By Adrienne Dellwo | Reviewed by Grant Hughes, MD
You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong hormonal ties and triggers. This does not seem surprising as we’ve long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions. What are we learning about this link and what might that mean for you?
The Link Between Fibromyalgia and Gynecologic Disease
People have noted the onset or changes in their fibromyalgia symptoms in relation to gynecological conditions for many years. For example, it’s not uncommon for symptoms to appear shortly after the symptoms of perimenopause. Likewise, some people have noted an improvement in their fibromyalgia symptoms after procedures that alter female hormone production.
In addition, some people note that a worsening of symptoms or occurrence of flares coincides with certain times in their menstrual cycle. But correlation doesn’t mean causation. Is there truly any link between fibromyalgia and gynecologic disease or hysterectomy?
First, let’s take a look at fibromyalgia symptoms in women and how they seem to vary with hormones.
Fibromyalgia Symptoms in Women
There are many differences between men and women with fibromyalgia that could have something to do with hormonal differences, beginning with the fact that fibromyalgia is much more common in women than in men.
Women with fibromyalgia are especially prone to painful menstrual periods (dysmenorrhea) and certain pregnancy complications, although we know women with fibromyalgia often experience hyperalgesia or an amplification of pain. There is also some evidence that flares occur more commonly during the premenstrual period.
Fibromyalgia symptoms in women may also vary with the reproductive cycle, including pregnancy, and menopause, with early menopause and increased pain sensitvity in people with fibromyalgia possibly related to dropping estrogen levels.
But what about a link between gynecologic conditions or gynecologic surgery and fibromyalgia?
Fibromyalgia and Gynecologic Surgery
The research is young when it comes to looking at the link between gynecologic surgery and fibromyalgia, and little research has been done until recently.
A 2015 study, however, examined a possible link. In the study, researchers reviewed charts of 219 women with fibromyalgia and 116 women with non-fibromyalgia chronic pain. Specifically, they evaluated the time between illness onset and gynecologic surgery as well as the number of overlapping conditions in each group.
They also found that each of the three diagnosis types they were looking at was independently associated with fibromyalgia. Thyroid disease and gynecologic surgery were significantly more common in women with fibromyalgia than those with other types of chronic pain.
Timing of Gynecologic Surgery and Onset of Fibromyalgia
The timing of the gynecologic surgeries in relation to pain onset was especially interesting.
They found more surgeries in the years just before fibromyalgia pain began, or in the year after pain onset. That pattern was unique to the fibromyalgia group.
At first glance, it may seem odd that gynecologic surgeries in the year after pain onset would be considered related to the development of fibromyalgia. However, an association like that may be due to several pertinent factors. For example, consider that many women have gynecologic problems well before they opt for surgery as the preferred treatment. It may be that hormonal changes or gynecologic disease are risk factors for fibromyalgia because of some underlying relationship that we don’t yet understand.
According to the study, hysterectomies and oophorectomies (removal of the ovaries) were most likely within the four years before or after the onset of fibromyalgia pain.
This is certainly an area that calls for more research. In the end, it could help us understand why 90 percent of fibromyalgia patients are women. Beyond that, it may reveal physiological changes that can trigger the development of the illness, which could lead to better treatments and possibly even prevention.
For the women who develop fibromyalgia after gynecologic surgery, we also need to know what role, if any, the surgery itself plays, as well as the possible roles of hormonal changes caused by the surgery. Post-surgical hormone replacement therapy deserves a look, too.
Bottom Line on Gynecologic Surgery and Fibromyalgia
We know that fibromyalgia is much more common in women, and that the symptoms of the condition can vary with the menstrual cycle and menopausal state. A recent study found that gynecologic surgery, such as removal of the uterus and/or ovaries, appears to be more common prior to the onset of fibromyalgia. Whether this is correlation or causation has yet to be determined, as well as any possible reasons why this could be the case if it’s causation. Given the disability associated with fibromyalgia, this is an important finding to pursue.
Brooks, L., Hadi, J., Amber, K. et al. Assessing the Prevalence of Autoimmune, Endocrine, Gynecologic, and Psychiatric Comorbidities in an Ethnically Diverse Cohort of Female Fibromyalgia Patients: Does the Time From Hysterectomy Provide a Clue?. Journal of Pain Research. 2015. 8:561-9.