Why Women in Pain Are Still Begging Doctors to Listen

Abigail Libers, 39, experienced her first string of daily headaches when she was just 12 years old. As her pain intensified, her mom booked appointments with a doctor, a chiropractor, and an acupuncturist. "We talked to so many people trying to figure out what was wrong with me," Libers recalls. "None of them said the word migraine."

Libers, a freelance journalist, vividly remembers one of her first consultations with an older male doctor. "I told him I had a headache every day. He was like, 'Every day? That's not possible.' I felt like he thought I wasn't telling the truth." Frustrated by the lack of answers, she started acting like the headaches weren't happening, a tactic she relied on throughout high school, college, and her early 20s. "I was in denial for a long time," she says. "I pushed through a tremendous amount of pain, and no one knew."

Libers is among the nearly 25 percent of women in the US who live with chronic pain. Today, she no longer hides her migraine attacks, which she likens to a knife being screwed into her head. After seeing a slew of specialists over many years, she now has an arsenal of tools to treat her chronic migraine, an often debilitating neurological condition, but still deals with pain daily. "It's just a question of how bad it is," she says.

Pain is tough to diagnose and treat because no two people experience it the same way. "It's not like your blood pressure or your heart rate. There is no objective way to measure pain," explains Kimberly Templeton, MD, professor of orthopedic surgery at the University of Kansas Medical Center and past president of the American Medical Women's Association.

Yet women carry a heavy and unique burden. Women's pain is frequently misdiagnosed, brushed off, or straight-up ignored by healthcare providers. Studies show women are more likely to experience chronic pain conditions like fibromyalgia and migraine — and perceive pain more intensely — than men. There's a host of excruciating health conditions that only affect the reproductive systems of people assigned female at birth, like endometriosis and uterine fibroids, which are easily missed or undertreated. We also know that women are twice as likely to be diagnosed with depression and anxiety — feelings that are often seen as emotional overreactions versus chronic conditions that can increase pain sensitivity.

And that's all just the tip of the (very sharp) iceberg. Here's why our healthcare system continues to fail women in pain, how experts are trying to shrink the pain gap, and how to advocate for yourself if you're not getting the help you need.

Experts Featured in This Article:

Kimberly Templeton, MD, is a professor of orthopedic surgery at the University of Kansas Medical Center and the past president of the American Medical Women's Association.

Akiko Okifuji, PhD, is a licensed clinical psychologist specializing in pain management and a member of the treatment team at the University of Utah Pain Management Center.

Janiece L. Taylor, PhD, is an assistant professor at the Johns Hopkins School of Nursing who researches pain disparities in older women of color and people aging with disabilities.

Fadel Zeidan, PhD, is a professor in the Department of Anesthesiology in the Center of Pain Medicine and the director of the Pain Health and Mindfulness Laboratory at UC San Diego.

A Healthcare System Built on Biases

Pain isn't just a literal zap! to your body tissues. It's a biopsychosocial phenomenon, says Akiko Okifuji, PhD, pain researcher, licensed clinical psychologist specializing in pain management, and member of the treatment team at the University of Utah Pain Management Center. It's influenced by biological traits, like your family's health history or past injuries; your psychological state, or emotional and mental well-being; and social factors including things like cultural norms and whether or not you have affordable health insurance. All of these things can be pieces in your pain puzzle.

And this is where the pain gap starts to widen: Many women have been conditioned to feel like they're pestering their doctor with too many questions or overstating how much they're hurting. Women are told it's "normal" to live with pain because they experience it monthly. From a young age, girls are socialized to be nice, nurturing, and selfless. "We're expected to take care of everyone else before we take care of ourselves," Dr. Templeton says. Women may try to tamp down their bodies' warning signals — even if they're flashing red — leading to devastating delays in care.

Eva Woolridge, a 31-year-old photographer, will never forget rushing to urgent care in 2018 after about three weeks of on-and-off abdominal pain. She initially tried to brush it off, not wanting to "dramatize" her symptoms, but the "internal stabbing" got so bad, so suddenly that she toppled over and started projectile vomiting. Her white female doctor cracked jokes during the appointment and brushed it off as food poisoning.

Stunned by the interaction, Woolridge headed to the ER, where she waited 40 minutes to be seen, despite her severe pain. "I felt so helpless," says Woolridge, who channeled her experience into an award-winning photography project. "I was in such disbelief at how the system was failing me. They weren't listening to me." Meanwhile, a grapefruit-sized dermoid cyst was blocking the blood supply to one of her ovaries.

Black Women Face Even Harsher Realities

As a Black woman, Woolridge remembers thinking, "It's happening to me. I'm a statistic." Unfortunately, her experience is in fact all too common and distressing, especially for women of color. Pain doesn't discriminate, but unfortunately, people do, points out Janiece L. Taylor, PhD, an assistant professor at the Johns Hopkins School of Nursing who researches pain disparities in older women of color and people aging with disabilities. "Expectations and beliefs surrounding Black women can really influence how their pain is assessed and treated," she says.

The US healthcare system has a sordid history of medical racism and blatantly false beliefs about Black people's bodies persist. A 2016 study found that a whopping 40 percent of first- and second-year medical students believed Black people have "thicker skin" than white people; trainees who believed Black people were less sensitive to pain were also less likely to prescribe effective treatments. Research has also shown that Black patients who land in the ER are 40 percent less likely to receive pain relievers than white patients.

When Woolridge's doctors told her they needed to remove her affected ovary, her dad sprung into action, asking question after question to ensure the procedure was necessary. Historically, when women (especially women of color) complained of reproductive issues like pelvic pain, doctors often performed major procedures, such as removing entire organs, Dr. Okifuji notes. In Woolridge's case, the procedure was warranted, but she was grateful to have a parent with knowledge of racial bias in the healthcare system as her advocate.

Race is one of the most glaring social determinants of health in the pain gap conversation, but scientists are digging into other factors too. Your level of education, how much money you make, access to health care and nutritious food, and the safety of your immediate environment can also tip the pain scales.

The Pain Gap Is Rooted in a Data Gap

Every expert PS spoke with agreed that the gold standard for pain treatment is personalized care that adopts a multidisciplinary approach. For example, a woman with rheumatoid arthritis would ideally see a rheumatologist, a physical therapist, an orthopedic surgeon, and a mental health professional. "In our own disciplines, we have biases based on our focus and how we were trained as clinicians," Dr. Taylor explains. "That's why working with other disciplines is so important. We can check each other to develop the best plan with the patient."

But there are "fundamental questions" to answer and "significant knowledge gaps" to fill before we reach that level of personalized care for women, per a recent congressionally mandated report. Experts lack clear and consistent guidelines that would allow them to effectively diagnose, treat, and prevent many women's health issues, especially reproductive health conditions. Yet only about 9 percent of the National Institutes of Health's (NIH) grant spending focused on women's health research between 2013 and 2023. Critical departments like the Office of Research on Women's Health remain underfunded.

"Most studies that look at ways to try to improve pain do not consistently disaggregate data based on either sex or gender," Dr. Templeton explains. (Remember: Sex is based on biological characteristics and gender is a social construct.) "Unless we actually look at the patients who are involved in those studies, to see what the differences are between how women respond and how men respond, we're not going to make a lot of progress." Layering in social determinants of health is extremely important, she adds, but it will take a massive education effort to power studies that are large enough to look at all of the significant variables and how those influence pain.

One example of why a sex-specific approach just might be a game-changer: A study published in October suggests that opioids—some of our most powerful pain medications—can be less effective for women because of how women's bodies process pain. Researchers found that while men clearly rely on the body's natural opiate system (certain neurotransmitters that bind to receptors in the nervous system) to reduce pain, women seem to rely on a different body system for similar relief. It's one that scientists have yet to pinpoint, says study author Fadel Zeidan, PhD, professor in the Department of Anesthesiology in the Center of Pain Medicine and director of the Pain Health and Mindfulness Laboratory at UC San Diego. "Once we discover that, then we could use therapies that we know target said system, and possibly optimize pain relief in a sex-dependent fashion."

But we're not quite there yet: "The biggest hurdle right now is funding," he adds. "It's expensive to do this work. It really takes a village to make it happen." (Including a woman's voice. Dr. Zeidan notes that this study, which he calls one of the biggest discoveries in his lab, was kicked off, in part, because an undergraduate female student—Mikaila Reyes, an author on the paper—wanted to look for potential sex differences in this natural opiate system.)

While women have been included in clinical trials in recent years, the science is slow-going, Dr. Okifuji notes. After all, researchers are building on a decades-long foundation of studies largely conducted in men or mice. It's promising that certain biological factors could help illuminate why women uniquely experience pain—from hormonal fluctuations to neurological differences—but scientists aren't always looking for or analyzing these disparities in the data, even when they do include women in their research. "If you don't look, you don't find," Dr. Templeton says. "You can't have personalized medicine until you have the data to show what those differences are."

Advocacy Can Fuel Hope — And Change

Where do we go from here? Dr. Templeton says pain researchers are focusing on building awareness around sex and gender differences at the source, baking it into the curricula taught to medical students. They're also working with academic institutions and medical journal leadership who influence proposals and guidelines for publishing studies.

For example, the NIH funded a 2023 symposium where editors and leaders from top orthopedic journals came together to discuss how to "fix" the lack of sex-specific data in medical research. "We published an editorial as a call to action for journals to find a way, from a publishing perspective, to address this," Dr. Templeton says. The hope? "If journals take a stand on this, which several of them have, and set the bar that they will be looking for [sex-specific data] then the researchers will follow suit, ideally designing their studies to include the validity of the data for both women and men."

There's also a renewed spotlight on federal funding: The above report calls on Congress to catalyze serious change, with a recommendation to pump $15 billion into women's health research over the next five years. This would nearly double the average NIH annual investment. However, it's unclear how things will shake out as the Trump administration, which has temporarily frozen federal health communications and funding that impacts healthcare research, steps in.

Dr. Templeton notes that while people with certain conditions will never be 100 percent pain-free, doctors should still do everything possible to improve the quality of life for these patients. Unfortunately, that often means that women in pain are left to fight for the care they need and deserve.

Until We See Sweeping Change, Don't Hesitate to Speak Up

Remember, you know your body best. If something feels seriously off with your health but you're being brushed off by a doctor, keep these tips in mind:

Push for a second (or third) opinion.

For Libers, finding the right neurologist—someone she felt genuinely safe with—made all the difference. "If you're uncomfortable with your doctor, you're not going to say what you need to say in your appointments—and that's a waste of your time and their time," she says.

That said, a lot of people (understandably) have a hard time navigating our complex healthcare system. If you're feeling overwhelmed, ask your current provider for a social worker to help you, says Dr. Taylor, who adds that you don't have to explain why. A social worker can help you parse through insurance requirements, connect you to financial aid and educational resources, and generally help advocate for your needs.

Interview your doctor.

Ask them about how they work, what they think your treatment plan should be, and whether or not they have personal experience with your condition. Pay attention to how they make you feel, Libers suggests. Are they rushing? Do they ask thoughtful questions about your symptoms? If you leave your appointment feeling disheartened, don't ignore the gut instinct to keep looking.

Connect with others.

At the height of the pandemic, Libers joined a support group for people with migraine, where members simply validate each other's pain, exchange treatment tips, and just vent with "people who get it." She says the experience has been crucial in her journey to finding relief.

Lean on someone you trust.

"Never downscale the pain you're feeling," Woolridge says. If possible, bring a trusted friend, family member, or partner with you. "You might be so overwhelmed by the actual pain that you need someone who can process the information doctors are telling you, challenge why certain actions are necessary, and be a witness to what they're saying," she explains.

Be an active participant in your care.

Tell your doctor when something doesn't work, Dr. Taylor says. For example, if they refer you to a physical therapist who's located somewhere you can't easily get to, that's a barrier worth bringing up. Or, if you tried a prescription medication and experienced a ton of side effects, be sure to mention that during your next appointment.

"Sometimes it feels like we're meant to be passive in the healthcare system," Dr. Taylor says. "But as patients, we definitely have a right to ask about the plan of care. Being a shared decision partner in that is so important."

Alisa Hrustic is a health, science, and lifestyle writer and editor with eight years of experience in digital media and service journalism. She's passionate about creating trustworthy wellness content that's rooted in science, inclusivity, and empathy. Most recently, she was the executive editor and health director at Self. She was previously the deputy editor at Prevention.com. Her work has also appeared in Men's Health and Women's Health.