Ovarian hormones and chronic pain: A comprehensive review

Abstract

Most chronic noncancer pain (CNCP) conditions are more common in women and have been reported to worsen, particularly during the peak reproductive years. This phenomenon suggests that ovarian hormones might play a role in modulating CNCP pain. To this end, we reviewed human literature aiming to assess the potential role of ovarian hormones in modulating the following CNCP conditions: musculoskeletal pain, migraine headache, temporal mandibular disorder, and pelvic pain. We found 50 relevant clinical studies, the majority of which demonstrated a correlation between hormone changes or treatments and pain intensity, threshold, or symptoms. Taken together, the findings suggest that changes in hormonal levels may well play a role in modulating the severity of CNCP conditions. However, the lack of consistency in study design, methodology, and interpretation of menstrual cycle phases impedes comparison between the studies. Thus, while the literature is highly suggestive of the role of ovarian hormones in modulating CNCP conditions, serious confounds impede a definitive understanding for most conditions except menstrual migraine and endometriosis. It may be that these inconsistencies and the resulting lack of clarity have contributed to the failure of hormonal effects being translated into medical practice for treatment of CNCP conditions.

Biopsychosocial factors of Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders in individuals with muscular temporomandibular disorder and migraine

“…So, we have considered that stress of economically active age group is a contributing factor for pain worsening. A common feature of TMD and migraine is the role of female hormones in symptoms duration and severity [16][17][18] . There are evidences that the association between migraine and TMD in females may be due to genetic susceptibility factors shared by both conditions or even to biopsychosocial factors which, associated to the former, would contribute to make the presentation more evident 5,17,19,20 .…”

Trends in Ovarian Cancer Incidence in Iran

“…The mean age of women at diagnosis is 51 years (12). Although the improved treatment methods of ovarian cancer has increased the life expectancy of patients in the last decade, patients' survival has ultimately increased slightly (13). One of the major causes of mortality in these patients, despite appropriate treatment, is delay in referral of women with ovarian cancer, especially epithelial tumors (14).…”

The magnitude, long-term trend and lifestyle risk factors of dysmenorrhea and premenstrual syndrome

“…Under this theory, there may be psychological stress related to being underweight or obese which may cause differences in pain perception and sensitivity between these women and normal weight women, resulting in different subjective experiences of pain [206,208]. In addition, there is evidence that ovarian hormones (especially oestrogens) play a role in modulating a range of chronic pain conditions through affecting concentration of oestrogen receptors in the spinal cord or the corresponding brain regions, or through interacting with different neurotransmitters that modulate pain perception [212]. Generally, a low oestrogen milieu is suggested to exacerbate the severity of chronic pain [212], which may be particularly relevant in the association between underweight and dysmenorrhea.…”

“…In addition, there is evidence that ovarian hormones (especially oestrogens) play a role in modulating a range of chronic pain conditions through affecting concentration of oestrogen receptors in the spinal cord or the corresponding brain regions, or through interacting with different neurotransmitters that modulate pain perception [212]. Generally, a low oestrogen milieu is suggested to exacerbate the severity of chronic pain [212], which may be particularly relevant in the association between underweight and dysmenorrhea.…”

“…Other factors such as psychological stress related to being underweight or obese or a low oestrogen milieu have also been suggested to play a role in the causal pathways but are yet to be proven [206,208,212].…”