Symptoms of fatigue and generalized aches and pains is a common discussion in my women’s health practice. These symptoms also have some specifics related to menopausal women. Fatigue is frequently reported by menopausal woman. There are many possible explanations including: hypothyroid, insomnia, depression, allergies, anemias, chronic disease, chronic pain, adrenal dysregulation, Lyme disease, chronic fatigue syndrome, chronic Epstein Barr Virus (EBV), fibromyalgia syndrome (FMS), multiple chemical sensitivities (MCS), menopause….and there’s even more.
Fatigue is considered chronic if it has been present for at least 6 months. This list of possible causes, called the differential diagnosis, requires a comprehensive history, physical exam and select laboratory testing. Unfortunately, the usual and customary testing may identify the cause of the fatigue in only about 1 in 20 cases….not a very good statistic. A well trained and experienced naturopathic physician or integrative medicine physician has some expanded tools in testing and thinking to consider some of the more challenging conditions to diagnose such as EBV, adrenal dysregulation, fibromyalgia and MCS. If a cause of the chronic fatigue is not adequately diagnosed, some just call it chronic fatigue syndrome, but this is actually a distinct clinical diagnosis of its own.
It’s important to consider either CFS or fibromyalgia in women with post-exertional malaise. This is described as a prolonged increase in fatigue disproportionate to the amount of physical, emotional or mental exertion that occurred. This is a particular characteristic of CFS or fibromyalgia. Frankly, chronic fatigue syndrome is not a very well understood condition but can be debilitating with its fatigue that is only minimally helped by rest. It is common for those with CFS to report non-refreshing/non-restorative sleep, post-exertional malaise that can be experienced with even small exertions like vacuuming, intolerance of body position changes of sitting/lying to standing called orthostatic intolerance and cognitive impairment. Fibromyalgia is described currently as a central sensitization syndrome that is characterized by amplification of pain signals that our out of proportion to the amount of sensory input. This is called hyperalgesia. Even normal touch can generate pain, called allodynia. Both CFS and FMS have been associated with post-viral syndromes, including coronaviruses.
There is an overlap of the diagnostic criteria for FMS and CFS. Up to 70% of patients with fibromyalgia meet the diagnostic criteria for CFS and 35% to 70% of patients with CFS meet the criteria for fibromyalgia. The most common age of incidence of FMS is during the teen years and during the 30s and the typical age of onset of fibromyalgia is between ages 20 and 50 with increasing prevalence closer to age 50. The predominant view is that at least 80-90% of individuals with FMS are women although other studies report about 60%. Why it is so much more common in women is not exactly clear but there are links between a decline in estrogen and menopause and enhanced chronic pain symptoms. There is also evidence that women report worsening of their fibromyalgia symptoms around their final menstrual period. However, new onset aches and pains can be quite common in perimenopause/menopause, and they may or may not meet the diagnostic criteria for fibromyalgia. While there may be this hormonal connection with FMS, there is no clear evidence that taking hormone therapy improves fibromyalgia associated pain, although some women do experience pain improvement with hormone therapy and their fibromyalgia symptoms, but sometimes also their osteoarthritis symptoms and non-FMS/non-OA aches and pains that I call rheumatism. Menopause is also often associated with not only worsening fibromyalgia pain but worsening fatigue (whether it’s CFS or not), along with sleep disruption. Remember that improving sleep, can improve fatigue including CFS and improve FMS pain.
We have a long way to go in not only understanding FMS and CFS but that also means we have a long way to go in effective treatments, whether natural medicine and/or conventional medicine. In a future blog, I will offer some therapeutic options.
