Why do women experience joint pain more frequently than men. How does estrogen affect joint pain in women. What are the main causes of joint pain in women. How do female hormones impact pain sensitivity. Are women’s bodies physiologically different in handling joint pain. How can women effectively manage and treat joint pain

The Prevalence of Joint Pain Among Women

Joint pain is a common health issue that affects millions of Americans, but research indicates that women are disproportionately impacted. According to the Centers for Disease Control and Prevention (CDC), over 70 million Americans suffer from arthritis or chronic joint symptoms, with 41 million of these individuals being women. This gender disparity in joint pain prevalence raises important questions about the underlying factors contributing to women’s increased vulnerability to such conditions.

Statistics on Joint Pain in Women

• Over 60% of the 27 million Americans with osteoarthritis are women
• Rheumatoid arthritis affects approximately three times more women than men
• Women are nine times more likely to develop lupus than men
• Scleroderma is three times more common in women
• Multiple sclerosis occurs twice as often in women
• Fibromyalgia affects women eight times more frequently than men

These statistics highlight the significant gender disparity in joint pain and related conditions. But what factors contribute to this increased prevalence among women?

The Role of Estrogen in Joint Pain

One of the key factors influencing joint pain in women is the hormone estrogen. Dr. Tarvez Tucker, a pain specialist and director of the Pain Clinic at the University of Kentucky Medical Center, explains that “Women typically feel pain more intensively, more often, and in more parts of the body than men.” This heightened sensitivity to pain is closely linked to fluctuations in estrogen levels throughout a woman’s menstrual cycle and life stages.

Estrogen’s Protective Effect Against Pain

Estrogen is believed to have a protective effect against pain. During pregnancy, when estrogen levels are at their highest, many women with conditions such as rheumatoid arthritis experience a remission of symptoms. Conversely, joint pain often increases just before or during menstruation when estrogen levels drop sharply.

Is there a correlation between estrogen levels and joint pain severity? Research suggests that approximately 80% of women with rheumatoid arthritis experience symptom remission during pregnancy and a flare-up in the postpartum period when estrogen levels decline.

Autoimmune Diseases and Joint Pain in Women

Autoimmune diseases are another significant contributor to joint pain in women. These conditions, which occur when the immune system mistakenly attacks healthy cells in the body, are more prevalent in women, particularly during their childbearing years.

Common Autoimmune Diseases Affecting Women’s Joints

1. Rheumatoid Arthritis (RA)
2. Lupus
3. Scleroderma
4. Multiple Sclerosis (MS)

Why are women more susceptible to autoimmune diseases? While the exact reasons are not fully understood, researchers believe that reproductive hormones play a crucial role in the development and progression of these conditions.

Physiological Differences in Pain Perception

Beyond hormonal influences, there are physiological differences between men and women that may contribute to variations in pain perception and management. Dr. Patrick Wood, a pain researcher at Louisiana State University and medical advisor to the National Fibromyalgia Association, notes that female brains may be wired differently for pain processing.

Endorphins and Dopamine in Pain Management

Endorphins, the body’s natural painkillers, are thought to work more effectively in men than in women. Studies have shown that females release less of the brain chemical dopamine in response to painful stimulation. Without sufficient dopamine, endorphins cannot function effectively, potentially leading to increased pain sensitivity in women.

How does this difference in brain chemistry affect pain management strategies for women? Healthcare providers may need to consider these physiological variations when developing treatment plans for female patients experiencing joint pain.

Structural Differences and Joint Pain

Anatomical differences between men and women can also contribute to specific types of joint pain. For example, women are more prone to osteoarthritis of the knee. Dr. Bruce Solitar, a rheumatologist at the NYU Hospital for Joint Diseases, suggests that this may be due to women’s tendency to be more limber and loose-jointed than men.

The Knee Joint in Women

Women’s increased joint flexibility can lead to more movement in the knee area, potentially increasing the risk of the kneecap rubbing against the bones below it. This increased friction may contribute to the development of osteoarthritis symptoms in the knee.

What preventive measures can women take to protect their knee joints? Strengthening exercises, maintaining a healthy weight, and proper biomechanics during physical activities can help reduce the risk of knee-related joint pain.

Medication Responses and Gender Differences

When it comes to treating joint pain, women may respond differently to medications compared to men. Several factors contribute to these variations in drug effectiveness and dosage requirements.

Factors Affecting Medication Efficacy in Women

• Fluctuating hormone levels can reduce the amount of medicine circulating in the bloodstream
• Female digestive systems are generally slower, leading to increased absorption of certain medications
• Pain sensitivity increases before menstruation, potentially requiring higher doses of pain-relieving medications

How can healthcare providers account for these differences when prescribing medications for joint pain in women? Individualized treatment plans that consider a woman’s menstrual cycle, hormone levels, and overall health status may be necessary to optimize pain management.

Empowering Women in Joint Pain Management

Given the complex interplay of factors influencing joint pain in women, it is crucial for female patients to be proactive in their healthcare. Dr. Tucker emphasizes the importance of awareness and self-advocacy: “Women need to be aware of these factors, ask the right questions, and be persistent about getting an accurate diagnosis and proper treatment.”

Strategies for Effective Joint Pain Management in Women

1. Educate yourself about how joint pain specifically affects women
2. Track symptoms and their correlation with menstrual cycles
3. Discuss hormone-related pain fluctuations with healthcare providers
4. Explore both pharmacological and non-pharmacological treatment options
5. Consider lifestyle modifications to support joint health

By taking an active role in their healthcare and understanding the unique aspects of joint pain in women, patients can work more effectively with their healthcare providers to find relief and improve their quality of life.

Advances in Women’s Joint Pain Research

As awareness of gender differences in joint pain grows, researchers are increasingly focusing on developing targeted treatments and interventions for women. This emerging field of study holds promise for more effective, personalized approaches to managing joint pain in female patients.

Current Areas of Research

• Hormone-based therapies for autoimmune-related joint pain
• Gender-specific pain management protocols
• Investigating the role of genetics in women’s susceptibility to joint pain
• Developing diagnostic tools that account for gender differences in pain perception

What potential breakthroughs in joint pain management for women can we expect in the coming years? As research progresses, we may see more targeted therapies that address the unique physiological and hormonal factors influencing joint pain in women.

In conclusion, joint pain in women is a complex issue influenced by hormonal fluctuations, physiological differences, and various health conditions. By understanding these unique factors and working closely with healthcare providers, women can take proactive steps to manage their joint pain effectively and improve their overall quality of life. As research in this field continues to advance, we can look forward to more tailored and effective treatment options for women experiencing joint pain.

Joint Pain and Women – Women’s Health

Everyone gets the occasional ache or pain — a little soreness in the shoulder, a twinge in the knee — but research shows that women are more frequently and often more severely affected than men. The CDC estimates that from arthritis or chronic joint symptoms affect more than 70 million Americans, 41 million of whom are women. A number of factors contribute to this disparity: Women are more apt than men to have conditions that cause joint pain, experience hormone fluctuations that affect their vulnerability, and may not be physiologically equipped to deal with pain.

Causes of Joint Pain in Women

Of the nearly 27 million Americans with osteoarthritis (AO), 60 percent are women. Rheumatoid arthritis (RA), an autoimmune disease, strikes approximately three times more women than men. Other autoimmune conditions that cause joint pain, such as lupus, scleroderma, and multiple sclerosis (MS), also hit women harder than men: Women are nine times more likely to develop lupus, three times more likely to have scleroderma, and twice as likely to suffer from MS. And fibromyalgia, a little understood condition that can cause joint pain, affects women eight times more frequently than men.

The Estrogen-Joint Pain Connection

“Women typically feel pain more intensively, more often, and in more parts of the body than men,” says Tarvez Tucker, MD, a pain specialist and director of the Pain Clinic at the University of Kentucky Medical Center, in Lexington. Female hormones are believed to play a role in women’s high vulnerability to pain. Many women with OA, RA, lupus, and fibromyalgia report an increase in joint pain just before or during their periods. This is likely because estrogen levels plummet right before menstruation and rise again after a woman’s period is over. “Estrogen is believed to be protective against pain,” says Dr. Tucker. “It peaks during pregnancy, probably to protect women from the pain of childbirth.” Some research shows that 80 percent of women with RA experience a remission of symptoms during pregnancy and a flare-up when estrogen dips during the postpartum period. Additionally, reproductive hormones are suspected as factors in the high incidence of autoimmune diseases in women since conditions such as RA and lupus are most common during the childbearing years.

Women’s Bodies and Joint Pain

Hormones are only part of the picture, however. Female brains may be wired for pain. It’s thought that endorphins, the body’s natural painkillers, work more effectively in men than in women. “Studies have found that females release less of the brain chemical dopamine in response to painful stimulation. Without dopamine, endorphins can’t function effectively,” says Patrick Wood, MD, a pain researcher at Louisiana State University, in Shreveport, and medical advisor to the National Fibromyalgia Association.

Female structural differences may contribute to some kinds of joint pain, too. For example, women are more prone to osteoarthritis of the knee. One possible explanation: “Women tend to be more limber and loose-jointed than men, so there’s more movement in that area, increasing the risk that the kneecap will rub on the bones below it,” notes Bruce Solitar, MD, a rheumatologist at the NYU Hospital for Joint Diseases, in New York City. This may lead to osteoarthritis symptoms in the knee area.

Joint Pain Medication and Women

Women react differently than men to some medications for relieving joint pain. For example, fluctuating hormone levels can reduce the amount of medicine circulating in the bloodstream, which means that women may need more of the standard dose. Plus, female digestive systems are slower, causing certain medications (like pain relievers) to take more time to pass through the digestive tract where they’re absorbed more fully. And because pain sensitivity increases right before a woman’s period, more pain-relieving medicine may be required at this time of the month. “Women need to be aware of these factors, ask the right questions, and be persistent about getting an accurate diagnosis and proper treatment,” says Dr. Tucker. By becoming educated about how joint pain affects them, women can increase the odds of finding relief and getting the best health care possible.

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Got Knee Pain? Blame Your Cycle

Aching knees? Don’t blame the weather–check your cycle instead. The muscles in your knees work differently at different points in your menstrual cycle, according to a study presented at the Integrative Biology of Exercise Conference. This changing muscle function destabilizes your joints and can set you up for serious pain.

Since women tend to suffer more ACL tears and generalized knee pain than men, researchers have long wondered if part of the reason has to do with hormonal changes from the menstrual cycle. “We know that progesterone and estrogen affect how the nervous system functions, so we theorized that the menstrual cycle might be affecting how women use their muscles,” says study author Matthew Tenan, certified athletic trainer and doctorate candidate.

Tenan and his research team at the University of North Carolina-Chapel Hill tracked the menstrual cycles of seven female volunteers with natural cycles (no hormonal contraception was used). Then they measured the activity of muscles in their knees during a knee extension exercise. They found that the firing rates of the muscle fibers were significantly higher later in the women’s cycles, about a week before their next period, compared to earlier in the menstrual cycle.

Blame it on hormones and the brain: “The way the brain activates the neurons that cause the muscle to move are altered specifically at the latter part of the cycle right before start of next period, when the progesterone is decreasing and estrogen levels are maintained,” says Tenan.

But don’t let the stages of your cycle influence your gym patterns, at least not yet.

“We can’t say for sure that there is the time in a woman’s cycle that she’s more likely to be injured, but the fact that the patterns of muscle firings change through the cycle could mean that there is less stability in the joint due to the muscles being activated in a different way,” says Tenan.

Understanding how the menstrual cycle influences women’s muscles can help trainers better treat knee pain in their patients in the future. “Some say women have more knee pain because they have wider hips,” says Tenan “But you can’t change the width of someone’s hips. Our findings are good news because people change their hormones all the time.”

Your knees aren’t the only body part affected by your period. Learn when your female hormones can help (and hurt!) you at the gym, so you know when you push harder, and when you can back off without guilt.

Image: Photodisc/Thinkstock

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Look Better Naked: Buy the book to learn how to look (and feel!) your very best.

what to do and how to treat

Painless menstruation in women of childbearing age is a sign of good health and a stable hormonal background. Unfortunately, only a few can boast of such a phenomenon. Most women during this period experience discomfort of varying severity. Pain in the knees during menstruation is one of those troubles that worries constantly or from time to time, regardless of the age of the woman.

There is no unequivocal answer to the question about the causes of such a condition, each case is deeply individual. Causes of aching pain in the knee differ depending on the age and general health of the woman. Cause pain in the knee joints can be both individual features of the location of the uterus, and serious diseases of the joints. What do experts explain about this, and is it possible to alleviate the condition?

Contents

1. Peculiarities of adolescence
2. Menopause and menstruation
3. Women of childbearing age
4. What to do
5. General advice

Peculiarities of adolescence

During menstruation, the knees hurt with the time of physiological growth of the organism. The active development of the skeleton, muscles, does not always go simultaneously with the formation of the genital organs.

Knees hurt before menstruation in girls due to poor blood supply to the legs due to an unregulated vascular system. Along with pain, a slight numbness may be felt. The growth of the uterus during this period is also not yet complete, it may have bends. Contracting during the menstrual period, the incompletely formed uterus of a teenage girl causes spasmodic pains that radiate throughout the spine and reach the knees.

Physiological restructuring of adolescence is accompanied by a significant release of hormones, irritation of the nervous system. During menstruation, girls complain of pain all over the body, dizziness. Rotates joints at night, especially legs and knees.

Usually, as you get older and become sexually active, your menstrual cycle becomes more stable, heavy sensations subside, and knee pain goes away.

Menopause and menstruation

Maple pain is one of the manifestations of menopause

If the hormonal storms of adolescents are associated with the development of femininity, then mature women are destined to experience many unpleasant moments in connection with the restructuring of the body to complete the childbearing period. The situation when the knees hurt during menstruation is one of the manifestations of menopause.

During the period of premenopause, menstruation becomes more abundant, their regularity is lost. All signs of PMS intensify, heaviness appears in the whole body, fatigue, aching sensations in the legs are added. If the cause of such sensations is only hormonal changes, then during the period of entry into the postmenopausal period, pain in the legs subsides along with the subsidence of menstruation.

The question is different: during this period, more than ever, diseases of the joints are exacerbated in women, associated with the restructuring of the work of the whole organism. This is the time when a woman needs a complete change in habits, sleep and rest, nutrition, regular physical activity.

The cause of sore legs during menstruation or before them must be established together with the doctor – in some cases, this condition can signal the onset of serious pathologies in bone tissues.

Women of childbearing age

Arthrosis of the knee joint at the initial stage

During the period when the formation of the sexual sphere is completed, the woman has reached the peak of childbearing age, and far from menopause, menstruation in a larger group of women becomes regular and proceeds with fewer complications. However, a significant number of complaints that knees ache during menstruation come from women of childbearing age, regardless of the presence or absence of pregnancy and childbirth.

One-time cases of such a condition may be associated with a prolonged load on the legs during menstruation, or, conversely, a long sitting in one position.

This condition can be caused by an organism weakened by overloads, deficiency of vitamins, iron, calcium. Swelling and pain in the legs may be associated with the work of the reproductive system, or they may simply intensify against the background of menstruation, and be caused by completely different reasons.

Individual characteristics of the hormonal background of the body, causing a particular sensitivity to pain. Violations of the processes of regulation of the nerves, an imbalance of sex hormones leads to a pronounced PMS. Stress, exhaustion of the body as a result of constant low-calorie diets can aggravate this situation.

A disease caused by the anatomical features of the structure of the genital organs, called algomenorrhea. Regardless of whether the pathology is congenital or acquired, it provokes a serious condition of a woman during critical days: headaches and dizziness, abdominal pain spreads to the lower back, hips, inguinal zone, while knees may ache, general weakness and even vomiting may occur.

Running inflammatory processes in the genitals can also lead to the fact that not only the lower back, but also the legs begin to hurt badly.

Difficult childbirth, operations, not only gynecological, but also abdominal ones, can lead to a slight change in the location of organs, parts of the skeleton. Imperceptible at normal times, when the uterus swells during menstruation, these changes can cause pain in the lower part of the skeleton.

Such ailments can be caused by reasons that are not at all related to gynecology. In such cases, the pain in the knees, which initially occurs in the acute period for the woman, begins to appear later and at other times. This includes:

1. Problems with the spine.
2. Diseases of the joints.
3. Circulatory problems and venous insufficiency.
4. Polyneuropathy.
5. The condition is aggravated by the development of such concomitant diseases as diabetes mellitus, hernias, thrombophlebitis, sclerosis, tumors.

What to do

Pain heating pad

First of all, a consultation with a gynecologist. At the reception, it is necessary to describe in as much detail as possible the nature of pain in the knees, the time (before, after or during menstruation, the knees ache), the frequency of attacks. What will the doctor do?

First of all, he will do all kinds of procedures to determine the state of women’s health. If the question “why” remains open to the gynecologist, he will give a referral for examination by other doctors.

Modern medicine has in its arsenal effective ways to alleviate the period of critical days for women, but for the correct formulation, the cause of the ailment must be determined.

General advice

Salt baths to relieve swelling

Those who are prone to painful conditions during menstruation, including all age categories, should avoid overload during this period.

1. Exclude heavy, high-calorie foods from the diet, give preference to foods rich in vitamins and minerals.
2. Do not overload your feet with high heels.
3. Baths with salt will help to remove puffiness.
4. Try to sit or lie down with your legs slightly raised more often.
5. Traditional medicine recommends warm cabbage leaf wraps, mint teas, lemon balm to relieve pain.
6. In the morning, before getting up, it is useful to bandage the legs with an elastic bandage, apply any ointment with analgesic and anti-inflammatory effect under it.

Medicines for pain relief should be prescribed by a doctor after consultation, it is quite possible that not just painkillers can be prescribed, but drugs that act on the root cause of the disease state.

Effect of sex hormones on differences in pain perception | Danilov A.B., Ilyasov R.R.

The article discusses the influence of sex hormones on differences in pain perception

For citation. Danilov A.B., Ilyasov R.R. Effect of sex hormones on differences in pain perception // BC. Pain syndrome. 2015, pp. 3–6.

Introduction

Gender differences in pain perception are now increasingly being studied. Data obtained, of course, allow us to assert the ability of sex hormones to change the degree of pain perception in men and women, but this is practically not used in clinical practice. It is known that sex hormones can affect the processing of the nociceptive signal at many levels of the human nervous system: both central and peripheral. The absolute concentration of sex hormones, as well as fluctuations in their levels in the blood, determine the possibility of opposite effects: pronociceptive or antinociceptive. An undoubted fact is the occurrence of pronociceptive effects as a result of a deficiency in the secretion of sex hormones (in the female or male body), since it has been repeatedly noted that low levels of sex hormones correspond to a higher level of pain. These patterns are still difficult to describe, since pain is a dynamic phenomenon that depends on the influence of various excitatory and inhibitory control mechanisms. It is interesting to study the possibility of sex hormones (testosterone and progesterone), in addition to the main effects, to provide an antinociceptive effect. To fully understand the role of sex hormones in the perception of pain, it is necessary to assess 3 important components – testosterone, progesterone and estrogen levels.

Sex hormone levels and pain
There is a large body of evidence demonstrating different pain perception and response to certain classes of analgesics in men and women [1]. Laboratory and clinical experiments show that women have a lower pain threshold than men in response to the same types of stimuli, such as heat, cold, pressure, and electrical stimulation. It is shown that girls and women in the first days of the postoperative period often complain of pain than boys and men. Newborn girls show a more pronounced mimic reaction in response to pain irritation than boys. It is noted that women experience more intense pain during dental procedures than men. The experiment revealed that when presented with pain stimuli of the same intensity in women, the objective indicator of pain (dilation of the pupil) is more pronounced. It has been experimentally shown that after 16 episodes of exposure to a painful agent on the fingers of 50 volunteers of both sexes, women compared with men noted a higher pain intensity both immediately at the time of exposure and after it ended. The study of the painful form of angina pectoris deserves special attention, which demonstrates that the severity of the accompanying pain syndrome was more pronounced in middle-aged and elderly men against the background of a decrease in blood testosterone levels. The current scientific literature discusses the presence of antinociceptive effects in testosterone, which should be considered in clinical practice in the treatment of pain.
Regarding the influence of estrogen levels on pain perception, there are reports of both a possible increase and a decrease in pain sensitivity, which may be due to the activation of various estrogen receptors. Some pain conditions in women increase after menopause when estrogen levels decrease (eg, joint and vaginal pain), which also suggests an antinociceptive effect of sufficient estrogen levels.
It should be noted the high prevalence of chronic non-cancer pain (CNP). CNP is a collection of clinical conditions characterized by pain that persists despite the removal of any stimulus and apparent tissue healing, or pain that occurs in the absence of any detectable injury, pain that is not associated with cancer. Many diseases accompanied by CNB occur more often in women [2]. The conducted studies suggest that gender differences in CNB may be associated with fluctuations in the level of ovarian hormones throughout the entire menstrual cycle (MC) in women [3]. Conditions associated with CNP include: musculoskeletal pain (MSP) (eg, fibromyalgia, rheumatoid arthritis (RA)), migraine headache, temporomandibular joint dysfunction pain (TMJD), and chronic pelvic pain (CPB) (eg, irritable bowel syndrome (IBS), endometriosis, and interstitial cystitis).

Musculoskeletal pain
Fibromyalgia
Fibromyalgia is one of the many diseases associated with CNP, which tends to occur predominantly in women and more often during the reproductive years. It is characterized by local soreness and stiffness in the muscles that spread throughout the body, as well as increased muscle fatigue, which often increases with exercise. Muscle pain in this case is variable in intensity and is associated with generalized manifestations of increased sensitivity to pain. Fibromyalgia is usually accompanied by other pain syndromes, such as TMD, chronic neck and back pain, and migraine headaches [4]. Research shows that women who have fibromyalgia at menopause (when testosterone levels drop) have more pain scores than premenopausal women. In women with regular MC, the pain associated with fibromyalgia is more common in the premenstrual period (a period of low progesterone levels) than in the postmenstrual period and is often accompanied by mastalgia. This distinguishes them from women using oral contraceptives (OCs) or having had an abortion, who have no difference in pain severity.

Rheumatoid arthritis
RA is a chronic systemic autoimmune disease that results in severe joint inflammation and pain. The prevalence of RA in adults is 0.5-1%, women suffer from this disorder 2-4 times more often than men. In RA, the joints of the fingers, wrists, as a rule, are affected, and eventually irreversible changes occur in them. It is believed that pain in RA occurs as a result of increased pressure on the joints, leading to severe swelling in the joints. However, there are data on the role of ovarian hormones in the pathogenesis and severity of pain in RA. Studies show that the severity of pain in RA varies depending on the phase of the MC, although there is no consensus as to which phase of the MC is associated with more pain symptoms. In women, the peak incidence of RA occurs in the 4th decade, which suggests a decrease in the level of female sex hormones, which contributes to its development: a decrease in estrogen levels leads to a decrease in the production of synovial fluid in the joints. In men, RA is observed more often against the background of a lack of weight, which corresponds to a deficiency of testosterone. Recent studies confirm that hormonal changes precede the onset of RA and influence the disease phenotype. Data have been published showing that a decrease in testosterone levels is a predictor of seronegative RA [5].

Chronic back and limb pain
The study of changes in the severity of MPS in various areas (for example, in the neck, shoulder, back, joints) depending on the hormonal status found that the intensity of pain in women is greater in the menstrual phase than in the middle of the menstrual cycle and the ovulatory phase, which suggests greater pain sensitivity during low levels of estrogen. According to most studies of MBS, it can be concluded that the severity of pain in women varies throughout the MC and increases against the background of a decrease in the level of estrogen, as well as progesterone and testosterone in the blood [6].
Men also often complain of diffuse MPS. There are data demonstrating low testosterone levels in these patients. However, there are currently no published prospective studies more clearly evaluating the potential association between diffuse MPS and testosterone levels in men, and describing the potentially effective testosterone therapy in these patients.

Migraine
The diagnosis of migraine headache is relevant throughout the entire reproductive period of a woman. The occurrence of a pain attack is most likely against the background of fluctuations in the level of ovarian hormones [7]. It is known that some migraine headaches are synchronous with different phases of MC. There are several variants of migraine, including depending on the time of onset of headache attacks (in the perimenstrual period or in other phases of the MC). Their study showed that migraine attacks are more common 2 days before and 2 days after menstruation, and that attacks associated with menstruation are more severe than those occurring in other phases of the cycle. This is the so-called menstrual migraine, which is associated with a significantly longer period of disability and is less sensitive to non-hormonal therapy (β-blockers, calcium antagonists, antidepressants, antiepileptic drugs, etc.) compared to attacks that occur outside the period of menstruation [7].
Studies of different types of migraine support the idea that ovarian hormones indirectly regulate the characteristics of migraine headaches, especially in the case of migraine without aura, which is more common in women with normal cycles, and that symptoms tend to change with changes in estrogen levels. The claim that headaches are related to fluctuations in hormone levels, rather than their absolute levels, is supported by studies involving pregnant women or those taking OCs, i.e. women with a constant level of estrogen in the blood. If estrogen levels do not change, then the frequency and intensity of headaches is negligible, which provides strong evidence that ovarian hormones, their levels and fluctuations in these levels affect the occurrence of migraine attacks.

Dysfunction

temporomandibular joint
The TMD syndrome includes a group of symptoms, chief among which is pain in the muscles of the jaw and/or temporal joint on palpation and during functioning (eg, chewing, opening the mouth, talking). Many patients with TMD also suffer from neck pain and headache (especially chronic tension-type headache). Many epidemiological studies have found that the prevalence of TMD is higher among women and highest in patients of reproductive age [8]. The peak incidence falls on the 3rd-4th decades of life, and then decreases to a level comparable to that of men. This indicates that the increase in the prevalence of this disorder in women may be related to the level of female sex hormones. In particular, MC disorders associated with fluctuating levels of sex hormones (both estrogen and progesterone) that begin at puberty are thought to be consistent with an increase in the intensity of jaw muscle pain in women with TMD.
The study of the relationship between TMD and ovarian hormones in women with a regular cycle showed a change in the severity of pain indicators throughout the day, the maximum level of pain was observed during menstruation. Data from studies that compared with women taking OCs were inconsistent, which is probably due to different combinations of estrogens and progestogens in OCs. One study noted greater variability in pain severity in natural cycle women compared to OC users, which may be due to minimizing the effects of hormonal fluctuations at the pain threshold. Another study showed more pain during menstruation in both regular cycling and OC users, which may be due to the effects of low estrogen levels. In a study that measured pressure pain threshold (PBP) to determine changes in experimentally induced pain sensitivity, PBP was highest during the follicular and luteal phases and lowest during the perimenstrual period [8], suggesting that pain is greatest when estrogen levels are at their lowest. A study evaluating the effect of hormone replacement therapy (HRT) in menopausal women on TMD pain showed that those receiving HRT experienced more severe TMD pain than those not receiving HRT. Thus, it can be argued that there are differences between endogenous and exogenous hormonal effects on conditions accompanied by CNB [8]. Taken together, these studies demonstrate the following pain pattern in TMD, similar to other conditions associated with CND: Pain sensitivity varies throughout MC, with thresholds lowest and highest at low estrogen levels.

Chronic pelvic pain
CPP, like other diseases accompanied by CNB, is more common among women of older reproductive age and postmenopausal women [9]. However, the correlation of the MC and CTB phases remains controversial, partly due to different ways of determining it. According to one definition, it is “non-periodic pain lasting at least 6 months, localized in the pelvis, anterior abdominal wall, at or below the navel, lower back and buttocks” [9], according to another, it is “continuous or intermittent pain in the lower abdomen, lasting at least 6 months. and not only associated with the menstrual period or sexual intercourse. It should be noted that there is a marked similarity in diseases that can lead to CPP (eg, endometriosis, interstitial cystitis, IBS), which makes it difficult to accurately identify the causative factor.

Irritable bowel syndrome
There is evidence of a high prevalence of IBS among women. Among men over 50 years of age, IBS is as common as among women. IBS is a common non-gynecological cause of CPP (up to 60% of all visits) [9]. IBS is characterized by changes in the rhythm of defecation and increased visceral sensitivity [9]. Women with IBS have more frequent and loose stools, as well as crampy abdominal pain and bloating when menstruation approaches, suggesting a possible association between IBS symptoms and MC [9]. Clinical studies examining differences in GI symptoms in women with IBS report more abdominal pain and bloating during menstruation than during other phases of MC. Other studies comparing the difference in symptom severity between Crohn’s disease, ulcerative colitis, and IBS during MC found that patients experienced more intense abdominal pain during the premenstrual phase compared to controls. There are also studies that do not show any difference in pain levels in IBS during the entire MC.
Thus, as in the case of other studies of diseases accompanied by CNB, despite conflicting results, the role of ovarian hormones in the modulation of abdominal symptoms in IBS is indicated, which is mainly more pronounced in the perimenstrual period, i.e., during the period of reduced estrogen levels. .
Some studies examining the relationship between IBS and sex hormones have discussed the possibility of a protective effect of male sex hormones. An inverse relationship was shown between the severity of IBS symptoms in men and the level of free testosterone in the blood serum, which indicates a potential protective effect of male sex hormones.
It should be noted that conditions accompanied by CNB rarely occur separately. Perhaps it is more appropriate to speak of chronic pain as a collection of conditions. In 70% of patients with fibromyalgia, concomitant orofacial pain is possible. Based on this, it is suggested that fibromyalgia (generalized) and orofacial (localized) pain may be a variation of the same problem. CPP has also been reported to be associated with other diseases associated with CNB. Many studies have noted that this duplication of diseases accompanied by pain makes it difficult to adequately treat chronic pain conditions. In patients with some types of CND-associated diseases, the occurrence of one type of pain may contribute to the reduction of pain associated with another disease, which is possible due to outgoing inhibitory pain control. In diseases that are not sensitive to the level of ovarian hormones, the actual level of pain (in diseases susceptible to ovarian hormones) may either not be determined or underestimated. Thus, in clinical practice, the treatment of pain should take into account comorbidities.

Obesity
Obesity exacerbates pain in both men and women, as it affects the secretion of both sex hormones and cytokines, inflammatory mediators that play an important role in the development of pain and hyperalgesia. In the elderly, the body is less able to inhibit the secretion of cytokines, the presence of a pro-inflammatory status is noted. There is evidence of a relationship between a decrease in testosterone levels and an increase in pro-inflammatory status in men, since androgens suppress the expression and release of cytokines and chemokines [10].
Different concentrations of sex hormones in men and women are considered important factors contributing to sex differences in the lipoprotein profile [10]. Epidemiological evidence suggests that testosterone levels are inversely related to levels of total cholesterol, low-density lipoprotein and triglycerides, as well as that male testosterone levels have a complex and inconsistent relationship with high-density lipoprotein levels and risk of cardiovascular disease [10 ]. Obesity, especially visceral excess fat, is associated with insulin resistance, hyperglycemia, atherogenic dyslipidemia and hypertension, as well as prothrombotic and proinflammatory status. Visceral fat cells secrete large amounts of cytokines that impair testicular steroidogenesis. There is evidence to suggest that obesity is a significant factor in reducing circulating testosterone levels. In addition, in white adipose tissue, found in large quantities in obese men, there is an increased activity of aromatase and the release of adipose tissue hormones – adipokines. Thus, obesity is an additional important factor contributing to the imbalance of sex hormones in the body of a man, and leads to an increase in the incidence of various pain syndromes against the background of increased pro-inflammatory status. Androgen therapy, including testosterone therapy, should lead to a decrease in the level of pro-inflammatory factors and an increase in the level of anti-inflammatory cytokines [10], which should be taken into account in clinical practice in the treatment of pain. Further research into the impact of obesity on the level of pro-inflammatory factors in women is also needed.

Pins
Most studies describe the relationship between the level of sex hormones in the blood and the perception of pain in men and women. A more pronounced perception of pain in women was noted. The frequency of development of pathologies accompanied by CNB is also higher in the female population. The clinical model of the influence of the level of sex hormones in the blood on the level of pain in women is MC. The vast majority of chronic pain syndromes (migraine, TMD pain, MPS, and CPS) share the same pain pattern: pain sensitivity varies throughout the MC, with the lowest thresholds and highest sensitivity at low estrogen levels. It must be remembered that not only the absolute levels of ovarian hormones, but also their fluctuations, as well as the level of testosterone in the blood in women, affect the severity of pain syndromes. HRT, including therapy with single or combined estrogen and progestogen preparations, can be effectively used in the treatment of chronic pain syndromes in women.
The clinical model of the influence of the level of sex hormones in the blood on the severity of pain in men is the state of androgen deficiency. At the moment, it is known that there is an effect of reduced testosterone levels on the level of pro-inflammatory status in men, since androgens suppress the expression and release of cytokines and chemokines. It can be concluded that the imbalance of sex hormones in the body of a man contributes to the occurrence of pronociceptive effects. There is evidence that obesity is an important factor in reducing circulating testosterone levels and thus contributing to chronic pain. HRT with androgens, including testosterone therapy, obviously leads to a decrease in the level of pro-inflammatory factors and an increase in antinociceptive activity, which should be taken into account in the treatment of pain in men.
Therefore, in the clinical practice of a neurologist, it is important to pay more attention to the detection of hypogonadism among female and male patients, which requires a hormonal examination, including the determination of testosterone, progesterone and estradiol levels (multisteroid analysis by mass spectrometry).