Osteopathic Journals and Research by Darren Chandler


Hormones and pain

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  • Introduction
  • When do hormones matter?
  • How Ovarian hormones work
  • Mood levels and chronic pain
  • Be aware of phytoestrogens


This blog is a summary of the paper: Ovarian hormones and chronic pain: A comprehensive review (2014). Hassan S, Muere A, Einstein G

When do hormones matter?

The conditions reviewed in the paper are those more prevalent between puberty and menopause. This suggests a potential link with ovarian hormones:

  • Musculoskeletal pain:
    • Fibromyalgia
    • Rheumatoid Arthritis
    • Migraine headache
    • Jaw problems (TMD) 
  • Chronic pelvic pain:
    • Irritable bowel syndrome (IBS)
    • Endometriosis
    • Interstitial cystitis

Many factors can contribute to these conditions only one of which is the menstrual cycle. So if, for example, 60% of your Irritable Bowel Syndrome is due to a food allergy you may not notice a link with your cycle. But if 60% of your Irritable Bowel Syndrome is linked with your hormones then you will notice a link.

The weight of the research suggests the higher the level of ovarian hormones (especially oestrogen) then the less pain you’ll have. Consequently with lower levels of ovarian hormones (especially oestrogen) you’ll have more pain.

The only exception to this is endometriosis where naturally occurring oestrogen can encourage endometriosis tissue to grow and shed.

The use of hormone replacement therapy (HRT) to artificially boost ovarian hormones has been shown to give more pain in one study on jaw pain but is used as a treatment of choice for other conditions e.g. endometriosis.

How ovarian hormones work

Most research finds pain and swelling (inflammation) is worse when ovarian hormones levels (especially oestrogen) is low. Consequently they find pain and swelling is better when the hormone levels are high.

For this purpose we’ve split the menstrual cycle in 2 parts:

(1) Oestrogen levels slowly increase from day 6 to peak at day 12/13 of the cycle (pre-ovulation). Pain is generally reported as being better during the latter part of this stage as oestrogen levels peak.

(2) Oestrogen levels tend to drop quickly post-ovulation slumping at day 15 and remain quite low especially just before, during and after the period. Pain is generally reported as being higher during this phase.

This may not be true in all women as commonly there are variations in the cycle and quantities of oestrogen produced. Also hormone levels constantly wax and wane so don’t always follow a strict their either ‘high’ or ‘low’ reading depending on the phase of the cycle.

Ovarian hormones (especially Oestrogen) reduces pain by:

  • Brain and nerves: These hormones affect parts of the brain and nervous system that make us aware of pain. Because of this they might also affect the effectiveness of pain medications.
  • Anti-inflammatory: Ovarian hormones fight against swelling (inflammation) acting as an anti-inflammatory. Therefore when the hormones are high swelling and pain goes down. When hormones are low pain and swelling goes up.

Mood levels and chronic pain

Depressed mood states, that can be associated with the menstrual cycle, has been associated with chronic pain.

In some women experiencing changes in mood during their cycle there was no correlation with their mood and oestrogen or progesterone levels. The two strongest causes for a change in mood in this particular group of women were (1) stress levels and (2) how women perceived their health at different stages of the cycle. 

Be aware of phytoestrogens

Many people try to boost their oestrogen levels by eating foods naturally high in phytoestrogens. These nutrients can have health promoting as well as health damaging effects(1). If you’re not sure whether taking any supplements or food sources is advisable contact your GP.


(1) The pros and cons of phytoestrogens (2010). Patisaul H and Jefferson W



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