialist care, including pelvic floor physical therapy. Sources: International Menopause Society, "Chronic pain at midlife," Climacteric, 2026; Harvard Health Publishing on the musculoskeletal syndrome of menopause.