Seen but not heard: how the Gender Pain Gap affects women with arthritis

Musculoskeletal (MSK) conditions affect more women than men, yet research shows that women are more likely to say that their pain is dismissed or ignored. This International Women’s Day, we are shining a light on the Gender Pain Gap to raise awareness of the issue and help our community to get the support they need.

What is the Gender Pain Gap?

Our State of Musculoskeletal Health 2024 report has shown that women are more likely to experience chronic pain, with 38% of women having chronic pain compared to 30% of men. We also know that 14% of women have high-impact chronic pain compared to 9% of men. Yet despite this, women often find that they are not listened to when talking about their pain.

When Anoushka went to see her doctor seeking answers for her pain she found that her experiences were dismissed leading to a delayed arthritis diagnosis which impacted her treatment.

"No one around me knew what was going on. It took me limping up to my GP practice, repeatedly advocating for myself and eventually saying 'please, I'm not leaving until you run a blood test because I know something isn't right.' The blood test showed that my inflammatory markers were all through the roof.”

Unfortunately, Anoushka is not alone. Research by pharmaceutical brand Nurofen in their Gender Pain Gap Index Report found that 81% of women aged between 18 and 24 said their pain had been dismissed or ignored compared with 73% of similarly aged men.

Out of those who felt their pain was ignored or dismissed, nearly 1 in 4 women said no one took their pain seriously, compared to 1 in 6 men.

This is the ‘Gender Pain Gap’.

How research is shining a light on the Gender Pain Gap in arthritis

A recent study which looked at associations of gender roles and pain in MSK conditions found that many women felt invalidated by healthcare professionals. They also found that gender roles can influence the pain experience of people with MSK conditions.

The researchers behind this study highlighted the need for more research in this area to support the development of more person-centred approaches to pain management.

Another recent study has helped demonstrate how gender can influence the perceptions of health care professionals listening to people talk about their pain.

When researchers showed healthcare professionals videos of people talking about their pain, they found that women were estimated to have less pain and thought to be more likely to exaggerate it.

These perceptions altered the treatment recommendations from healthcare professionals. It meant they were more likely to suggest pain medication to men and psychological treatment for women.

Why does the Gender Pain Gap exist?

While there are biological differences underpinning pain between women and men, the Gender Pain Gap is influenced by societal, environmental, and internal biases that lead to women receiving unequal treatment of pain within the healthcare system.

On top of this, health inequalities are deepened by factors such as ethnicity, socioeconomic background, disability, and other social determinants, further widening the Gender Pain Gap.

“Musculoskeletal pain is the most common form of pain in the UK, for both women and men," says Professor Lucy Donaldson, Director of Research and Health Intelligence at Versus Arthritis. "Women are much more likely to experience more severe musculoskeletal pain, and they are more likely to seek help and treatment. However, research shows women’s voices are too often unheard, diminished and dismissed - because they are female.

“At Versus Arthritis we often hear stories from women struggling to have their pain taken seriously and not being listened to or believed when it comes to their treatment or care, a situation backed by a growing volume of research evidence. 

"For many women, this slows the time for them to get the right diagnosis, and the help and treatment they need, leading to wasted years, and worse outcomes."

Confidently bridging the Gender Pain Gap: Tips for advocating for yourself in healthcare 

Advocating for yourself means to speak up for what you need through expressing how you feel, and ensuring that your concerns are heard and taken seriously.

We know that it can be difficult to advocate for yourself when it comes to getting the right care and support your pain, especially if you feel like your pain isn’t being taken seriously because of your gender.

Here are some helpful tips on helping you bridge the Gender Pain Gap with confidence, when advocating for yourself in the health system.

1. Keep a Pain Diary

Recording your symptoms every day can be a useful tool to help manage pain if you have arthritis. It can also be a useful record to share with your healthcare team as it can give health professionals a fuller picture of your condition, with the evidence to back it up, so they can decide what treatment is right for you. 

You could use it to keep a log of your symptoms and anything that might have affected them, such as activities or treatments.

You could log things with the times and dates like:

• Your pain levels (1-10)
• Which part of your body hurts and what did it feel like – hot or cold? Or, dull, aching, or sharp?
• Did it exhaust you?
• Did your joints feel stiff or swollen?
• What activities did you do, did you get enough sleep, what medications did you use?

2. Tools to describe your pain

Sometimes it can be difficult to describe how your pain feels, both in your pain diary and to the doctor. Here are some terms that you might find useful when describing your arthritis pain:

You could also describe how your pain affects your life on a day-to-day basis. This can help put your pain into context. For people who live with arthritis this might change on a daily basis or throughout the day, depending on fatigue, flare-up, or activity levels.

Here are some sentence starters to help you navigate this:

• “On days when I have a flare-up, I can’t manage my normal routine, everything is affected.”
• “My pain is constant, and I’m unable to manage my usual routine—everything is impacted.”
• “Mostly, I can carry on as normal, but I have noticed some changes”
• “My pain is getting worse, and I’m struggling more than usual and need support from others to manage.”
• My pain can vary throughout the day/week, sometimes I can carry on as normal but other times it causes a lot of disruption to my life, sleep, work and family.”

3. Ask for more detail and clarification

When speaking with your GP, physio, rheumatologist, or any healthcare professional managing your care, remember that your pain is valid, and you are entitled to receive the care you deserve.

Trust in the validity of your experience and have the confidence to speak up if you feel your concerns are being ignored or dismissed.

You can do this in a few ways but here are a couple of helpful ways to advocate for yourself when speaking to a health professional.

Pause the conversation and ask for more detail

If you feel like you're not being heard, you can pause the conversation by saying, "Can we pause here and discuss this in more detail together?"

Additionally, it's easy to forget what you've discussed, so take a pen and paper and make a note of any important points.

Ask for some clarification

Ask your healthcare professional to explain how they reached their diagnosis and to provide details about the treatment plan they recommend. You could say, "Could you please explain in another way how you arrived at this diagnosis and/or treatment plan?"

Take information with you

If you've already been diagnosed, you could access the health information that Versus Arthritis produce on your condition.

Print or download the 'Treatment' section before speaking to your health professional and you'll be more confident discussing the options that are available to you.

4. Family and friends

Another useful tip is to consider bringing a close friend or family member to your appointment. They can offer support; help ensure your concerns are heard and provide an additional perspective if you feel your pain or symptoms are being dismissed. Having someone with you can also help validate your experience and provide an extra voice to make sure your concerns are taken seriously.

5. Ask for another opinion

If you feel that your healthcare professional doesn't fully understand your situation, you're entitled to ask for a second opinion.

You could say, "I'd like another opinion; could you refer me to someone else?"

If you’ve been speaking with your GP and feel they may not fully grasp your condition, you might want to consider contacting your rheumatology team, as they may have a deeper understanding of your condition.

Alternatively, if you feel like you aren't being heard by a rheumatologist and you feel your GP knows you better, you could ask to consult with them or another trusted healthcare professional who may be able to offer more insight.

We’re here whenever you need us

Remember you don't have to face your pain alone. If you want help, support or information, get in touch.  You can:

• Call our  Helpline on 0800 5200 520 (Monday to Friday, 9am to 6pm)
• Talk to our arthritis virtual assistant, 24/7
• Take a look at what's on in your area
• Take a look at our Tracker App
• Join our online community
• Follow us on  X, Facebook and Instagram

References

1. Statistics around Musculoskeletal disorders in women were taken from The State of Musculoskeletal Health 2024. Versus Arthritis. July 2024. https://www.versusarthritis.org/media/tffdkiax/va_state-of-msk-report-nov2024-1.pdf 
2. Statistics around the Gender Pain Gap were taken from Gender Pain Gap Index Report 2024. Nurofen. October 2024 https://www.nurofen.co.uk/static/nurofen-gender-pain-gap-index-report-2024-8eede5529e884b5e496a1c02beea4210.pdf 
3. Research into gender roles and musculoskeletal pain was taken from Pedulla, R., Glugosh, J., Jeyaseelan, N., Prevost, B., Velez, E., Winnitoy, B., Churchill, L., Raghava Neelapala, Y. v., & Carlesso, L. C. (2024). Associations of Gender Role and Pain in Musculoskeletal Disorders: A Mixed-Methods Systematic Review. The Journal of Pain, 25(12), 104644. https://doi.org/10.1016/J.JPAIN.2024.104644
4. Research into gender and influences into healthcare management was taken from Schäfer, G., Prkachin, K. M., Kaseweter, K. A., & Williams, A. C. (2016). Health care providers' judgments in chronic pain: the influence of gender and trustworthiness. Pain, 157(8), 1618–1625. https://doi.org/10.1097/j.pain.0000000000000536
5. Understanding why the Gender Pain Gap exists was taken from Hoffmann, Diane E. and Tarzian, Anita J., “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” (2001). Faculty Scholarship. 145. https://digitalscommons.law.umaryland.edu/fac_pubs/145