Does pain vary across the menstrual cycle? A review

Abstract

Reproductive hormones are implicated in moderating pain. Animal studies support both pronociceptive and antinociceptive actions of oestradiol and progesterone suggesting that the net effect of these hormones on pain is complex and likely depends on the interaction between hormones and the extent of fluctuation rather than absolute hormone levels. Several clinical pain conditions show variation in symptom severity across the menstrual cycle. Though, there is still no consensus on whether the menstrual cycle influences experimental pain sensitivity in healthy individuals. Comprehensive literature searches on clinical and experimental pain across the menstrual cycle, as well as gonadal hormones and pain were performed using the electronic databases PubMed, Google Scholar and the Cochrane Library. Full-text manuscripts were reviewed for relevancy and reference lists were cross-checked for additional relevant studies. Most of the more recent, well-controlled studies show that menstrual cycle phase has no effect on the perception of pain in healthy, pain-free women. Although recent studies investigating pain-related brain activation have shown differential activation patterns across the menstrual cycle in regions involved with cognitive and motor function, even in the absence of a behavioural pain response, suggesting that cognitive pain and bodily awareness systems are sensitive to menstrual cycle phase. The interaction between the gonadal hormones and pain perception is intricate and not entirely understood. We suggest further investigations on the association between female reproductive hormones and pain sensitivity by exploring the interaction between clinical and experimental pain and the hormone changes that characterize puberty, post-partum and the menopause transition.

The Effect of Gender and Menstrual Phase on Serum Creatine Kinase Activity and Muscle Soreness Following Downhill Running

“…In support of the current findings, a previous study reports greater perception of pain and rating of perceived exertion during exercise in women during the EF phase compared with the LF or ML phase [43]. The influence of the menstrual cycle on pain perception is complicated and not clearly described [44]. In fact, oestrogen and progesterone receptors occur on central and peripheral nerves and have been reported to induce both pronociceptive and antinociceptive affects where the overall effect may be dependent on the receptor type and relative presence of oestrogen and progesterone [44].…”

“…In fact, oestrogen and progesterone receptors occur on central and peripheral nerves and have been reported to induce both pronociceptive and antinociceptive affects where the overall effect may be dependent on the receptor type and relative presence of oestrogen and progesterone [44]. Nevertheless, most evidence suggests the occurrence of reduced perception of clinical pain in the ML phase and heighted pain when oestrogen concentrations are low such as in EF phase or when oestrogen concentrations reduce rapidly [44]. Moreover, patients with rheumatoid arthritis report greater joint pain and stiffness during the LF phase [44].…”

“…Nevertheless, most evidence suggests the occurrence of reduced perception of clinical pain in the ML phase and heighted pain when oestrogen concentrations are low such as in EF phase or when oestrogen concentrations reduce rapidly [44]. Moreover, patients with rheumatoid arthritis report greater joint pain and stiffness during the LF phase [44]. …”

Evaluation of the antihyperalgesic effect of tapentadol in two human evoked pain models – the TapCapMentho pilot trial

“…However, it remains unclear, whether the menstrual cycle influences experimental pain in healthy female volunteers [31] .…”

Genes in the GABA Pathway Increase in the Lateral Thalamus of Sprague-Dawley Rats During the Proestrus/Estrus Phase

“…Women often have a higher incidence of pain (Amandusson and Blomqvist, 2013; Fillingim and Maixner, 2000; Iacovides et al, 2015; Sherman and LeResche, 2006) and women report orofacial pain more often than men (Koopman et al, 2009). Polymorphisms in the estrogen receptor will increase the risk of women developing various orofacial pain conditions supporting a biological basis for estradiol (Kang et al, 2007; Ribeiro-Dasilva et al, 2009).…”