Do you take painkillers for migraines or painful menstruation, but only feel minimal relief? You're not alone. New research shows that women and men not only experience pain differently, but also respond differently to common medications. Hormonal differences, slower metabolism, and years of neglecting women in clinical trials mean that drugs like ibuprofen, aspirin, or even morphine are not always as effective for women as they are for men.
Differences in Pain Perception
As recently as 1993, women were not required to be included in clinical trials. Many drugs were therefore tested exclusively on men, and their effects and dosages were automatically considered universally applicable to both sexes. Only more recent research confirms that the female body reacts differently in many respects – for example, to pain itself, but also to methods of treatment.
Although pain perception is a very individual matter, many studies suggest that biological sex characteristics also play a role. The widespread belief that women have a higher pain threshold because they can handle childbirth does not entirely correspond to reality. In fact, men have a higher pain threshold, especially due to hormonal differences:
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Hormonal influences: Sex hormones, especially testosterone and estrogen, affect pain sensitivity. Testosterone, which the male body naturally produces more of, reduces pain intensity. For example, one study showed that boys with higher testosterone levels reported lower perceived pain. In another study where both men and women were exposed to the same painful stimuli, such as cold, heat, or pressure, women tended to exhibit higher levels of pain. (1)
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Endorphins: The female brain produces fewer endorphins, so-called natural opiates, during pain, which suppress pain and improve mood. This can lead to a more intense experience of pain.
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Endogenous opioid system: This system, which is involved in regulating pain and stress, functions differently in both sexes. This also affects the effectiveness of some painkillers. For example, women need an average of up to 30% higher doses of morphine to achieve the same relief as men. (2)
Does this mean that women handle pain worse or that their experiences are not real? Absolutely not. The female body simply reacts differently. Statistics also confirm that women suffer more often from chronic and intense pain:
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Lower Drug Efficacy
Women not only experience pain more intensely, but often also react less effectively to common painkillers such as ibuprofen, opioids, or steroids. Why is this the case?
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Estrogen affects drug metabolism – It slows down gastric emptying, increases the proportion of body fat, and reduces the amount of specific proteins that bind active substances. All of this changes the rate and effectiveness of drug absorption and breakdown in the body.
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Stronger immune response – Women have a more active immune response, which can lead to a stronger inflammatory reaction and thus more intense pain. As a result, they often need higher doses of medication or longer use to achieve the same effect as men.
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Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin are often less effective in women than in men. Similarly, glucocorticoids, often used to suppress inflammation, tend to have a weaker effect in women. (7)
In other words, a drug may start to work later in a woman, have lower efficacy, or require a higher dose to provide the same relief as in a man.
Side Effects and Risks
Due to differences in metabolism, some drugs are metabolized more slowly in the female body, leading to a higher concentration of the active substance in the blood. This can increase the risk of adverse effects such as nausea, headaches, hallucinations or convulsions. Women often reduce the dosage or discontinue treatment altogether due to these difficulties. (8) Some drugs were even withdrawn from the US market in the past due to high health risks for women.
Another factor is typically lower body weight and different metabolism, which affect the tolerance of some drugs – for example, opioids. For women, this significantly increases the risk of overdose or addiction at lower doses. (9)
Hope for Positive Change
That women experience pain differently is not "over-sensitivity" but a biological fact. Hormones, specific drug metabolism, and the historical neglect of women's health in research contribute to many women not receiving the necessary relief. Whether it's pain during menstruation, migraines, endometriosis, or other chronic issues.
It is essential that healthcare is adapted to the specifics of the female body. However, this requires further research that takes female biology seriously and finally brings women effective and fair treatment.
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What else to read on the Femspace blog?
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Endometriosis: A new perspective on pain, diagnosis, and a holistic approach to care
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Discomfort that companies overlook: Why it's time to address menstrual pain in the workplace
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Sources Used
BALCH, Bridget. Do women and men feel pain differently? AAMCNews [online]. Available at: https://www.aamc.org/news/do-women-and-men-feel-pain-differently
CAMERO, Katie. Painkillers don’t work as well for women. Here’s why. National Geographic [online]. Available at: https://www.nationalgeographic.com/science/article/women-pain-medications
EVANS, Susan. Genders experience pain differently and women have it more. International Association for the Study of Pain [online]. Available at: https://www.iasp-pain.org/publications/relief-news/article/genders-experience-pain-differently/
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Frequently Asked Questions
How long does a normal period last?
A healthy period lasts 3 to 7 days. If you bleed longer or shorter repeatedly, consult a gynecologist.
Why is menstruation painful?
Menstrual cramps are caused by prostaglandins — substances that contract the uterine muscles. Magnesium, heat, exercise, or natural patches can help.
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What affects the regularity of the menstrual cycle?
Stress, diet, exercise, sleep, and hormonal balance — all these affect the length and regularity of the cycle. Tracking your cycle will help you identify patterns and any deviations.
