Credibility, Gender Bias and the Recognition of Pain During the Menopausal Transition: A Scoping Review

Pain during the menopausal transition can be normalized, minimized or attributed prematurely, including to stress or psychological distress, raising questions of patient credibility and possible sex- and gender-related bias in clinical interpretation. This scoping review mapped pain recognition, attribution, assessment and care during the transition, interpreting the evidence primarily through a lens of patient credibility and gender bias, with mental-health-informed and interdisciplinary implications considered alongside. The protocol was deposited on the Open Science Framework. Following JBI guidance and PRISMA-ScR, two human reviewers independently screened records from eight databases searched from inception to 30 June 2026; final decisions were concordant. Data were charted and analysed using hybrid deductive–inductive descriptive qualitative content analysis. Of 8938 records, 4856 were screened, 43 reports assessed and 21 sources of evidence included, representing 23 studies. Most evidence was qualitative (n = 15), and pain was usually secondary or incidental. Musculoskeletal pain (n = 12), headache or migraine (n = 9), and sexual or genitourinary pain (n = 5) predominated. Six categories addressed recognition and attribution, normalization and legitimacy, clinical response, delay and misframing, inequality, and transferable implications for mental-health-informed interdisciplinary care. The evidence identifies the risks of both diagnostic omission and premature attribution but cannot show that all pain is menopause-related, quantify diagnostic bias or delay, or establish epistemic injustice as a mechanism. Assessment should include psychological wellbeing without allowing distress, a mental-health label, or an assumption about reduced credibility to substitute for physical differential diagnosis, referral and follow-up. No included study primarily examined mental-health services or tested a mental-health-specific intervention.