Pain changes at puberty: what neuroscience says (and why it isn't 'being dramatic')

During puberty clinical pain genuinely increases: abdominal pain rises to nearly 30% in girls versus 16% in boys, and period pain affects 71.1% of young women — 20.1% miss school because of it. It isn't fragility or theatre: it's a developmental stage documented by neuroscience. What happens at 13-14, how to tell pain worth watching from pain that needs a doctor, and why it matters for coaches and parents.

During puberty a girl's clinical pain genuinely increases, and neuroscience has measured it. "Her stomach hurts", "she always has a headache", "she says she can't manage today": in youth sport these lines are often filed under low grit or a bit of drama. Research tells a different story: pain in this phase genuinely changes — not in the mind of the person feeling it, but in the mechanisms that generate it. And it changes precisely in the 13-14 age range, when a girl is most often asked to "grit her teeth".

In short

  • At puberty, experimental pain (to controlled stimuli) tends to decrease, but clinical pain — headaches, abdominal pain, dysmenorrhoea — increases.
  • The differences between girls and boys in pain emerge in adolescence, not before: at 9-11 there are none; later, girls show lower thresholds.
  • Abdominal pain after puberty rises to nearly 30% in girls versus 16% in boys; migraine increases more in girls.
  • Early menarche is associated with more headaches, abdominal pain and back pain in adolescence and adulthood.
  • Dysmenorrhoea affects 71.1% of young women under 25; 20.1% miss school because of it (Armour et al., 2019).
  • Practical upshot: pain should be treated as information, not as an excuse — nor, at the opposite extreme, dramatised.

If pain tolerance improves, why does a girl get more stomach aches?

Because these are two different kinds of pain, and at puberty they move in opposite directions: pain measured in the lab decreases, while the real pain of everyday life increases. A review published in Trends in Neurosciences — a high-impact neuroscience journal — lined up the literature on how pain shifts during adolescence (Nahman-Averbuch et al., 2023). The picture that emerges is counterintuitive, because it separates two things we often conflate.

Experimental pain — the kind measured in a lab with controlled stimuli, like cold or pressure — tends to decrease with pubertal maturation, in both sexes. In other words, faced with a standard stimulus, an adolescent's body becomes on average more tolerant.

Clinical pain — the real, spontaneous kind: headaches, abdominal pain, period pain — does the opposite: it increases. This is the form of pain that matters in everyday life, and it's exactly the one that grows during puberty. Confusing the two leads to the classic error: "if she can get through a hard race, then the stomach ache is an excuse". They're two different systems.

Do girls feel more pain than boys?

In adolescence, on average yes — but it is not a trait they had as children: it forms now. There's a widespread idea that girls "have always been more sensitive" to pain. The data say something more precise: that difference isn't there in childhood — it forms in adolescence.

It's not a character trait or a marker of "fragility": it's a developmental change that switches on in a precise window — the same one in which a girl starts doing more serious sport, with higher loads and more pressure.

Does early menarche leave a mark on pain?

In population data, yes: those whose first period comes earlier report more headaches, abdominal pain and back pain, both in adolescence and as adults. There's another thread the review highlights, and one that gets talked about very little: the timing of menarche. Several very large population studies — including the Norwegian HUNT and HBSC data on nearly 300,000 girls — find that early menarche is associated with a higher prevalence of headaches, abdominal pain and back pain, both in adolescence and in adulthood.

In parallel, the pain syndromes specific to the female body — dysmenorrhoea, endometriosis — appear right around menarche, and can increase the risk of other chronic pain syndromes later. Translated: early period pain is not an isolated episode to be minimised, but a signal worth observing over time.

How common is period pain, and what does it actually cost?

It affects roughly seven young women in ten, and the cost is measured in hours taken away. A meta-analysis of 38 studies covering 21,573 young women under 25 estimated a dysmenorrhoea prevalence of 71.1% (95% CI 66.6-75.2), essentially identical in high- and low-income countries; among school-age students it is 72.5% (Armour et al., 2019).

What makes the phenomenon impossible to file under "discomfort", though, is the measured impact: 20.1% report missing school or university because of period pain (95% CI 14.9-26.7), and 40.9% say classroom concentration and performance suffer (95% CI 28.3-54.9).

A note on the population, because it matters: the sample includes young women up to 25, not only adolescents, and the data concern school, not training. No study here measures how many sessions athletes miss because of dysmenorrhoea. But if pain removes a fifth of school attendance, it is reasonable to expect it removes training too — and that is exactly what is observed in physical activity, where 25% to 61% of adolescent girls reduce or avoid activity during menstruation.

If psychological factors are involved, does that mean it is "in her head"?

No: it means the opposite — that the pain is real and has several causes at once, not that it is imagined. The review proposes a biopsychosocial model: no single switch, but several factors intertwining.

The point is delicate and worth stating honestly: saying there are also psychosocial factors does not mean "it's all in her head". It means the opposite — that adolescent pain is real and multifactorial, and dismissing it as a whim ignores a biology that is genuinely changing.

What changes for coaches and parents

One necessary caveat: this is neuroscience and paediatrics literature, not sport science. It concerns adolescents in general, not athletes specifically, and should be taken as basic scientific context — not as data on performance or training. With that limit clear, three takeaways hold:

The same applies to musculoskeletal pain that lasts: a knee that has hurt for months in an adolescent girl is not growing pains that resolve on their own, and it is the case where "looking at patterns" pays off most — we wrote about it here. One caveat on vocabulary is worth adding: "common" and "normal" are not synonyms. It is the same confusion that keeps another very widespread symptom silent among young athletes, urinary leakage during jumping — present in nearly one in two, yet withheld from the coach by 87% of girls.

BAB's role

This is exactly where BAB works. It gives the athlete a private space to record her own signals — including pain, with an intensity you can follow over time — turning scattered sensations into a readable pattern. It adds an educational layer that explains, in non-clinical and non-alarmist language, why certain things change at this age. And it gives clubs back only aggregated, anonymous signals — never an individual's data.

It is not a diagnostic tool and doesn't pretend to be: it's there to recognise and to give words to what the body does in exactly the window when pain, as the research shows, changes the most. Because the difference between "being dramatic" and "having something real to say" is often just a simple way to notice it.

Sources

This article is for informational and educational purposes and does not constitute medical advice. In case of intense or persistent pain, consult a healthcare professional.

At fourteen she has more stomach aches and headaches: is that normal?

Clinical pain — headaches, abdominal pain, period pain — tends to increase during puberty. In a study of more than 15,000 adolescents, abdominal pain after puberty rose to nearly 30% in girls, versus 16% in boys (Nahman-Averbuch et al., 2023). It's a documented change, not a whim. But it's still important not to self-diagnose: intense or persistent pain should always be assessed by a doctor.

Do girls 'feel' more pain than boys?

The differences emerge during adolescence, not before. Between ages 9 and 11 there's no sex difference in pain to controlled stimuli; in late adolescence girls show, on average, lower thresholds — that is, greater sensitivity (Nahman-Averbuch et al., 2023). It's developmental physiology, not a character weakness.

Why does tracking pain make sense for a 13-14-year-old athlete?

Because this is exactly the window in which pain changes and sex differences form. Recording intensity and recurrence over time turns an isolated symptom into a readable pattern — useful for understanding yourself and for talking about it with the right person. But monitoring is not diagnosing: a tool like BAB helps recognise the signals, it doesn't replace a professional.

How common is period pain, and how much does it really cost?

Very common, and more costly than usually admitted. A meta-analysis of 38 studies covering 21,573 young women under 25 estimated a dysmenorrhoea prevalence of 71.1% (95% CI 66.6-75.2), which among school-age students is 72.5%. The impact is measurable: 20.1% report missing school or university because of period pain, and 40.9% say classroom concentration and performance suffer (Armour et al., 2019). If it removes school hours, it is reasonable to expect it removes training sessions too.

How do you tell pain to observe from pain that needs a doctor?

You don't tell them apart on your own, and this article is not the tool for it. Some markers do indicate it is time to see a healthcare professional rather than simply keep observing: pain that is very intense, pain that does not respond to the usual measures, pain that recurs and regularly costs school or training, or pain that is new and unlike the usual. Noting intensity and recurrence serves exactly this purpose: arriving at the appointment with a precise description instead of an approximate memory.