Pain has always been one of the main complaints in medicine throughout history however it is only until recently that it has been acknowledged that women and men experience pain differently and respond to treatments and medicines differently.
Up until 1993 women and people assigned female at birth were excluded from all clinical and research because it was considered that women’s menstrual cycles could skew results plus of course be harmful to potential pregnancies. Consequently the majority of treatments, drugs, their effectiveness and potential side-effects are only relevant t half the population.
It is now understood that girls, women and people assigned female at birth metabolise drugs differently to boys, men and people assigned male at birth predominantly due to the sex hormones oestrogen. Oestrogen slows stomach emptying, increases body:fat ratio and reduces special proteins in the blood required to distribute and breakdown medications in the body. This means the drugs may not as effective in women and can build up at lower doses causing toxicity and more side effects.
In addition female immune systems are more active than male immune systems therefore women require comparatively higher doses of anti-inflammatory drugs to get the pain relief effect as men. Furthermore recent studies have shown that women potentially have less opioid receptors compared to men therefore opiate drugs like codeine are not as effective in women.
In 2020 a clinical trial found major significant differences between male and female in how their bodies broke down 86 different drugs including morphine and prednisolone. Women metabolised virtually all of them slower than men which led to higher concentrations left in their blood and more bad side effects including nausea, headaches, seizures and hallucinations.
Some drugs have now been withdrawn for treating women due to the toxicity and side effects.
Understanding that female hormones play a dramatic role in how treatments work and how women perceive pain means that a lot more research in this area is now happening.