# Hormones & Pain
##### Untangling Pain
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## tl;dr
- Oestrogen can be linked to both more and less pain, depending on timing, levels, and the person.
- Research on progesterone is mixed too; some findings suggest more sensitivity, while others suggest less pain.
- My own sensitivity has not always matched the neat patterns described in studies.
- Testosterone may have a pain-reducing effect, but we need more research, especially in women.
- There is no simple “good” or “bad” hormone when it comes to pain.
> [!abstract]- Transcript
>
> Let's look at how oestrogen affects pain.
>
> We've already mentioned how, in sex reassignment, how having oestrogen as a treatment increased pain. But I wanted to see if I could find any more studies to support this, and obviously I did.
>
> Now, there were a few studies that looked at what would happen when ovaries were removed and oestrogen receptors were blocked.
>
> And they found that both inflammatory and visceral pain was reduced. So again, more oestrogen meant more pain, and less oestrogen meant less pain.
>
> There's also been a study on mid cycle symptoms, so these were symptoms such as PMS and migraine that came on after our period had finished.
>
> Usually PMS and migraine happens for a lot of women before their period, but this study found that some women actually struggle more mid cycle, so again, looking at that idea, it's that oestrogen increases pain.
>
> But it's not always high oestrogen that's linked to more pain.
>
> Low oestrogen has been associated with more pain.
>
> Studies have found that 51% of women experience headaches and migraines around menstruation, when our oestrogen is low, and this low oestrogen may be the reason for this pain.
>
> This is also backed up by the fact that researchers have found that migraines can actually be improved by achieving a steady hormonal state using oestrogen.
>
> Then we have evidence that high oestrogen levels can reduce pain sensitivity. So like that previous one I mentioned, where migraines were improved with oestrogen, there are other studies to suggest the same.
>
> So, I've literally just thrown everything at you there, haven't I?
>
> So I've said that high oestrogen creates more pain. I've said that low oestrogen creates more pain. And I've said that high oestrogen is less pain.
>
> So which is it?
>
> The first things I need to say is that oestrogen's effects on pain are,
>
> in a word,
>
> complex.
>
> This is because
>
> not only does it have pro-nociceptive effects on pain,
>
> which means that it leads to the perception of pain,
>
> but it also has anti-nociceptive effects on pain,
>
> meaning that it can block the detection of a painful or injurious stimulus.
>
> So the question...
>
> Oestrogen can increase the perception of pain, right?
>
> So this is correct.
>
> Oestrogen can increase the perception of pain. But, oestrogen has also been found to reduce pain. Correct again. It is complex. It is really, really, fucking complex.
>
> But it's not just oestrogen. The same can be said for progesterone. And please don't think that I'm going to leave you in the lurch and let you think that you're not gonna go away knowing what the hell is going on.
>
> I promise I will give you some answers in a bit. But for now, let's look at progesterone.
>
> Right, so we've looked at how oestrogen and pain are linked. Now we're going to look at progesterone and how that is linked to pain.
>
> So, firstly, some of the studies I found talk about progesterone and how it increases pain sensitivity and something called hyperalgesia. So hyper meaning more, algesia, pain.
>
> And this happens within the luteal phase. So hyperalgesia is an increased response to a stimulus that is normally painful. So basically the first idea is that we may experience more pain during the luteal phase. Because of progesterone.
>
> However what I'm actually seeing more of is just how beneficial progesterone actually is, especially when it comes to pain. Which again, remember, we need to ovulate in order to produce progesterone. And it's why so many people, so many health professionals advocate for us actually ovulating.
>
> Now, a paper I was looking at talks about how high progesterone during the luteal phase may actually reduce pain and the emotional impact of pain and therefore creating a kind of luteal analgesia, so anal meaning basically like less pain. So basically the women in the study reported that pain was less unpleasant.
>
> So even if it was still intense. The research concluded that progesterone reduces the kind of emotional sting of pain. And I sort of get this because during my follicular phase, during the first half of the menstrual cycle when oestrogen is dominating, this is when I'm really sensitive to touch.
>
> And even soft touch can feel painful. Whereas I don't get that same response during the luteal phase.
>
> Now I also came across a study from 2018 which looked at the relationship between sex hormones and fibromyalgia pain. Now it wasn't a large study, I think it was only 8 women in the study.
>
> But I feel that any data that helps to fill in the gender data gap is better than none. So I'm going to take it.
>
> Anyway, this study found that higher progesterone levels meant less pain in those women who had fibromyalgia. So again, it could be that for some women, progesterone actually helps with pain.
>
> So to summarise, when it comes to progesterone and its role in pain, we've seen that high progesterone means more pain.
>
> And we've seen that high progesterone means less pain. So, progesterone and its role in pain is again complex. There is not one definitive answer. And, I'm going to come to what we can get out of this conclusion fully in a moment. But we're going to move on to testosterone.
>
> So I already mentioned at the start of this training about how a study into sex reassignment found that those treated with testosterone had reduced pain.
>
> Now I also came across a research paper from 2017 that found that lower testosterone levels meant more pain. That said, this particular study was in men and actually most of the research is on men when it comes to testosterone. Probably for obvious reasons.
>
> The studies I did find on women mainly focused on testosterone treatment, usually during perimenopause. Although I did find another study which looked at sex hormones in women throughout their menstrual cycle and how this relates to pain, and they found that testosterone was anti-nociceptive, whereas oestrogen was pro-nociceptive. So what this means is that if we think back to the fire alarms, basically testosterone reduces the sensitivity of the fire alarms, whereas oestrogen may increase it. How this relates to pain is that if we have high testosterone levels, then we may be less likely to experience pain, whereas low levels may again increase the pain.
>
> So to summarise this one, pretty much the research out there seems to suggest that testosterone improves pain. Now as always, much more research is needed. We need to know how it affects pain specifically in women.
>
> And also whether this changes throughout the menstrual cycle or whether this changes throughout perimenopause or whether it's different for different conditions.
Next lesson → [[Untangling Pain – Module 3 Lesson 04 – The Reasons for Differences|The Reasons for Differences]]
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## Extra
## Version 1: Full
Oestrogen Increases Pain
We’ve already mentioned how, in sex reassignment, having oestrogen as a treatment increased pain
I wanted to see if I could find any more studies to support this, and obviously I did
There were a few studies that looked at what would happen when ovaries were removed and oestrogen receptors were blocked
They found that both inflammatory and visceral pain was reduced
So again, more oestrogen meant more pain, and less oestrogen meant less pain
Mid-Cycle Symptoms and Pain
There’s been a study on mid-cycle symptoms, such as PMS and migraine, that came on after our period had finished
Usually PMS and migraine happens for a lot of women before their period, but this study found that some women actually struggle more mid-cycle
So again, looking at that idea, it’s that oestrogen increases pain
Low Oestrogen and Pain
It’s not always high oestrogen that’s linked to more pain
Low oestrogen has been associated with more pain
Studies have found that 51% of women experience headaches and migraines around menstruation, when our oestrogen is low
This low oestrogen may be the reason for this pain
Researchers have found that migraines can actually be improved by achieving a steady hormonal state using oestrogen
High Oestrogen Reduces Pain
We have evidence that high oestrogen levels can reduce pain sensitivity
Like that previous one I mentioned, where migraines were improved with oestrogen, there are other studies to suggest the same
Oestrogen and Pain: It’s Complex
I’ve said that high oestrogen creates more pain
I’ve said that low oestrogen creates more pain
And I’ve said that high oestrogen is less pain
So which is it?
The first thing I need to say is that oestrogen’s effects on pain are, in a word, complex
This is because not only does it have pro-nociceptive effects on pain, which means that it leads to the perception of pain
But it also has anti-nociceptive effects on pain, meaning that it can block the detection of a painful or injurious stimulus
Oestrogen can increase the perception of pain, right? So this is correct
Oestrogen can increase the perception of pain
But oestrogen has also been found to reduce pain
Correct again. It is complex. It is really, really, fucking complex
It’s not just oestrogen. The same can be said for progesterone
I promise I will give you some answers in a bit
Progesterone and Pain Sensitivity
Firstly, some of the studies I found talk about progesterone and how it increases pain sensitivity and something called hyperalgesia
Hyper meaning more, algesia, pain
This happens within the luteal phase
Hyperalgesia is an increased response to a stimulus that is normally painful
Basically the first idea is that we may experience more pain during the luteal phase because of progesterone
Progesterone as Beneficial for Pain
What I’m actually seeing more of is just how beneficial progesterone actually is, especially when it comes to pain
Remember, we need to ovulate in order to produce progesterone
It’s why so many people, so many health professionals advocate for us actually ovulating
A paper I was looking at talks about how high progesterone during the luteal phase may actually reduce pain and the emotional impact of pain
Therefore creating a kind of luteal analgesia
Women in the study reported that pain was less unpleasant
So even if it was still intense, the research concluded that progesterone reduces the kind of emotional sting of pain
Personal Experience with Pain Sensitivity
During my follicular phase, during the first half of the menstrual cycle when oestrogen is dominating, this is when I’m really sensitive to touch
Even soft touch can feel painful
Whereas I don’t get that same response during the luteal phase
Progesterone and Fibromyalgia
I also came across a study from 2018 which looked at the relationship between sex hormones and fibromyalgia pain
It wasn’t a large study, I think it was only 8 women in the study
I feel that any data that helps to fill in the gender data gap is better than none, so I’m going to take it
This study found that higher progesterone levels meant less pain in those women who had fibromyalgia
So again, it could be that for some women, progesterone actually helps with pain
Progesterone and Pain: It’s Complex
To summarise, when it comes to progesterone and its role in pain, we’ve seen that high progesterone means more pain
And we’ve seen that high progesterone means less pain
So, progesterone and its role in pain is again complex
There is not one definitive answer
Testosterone and Pain
I already mentioned at the start of this training about how a study into sex reassignment found that those treated with testosterone had reduced pain
I also came across a research paper from 2017 that found that lower testosterone levels meant more pain
This particular study was in men and actually most of the research is on men when it comes to testosterone, probably for obvious reasons
Testosterone and Pain in Women
The studies I did find on women mainly focused on testosterone treatment, usually during perimenopause
I did find another study which looked at sex hormones in women throughout their menstrual cycle and how this relates to pain
They found that testosterone was anti-nociceptive, whereas oestrogen was pro-nociceptive
If we think back to the fire alarms, basically testosterone reduces the sensitivity of the fire alarms, whereas oestrogen may increase it
If we have high testosterone levels, then we may be less likely to experience pain
Whereas low levels may again increase the pain
Testosterone and Pain: Summary
Pretty much the research out there seems to suggest that testosterone improves pain
Much more research is needed
We need to know how it affects pain specifically in women
And also whether this changes throughout the menstrual cycle or whether this changes throughout perimenopause or whether it’s different for different conditions
⸻
Resources or Mentioned
Study on sex reassignment and pain
Study on mid-cycle PMS and migraine
Study on oestrogen receptor blocking and pain reduction
2018 study on fibromyalgia and progesterone
2017 study on testosterone and pain in men
Study on sex hormones and pain in women across the menstrual cycle
⸻
⸻
Resources or Mentioned
Study on sex reassignment and pain
Study on mid-cycle PMS and migraine
Study on blocking oestrogen and pain
2018 study on fibromyalgia
2017 testosterone study
Hormone and pain study across menstrual cycle
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