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Menopause symptoms and chronic pain in a national sample of midlife women veterans

Gibson, Carolyn J. PhD, MPH1,2; Li, Yongmei PhD1; Bertenthal, Daniel MPH1; Huang, Alison J. MD, MAS2; Seal, Karen H. MD, MPH1,2

doi: 10.1097/GME.0000000000001312
Original Articles

Objective: Women are more likely than men to suffer chronic pain, with the highest rates seen in midlife. The symptoms that characterize menopause broadly affect health and well-being, but their contribution to chronic pain risk during this period is poorly understood. To address this gap in knowledge, we examined relationships between indicators of menopause symptoms and chronic pain among midlife women veterans, a population with prevalent chronic pain diagnoses and elevated risk for bothersome menopause symptoms.

Methods: This is a cross-sectional analysis of national Veterans Health Administration medical and pharmacy records. Using national medical and pharmacy records from women veterans aged 45 to 64 with at least one VA encounter during 2014 and/or 2015 (n = 200,901), we developed multivariable logistic regression models to examine associations between menopause symptoms (defined by menopause symptom-related diagnoses on ≥2 encounters and/or menopause hormone therapy use) and chronic pain outcomes, adjusting for age, race, body mass index, mental health diagnoses, and substance use disorders.

Results: In this national sample of midlife women veterans (mean age 54.3 ± 5.4), 13% had menopause symptoms, 52% had chronic pain, and 22% had ≥2 distinct chronic pain diagnoses. In multivariable analyses, women with menopause symptoms had nearly two-fold odds of chronic pain (odds ratio 1.84, 95% confidence interval 1.79-1.90, P < 0.001) and multiple chronic pain diagnoses (odds ratio 1.79, 95% confidence interval 1.74-1.83, P < 0.001).

Conclusions: These findings raise the possibility within this vulnerable critical period, midlife women with a higher menopause symptom burden may be most vulnerable for chronic pain.

1San Francisco VA Health Care System, San Francisco, CA

2University of California, San Francisco, CA.

Address correspondence to: Carolyn J. Gibson, PhD, MPH, San Francisco VA Medical Center, 116P, 4150 Clement St, San Francisco, CA 94121. E-mail:

Received 7 November, 2018

Revised 2 January, 2019

Accepted 2 January, 2019

Funding/support: This research was supported, in part, by the VA Advanced Fellowship Program in Women's Health at the San Francisco VA Health Care System (C.J.G.), VA Health Services Research and Delivery Career Development Award #5 IK2 HX002402-02 (C.J.G.), and the VA HSR&D QUERI (Evaluation of the Implementation of the Integrated Pain Team Clinic; K.H.S., Y.L.). This manuscript is the result of work supported with resources and the use of facilities at the San Francisco VA Health Care System and the University of California, San Francisco.

Financial disclosure/conflicts of interest: Dr Huang has received research grants from Pfizer Inc. and Astellas through the University of California San Francisco to conduct research unrelated to this manuscript. The authors have no other conflicts of interest to declare.

Preliminary findings from this research were presented at The North American Menopause Society 2017 Annual Meeting (Philadelphia, PA, October 11-14, 2017) and the Society of General Internal Medicine 2018 Annual Meeting (Denver, CO, April 11-14, 2018).

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© 2019 by The North American Menopause Society.