Unlocking Better Outcomes for Women with Chronic Pain
A WRH Research Group operates within our department's Global Health theme and is run by Prof Katy Vincent.
Pain in women research group
Why this project is important?
Our work aims to optimise pain relief and quality of life for women with chronic pain by improving our understanding of the mechanisms generating pain in women and the interaction between hormones and pain.
What we do
Women suffer with almost all chronic pain conditions to a much greater extent than men. Additionally, they also suffer from female-specific pains; particularly in their pelvis, including period pain (dysmenorrhoea) and the pains associated with diseases such as endometriosis. Unfortunately, it is frequently difficult to treat chronic pain and attempts at finding new drugs have not usually been successful.
Our work focuses on two aspects of pain specific to women. Firstly, we are interested in better understanding the mechanisms generating and maintaining pain in gynaecological pain conditions such as dysmenorrhoea and endometriosis. Secondly, we are investigating the relationship between steroid hormones and pain. In the long-term we hope to be able to optimise both analgesia and quality of life for women with chronic pain whatever its original cause.
Epidemiology of chronic pelvic pain
Our past work has shown that chronic pelvic pain (constant or intermittent lower abdominal pain unrelated to periods or intercourse, lasting for six months or more) is common, with up to 24% of women in the UK reporting having experienced such pain. The extent to which women's lives were affected varied widely, and our studies of general practice records showed that approximately 4% consult a GP for their symptoms annually.
Most women with chronic pelvic pain also reported pain with periods and intercourse, and many had additional bowel or bladder related symptoms, complicating differential diagnosis and leading to multiple 'diagnoses' over time, including irritable bowel syndrome, cystitis, endometriosis, chronic pelvic inflammatory disease, and 'stress'.
Associations of dysmenorrhoea
Period pain (dysmenorrhoea) is common. Our work combined brain imaging (functional magnetic resonance imaging, fMRI) with hormone levels and psychological measures to investigate the long-term consequences of experiencing pain for one or more days every month.
Despite the women we studied having no pain outside of their periods, they showed many of the long-term changes typically seen in chronic pain conditions. Although they were psychologically healthy (with normal levels of anxiety and depression) they were more sensitive to experimental pain, showed altered brain processing of painful stimuli, and had reduced blood levels of cortisol, a stress hormone.
Combined with other recent studies demonstrating altered brain structure in women with dysmenorrhoea, our findings contributed to the reclassification of dysmenorrhoea as a chronic pain condition in the most recent IASP taxonomy of pain.
The influence of sex hormones on acute pain in healthy women
Even non-gynaecological pain conditions frequently show variation in symptom severity with the menstrual cycle. We have combined fMRI with measures of blood hormone levels to investigate the relationship between specific hormones and the response to painful stimuli and to try to understand the mechanisms underlying these findings.
Our results suggest that steroid hormones interact with known internal pain-modulating mechanisms. For example, when estrogen levels are low it appears that testosterone is important in reducing pain, whilst when estrogen levels are high progesterone reduces the unpleasantness of a pain experience. We are now investigating whether these relationships are the same for women with chronic pain conditions.
The Advanced Pain Discovery Platform (APDP)
The Advanced Pain Discovery Platform (APDP) is a UK-based network of scientists, clinicians and patients who are coming together to try and deliver new breakthroughs in understanding human pain.
Chronic pain is one of the greatest unmet needs in healthcare. It is the leading global cause of disability and carries an enormous socioeconomic cost in the UK and worldwide. But progress in delivering new treatments has been difficult and slow.
Prof Katy Vincent is leading a project focusing on pain in women. Her research aims to understand whether period pain during adolescence increases the risk of developing chronic pain as a young woman, and to identify the mechanisms that underlie this risk from childhood through to adulthood.
In collaboration with Prof. Krina Zondervan, Mina Fazel, Kate Stein, Sharon Dixon, MaryAnn Noonan and colleagues from Endometriosis UK and Bristol University, she will be combining both laboratory and clinical epidemiological data in a wide variety of contexts. Read more
We are really excited for the opportunity this funding gives us to better understand period pain in teenagers. Severe period pain is incredibly common yet is frequently dismissed as a normal part of being a woman. We hope to be able to better understand who is at risk of developing severe period pain soon after their periods start and determine whether experiencing period pain as a teenager increases the risk of other chronic pain conditions in adulthood. Ultimately we hope to use this information to reduce pain and improve quality of life for both teenagers and adult women - Professor Katy Vincent
Laparoscopy for Pelvic Pain
Understanding the experiences & perspectives of women and healthcare professionals (LaPPCare1)
The purpose of this study is to find out more about the experience of having normal findings following keyhole surgery to investigate symptoms of pelvic pain and understand what support and information it would be helpful to have around the time of surgery. We will use this information to help plan changes to improve experiences of healthcare.
For more information about how you can get involved, please read the following participant information sheets:
Useful links
EndoCaRe
The Oxford Endometriosis CaRe Centre is an internationally acclaimed centre of expertise in clinical care and research into Endometriosis. It is part of the Nuffield Department of Women's and Reproductive Health at the University of Oxford.
PrePOSE Study
Predicting the Pain Outcome of Surgery for Endometriosis
This study aims to identify who is most likely to benefit from endometriosis surgery through a reduction in pelvic pain. Building on previous research, we will explore whether pre-surgical brain scans (MRI), alongside questionnaires and other clinical measures, can predict surgical outcomes - potentially offering a more accessible way to help patients make informed decisions about surgery.
Reproductive Medicine & Genetics
Our Reproductive Medicine & Genetics research covers the following research groups: Assisted Reproductive Technology (ART); EndoCaRe; Fertility Preservation; Miscarriage; Oocytes and Ovaries; Pain in Women; Rhino Fertility Project and Sperm.
Latest publications
Symptom flares in endometriosis: burden, self-management and barriers to care in a cross-sectional survey
Journal article
Coxon L. et al, (2026), BJOG: An International Journal of Obstetrics and Gynaecology
Serum Neurofilament Light Chain in Fibromyalgia: Comparative Evidence of Neuronal Injury Across Chronic Pain Conditions.
Journal article
Fundaun J. et al, (2026), PAIN Reports
The value of a non-invasive bladder sensitivity paradigm in chronic pelvic pain.
Journal article
Coxon L. et al, (2026), Reprod Fertil
Role of Gynecologic Findings in Interstitial Cystitis/Bladder Pain Syndrome: A Consensus.
Journal article
Sullivan ME. et al, (2026), Neurourol Urodyn, 45, 39 - 45
Women with chronic pelvic pain can be stratified using multimodal assessment
Journal article
Demetriou L. et al, (2025), Pain
The research team
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Katy Vincent
Professor of Gynaecological Pain and Honorary Consultant Gynaecologist
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Krina Zondervan
Head of Department, Professor of Reproductive & Genomic Epidemiology, Co-Director Endometriosis CaRe Centre.
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Lydia Coxon
Senior Postdoctoral Research Assistant in Pain Data Collection and Analysis
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Chloe Curtis
DPhil Student
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Lysia Demetriou
Postdoctoral Research Assistant in Neuroimaging and Pain Data Analysis
How can you help?
You can support the ongoing work of the Pain in Women project through donations, collaborations and research support. If you wish to support our work, please contact us.