Ask The Expert
April 28, 2003
The answer is yes many women with fibromyalgia notice a connection between their menstrual cycles and their symptoms.
Fibromyalgia is a chronic pain syndrome of unknown cause that affects far more women than men. Pain in the joints and muscles, fatigue and poor sleep are the hallmarks of this condition. The examination is normal except for multiple areas of soreness when pressure is applied. Routine tests for arthritis are normal and there is no evidence by physical examination or testing to suggest that there is inflammation in the body.
There are several theories about why fibromyalgia develops, including the notion that the primary problem is abnormal hormonal regulation; if true, that could link the symptoms to menstrual cycles. Your description of a "link" is probably the best way to think about the relationship between menstrual cycle and fibromyalgia symptoms. Although it's not at all clear that having your period causes an increase in symptoms, doctors and patients alike have long noted an association in timing between an increase in pain and the time just before or during menstrual bleeding. However, not every woman with this condition notices this connection.
Other theories focus on heightened pain perception, abnormal regulation of growth hormone, stress hormones, or stages of sleep. For instance, sophisticated studies of brain function show that when compared with people who don't have fibromyalgia, those with this syndrome demonstrate increased activity in the areas of the brain involved in pain perception following minor trauma.
Just as the cause of fibromyalgia is unknown, the things that make it better or worse are variable as well. On average, cold or humid weather, mental or physical fatigue, excessive activity or inactivity, or anxiety tend to make symptoms worse for many, having their period is on this list as well. Warm or dry weather, warm water, adequate sleep, and regular, moderate exercise tend to improve symptoms. A number of medicines have demonstrated modest benefit, including low doses of amitriptyline, cyclobenzaprine or fluoxetine. Alternative therapies may be more helpful (and better tolerated) than conventional therapies in this condition.
We need a better understanding of what causes this illness. Only then will the connection between menstrual cycles and symptoms of fibromyalgia become clearer. Ongoing research may provide this information in the near future. See your health-care providers for evaluation so that appropriate treatment for fibromyalgia can be offered and to rule out another cause of your symptoms.