Joint Pain and Women
Women are not only more likely to suffer from joint pain, they also have a harder time finding the right treatment
By Jan Sheehan
Medically Reviewed by Ed Zimney, MD
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Everyone gets the occasional ache or pain — a little soreness in the shoulder, a twinge in the knee — but research shows that women are more frequently and often more severely affected than men. The CDC estimates that from arthritis or chronic joint symptoms affect more than 70 million Americans, 41 million of whom are women. A number of factors contribute to this disparity: Women are more apt than men to have conditions that cause joint pain, experience hormone fluctuations that affect their vulnerability, and may not be physiologically equipped to deal with pain.
Causes of Joint Pain in Women
Of the nearly 27 million Americans with osteoarthritis (AO), 60 percent are women. Rheumatoid arthritis (RA), an autoimmune disease, strikes approximately three times more women than men. Other autoimmune conditions that cause joint pain, such as lupus, scleroderma, and multiple sclerosis (MS), also hit women harder than men: Women are nine times more likely to develop lupus, three times more likely to have scleroderma, and twice as likely to suffer from MS. And fibromyalgia, a little understood condition that can cause joint pain, affects women eight times more frequently than men.
The Estrogen-Joint Pain Connection
"Women typically feel pain more intensively, more often, and in more parts of the body than men," says Tarvez Tucker, MD, a pain specialist and director of the Pain Clinic at the University of Kentucky Medical Center, in Lexington. Female hormones are believed to play a role in women's high vulnerability to pain. Many women with OA, RA, lupus, and fibromyalgia report an increase in joint pain just before or during their periods. This is likely because estrogen levels plummet right before menstruation and rise again after a woman's period is over. "Estrogen is believed to be protective against pain," says Dr. Tucker. "It peaks during pregnancy, probably to protect women from the pain of childbirth." Some research shows that 80 percent of women with RA experience a remission of symptoms during pregnancy and a flare-up when estrogen dips during the postpartum period. Additionally, reproductive hormones are suspected as factors in the high incidence of autoimmune diseases in women since conditions such as RA and lupus are most common during the childbearing years.
Women's Bodies and Joint Pain
Hormones are only part of the picture, however. Female brains may be wired for pain. It's thought that endorphins, the body's natural painkillers, work more effectively in men than in women. "Studies have found that females release less of the brain chemical dopamine in response to painful stimulation. Without dopamine, endorphins can't function effectively," says Patrick Wood, MD, a pain researcher at Louisiana State University, in Shreveport, and medical advisor to the National Fibromyalgia Association.
Female structural differences may contribute to some kinds of joint pain, too. For example, women are more prone to osteoarthritis of the knee. One possible explanation: "Women tend to be more limber and loose-jointed than men, so there's more movement in that area, increasing the risk that the kneecap will rub on the bones below it," notes Bruce Solitar, MD, a rheumatologist at the NYU Hospital for Joint Diseases, in New York City. This may lead to osteoarthritis symptoms in the knee area.
Joint Pain Medication and Women
Women react differently than men to some medications for relieving joint pain. For example, fluctuating hormone levels can reduce the amount of medicine circulating in the bloodstream, which means that women may need more of the standard dose. Plus, female digestive systems are slower, causing certain medications (like pain relievers) to take more time to pass through the digestive tract where they're absorbed more fully. And because pain sensitivity increases right before a woman's period, more pain-relieving medicine may be required at this time of the month. "Women need to be aware of these factors, ask the right questions, and be persistent about getting an accurate diagnosis and proper treatment," says Dr. Tucker. By becoming educated about how joint pain affects them, women can increase the odds of finding relief and getting the best health care possible.
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