Connections Between Fibromyalgia and Menopause

Connections Between Fibromyalgia and Menopause

Understanding the connections between fibromyalgia and menopause is super important - there is so much overlap and some perimenopausal women can be misdiagnosed with fibromyalgia when their symptoms are due to perimenopausal hormone changes.
Deborah Brunt
6th January 2025

Fibromyalgia and menopause have symptoms that overlap. Symptoms of both conditions can come on slowly over time, the symptoms vary and fluctuate. It is important to know the connections between these two conditions so women who are experiencing perimenopause or menopause are not misdiagnosed with fibromyalgia and are offered evidence-based treatments and so they can better understand their bodies and health.

Also those who have pre-existing or coexisting fibromyalgia and menopause need both conditions considered in their treatment plans.

Understanding Fibromyalgia

Fibromyalgia is a condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. While it predominantly affects women, men can also develop fibromyalgia. The cause is multifactorial and involves a combination of factors including;

  • genetic,

  • hormonal,

  • environmental and

  • psychological factors.

Menopause and Hormonal Changes

Menopause is the condition where ovarian function declines and is defined as the absence of menstruation for at least 12 consecutive months. It typically occurs between the ages of 45 and 55.

The 5-10 years preceding menopause is known as perimenopause. During this time there is fluctuating and reducing oestrogen levels, and declining progesterone and testosterone. These hormonal changes lead to physical, mental, cognitive and metabolic changes.

Women with pre-existing fibromyalgia, these hormonal fluctuations can exacerbate symptoms of fibromyalgia and introduce new challenges to managing the condition.

Related: What are the 3 Stages of Menopause?

Perimenopause and Fibromyalgia Symptoms

Perimenopause symptoms can be very similar to the symptoms of fibromyalgia. Overlapping common symptoms include:

  • Pain in the joints and muscles, which can be chronic widespread pain

  • Pain in the body after exercise

  • Fatigue

  • Waking unrefreshed

  • Cognitive symptoms such as brain fog, memory issues, attention difficulties

  • Low mood

  • Headaches

In both perimenopause and fibromyalgia the symptoms are multiple, vary from day to day and fluctuate in severity. Symptoms of both conditions can also be influenced by stressors.

Fibromyalgia and perimenopause onset is usually gradual and takes months to years to fully develop or be recognised.

 

The Musculoskeletal Syndrome Of Menopause

Perimenopause is associated with the start of a number of changes in the musculoskeletal system that are related to the decline in ovarian hormones. This has been coined as 'the musculoskeletal syndrome of menopause' by Dr Vonda Wright and her team outlined in their academic paper in 2024.

There changes include:

  1. Inflammation of joints/tendons/ligaments and includes conditions such as frozen shoulder, plantar fasciitis and archilles tendonitis

  2. Sarcopenia which is the progressive loss of muscle mass and strength.

  3. Loss of muscle satellite cells (muscle stem cells) which are important for maintaining and repairing muscle.

  4. Osteoporosis, which is the thinning and loss of flexibility of bones.

  5. Osteoarthritis, the cartilage matrix loss increases with low estrogen.

Distinguishing between Perimenopause and Fibromyalgia

If you have; new onset of symptoms of pain, fatigue, low mood and or headaches in midlife (ie from 35 onwards), it is important that perimenopause is considered as a cause of your new symptoms.

Many women who experience these pain in their joints, muscles, ligaments and tendons have normal lab tests and imaging investigations - as both perimenopause and menopause are clinical diagnosis. This means there are no blood tests to diagnose them, but the diagnosis is made by your symptoms.

Your doctor will still likely do investigations to rule out other causes of your symptoms such as thyroid disease or rheumatoid conditions or nutrient deficiencies such as iron or vitamin B12 that can have similar symptoms to fibromyalgia.

If perimenopause is suspected as a possible cause of your symptoms, it is reasonable to trial treatment with hormone replacement therapy.

Some women who are in early perimenopause can be mistakenly diagnosed as having fibromyalgia when they are experiencing early perimenopause.

Perimenopause should be excluded as well. However this can be difficult as there is no blood test for perimenopause unless you are in late perimenopause when follicle stimulating hormone (FSH) rises.

If you are aged over 35, it is reasonable to trial perimenopause treatment for 3 months, ideally body identical hormone replacement therapy ie estradiol and progesterone to see if your symptoms resolve. If they resolve or improve you may be experiencing perimenopause rather than fibromyalgia.

Likewise, if you are younger than 35 but you have other symptoms of perimenopause or have suspected early menopause, your doctor may consider a trial of hormone replacement therapy. treatment.

Oestrogen therapy has been shown in the Women's Health Initiative Study to reduce joint pain (Chlebowski).

As chronic fatigue syndrome also has considerable overlap with perimenopause it is important to consider perimenopause when considering this diagnosis as well.

 

Distinguishing between Menopause and Fibromyalgia

Postmenopausal women with new onset of symptoms compatible with a diagnosis of fibromyalgia, the symptoms can be due to the low oestrogen, low testosterone, low progesterone state after menopause. This hormonal state can impact sleep, mood, muscle, joint and tendon integrity, cognitive function and pain.

It is worthwhile considering a trial of HRT to see if symptoms are improved or resolved with hormone replacement therapy due to the overlap and difficulty distinguishing the two conditions.

Related: 10 Top Tips for a Good Night's Sleep

Fibromyalgia and Hormones During Menopause

If you have pre-existing fibromyalgia, it may be impacted during perimenopause and after menopause in the following ways.

1. Increased Pain Sensitivity

Estrogen plays a role in modulating pain perception (Sex Hormones and Pain 2023). Stable levels promote less pain while fluctuating and low levels promote increased pain perception. As estrogen levels fluctuate and decline in perimenopause and after menopause, women with fibromyalgia may experience an increase in pain sensitivity, resulting in chronic pain.

2. Sleep Disturbances

Both perimenopause, menopause and fibromyalgia are associated with sleep disturbances. Estrogen is involved in your sleep-wake cycle and progesterone is supporting sleep, so loss of these hormones disturbs sleep. The combined effects can lead to chronic fatigue and exacerbation of fibromyalgia symptoms.

Learn more about Managing Insomnia and Perimenopause

3. Mood Changes

Hormonal shifts during menopause can contribute to mood swings, anxiety, and depression. This is due to the impacts changes in these hormones have on neurotransmitter and receptor function including: norepinephrine, dompamine, GABA, melatonin which can further exacerbate the emotional aspects of living with fibromyalgia.

4. Cognitive Function

Many women report 'fibro fog', a term used to describe cognitive difficulties associated with fibromyalgia. Menopause-related cognitive changes also are commonly described as 'brain fog'.

You may experience other menopausal symptoms including:

Related: 34 symptoms of Perimenopause and What Can Help

Strategies for Managing Fibromyalgia During Menopause

There are many things you can do to support your health and wellbeing and reduce your symptoms of fibromyalgia during menopause.

Lifestyle Changes

Exercise as you are able. If joint and muscle pain is problematic, engage in regular low-impact exercise like walking to promote bone strength, flexibility and increase the body's production of anti-inflammatory molecules such as nitric oxide, cannabinoids and endorphins as these reduce pain.

If you can add weights into your regime this will maintain your muscle and bone strength.

Adopt a balanced, nutritious diet for fibromyalgia includes a whole food diet rich in plant anti-inflammatory foods like fruits, berries, colourful vegetables to provide plenty of antioxidants. It should also contain adequate fish or plant-based sources of omega-3 fatty acids.

Related: The Best Anti-Inflammatory Diet for Menopause

It is also important to get adequate protein intake during perimenopause and menopause to maintain muscle mass and strength. This should ideally come from diverse plant foods such as beans, lentils, chickpeas nuts and seeds and if consuming animal sources; fish, poultry and other unprocessed meats.

Prioritise stress management techniques such as meditation, deep breathing exercises, and mindfulness.

Related: 5 Lifestyle Pillars of Perimenopause Health and Wellbeing

Fibromyalgia and HRT

The hormonal changes associated with perimenopause and menopause can exacerbate your fibromyalgia symptoms.

Consult with your healthcare provider to explore menopause hormone replacement therapy (HRT) options. These can help improve all the main symptoms of both menopause and fibromyalgia such as pain management, sleep improvement, cognitive function and mood stabilisation.

Make a list of questions about the risks and benefits of HRT. HRT is the most effective treatment for perimenopause and menopause related symptoms. It is safe for most women. There are many options of HRT and most women find a type that suits them. These options are can include:

HRT comes in a number of different preparations such as tablets, patches and gels. 

Psychological Support & Stress Reduction for Fibromyalgia

Stress is a significant trigger for worsening of fibromyalgia symptoms.

Seeing a counsellor or therapist with cognitive-behavioural therapy (CBT) skills and other forms of counselling can help you with the emotional challenges of both fibromyalgia and menopause.

Your therapist can also help you with techniques for stress management - which are essential life skills given modern society is stress-driven.

Activities such as tai chi, yoga and mindfulness can be helpful to lower stress levels.

Sleep and Fibromyalgia

  • Establish a consistent sleep routine, including a regular bedtime and wake-up time.

  • Create a comfortable, dark, quiet sleep environment, free from distractions and conducive to restful sleep.

  • Avoid screen time or excitatory stimuli such as the news or video games for at least an hour before bed.

  • Consider sleep support with melatonin and/or hormone replacement therapy.

Medications for Fibromyalgia

  • The most effective treatment if you are perimenopausal or menopausal is hormone replacement therapy. If you are unable to use HRT there are other medications available. Some women also opt to use supplements to support their health and wellbeing. 

  • Discuss the potential benefits and risks of medications for fibromyalgia, which are typically antidepressants and pain medications, with your healthcare provider.

  • Often chronic pain medications are less helpful than in acute pain and working with a health provider to discover what flares and reduces your pain can be useful.

Fibromyalgia Support Groups

  • Joining a support group or online community focused on fibromyalgia and menopause can help you connect with others who share similar experiences and strategies. They can be found on facebook such as this New Zealand based Fibromyalgia Support Group.

Frequently Asked Questions about Fibromyalgia and Menopause

Is There A Fibromyalgia Blood Test?

No, there is no specific blood test for fibromyalgia. Diagnosis is made through a physical examination and the presence of widespread pain for at least 3 months.

Can Menopause Cause Fibromyalgia?

Menopause does not cause fibromyalgia, but it can worsen symptoms in women who already have the condition. It can also mimic the symptoms of fibromyalgia due to loss of hormonal function in the brain, muscles and joints.

Can I Use CBD For Fibromyalgia?

There is limited research on the use of cannabidiol (CBD) in people with fibromyalgia. However it does suggest as positive effect on symptoms (Berger). We will find out more about the benefits and potential risks as more studies are conducted.

CBD is also used commonly by menopausal women to reduce their symptoms (Dahlgren). If you wonder if CBD would be useful for you, discuss this with your doctor.

 

Dr Deborah Brunt is a menopause doctor at Rebelle Health and would love to support you through the perimenopause and menopausal stages, supporting all aspects of your health and wellbeing.

Join our Menothrive Programs to feel great and love your life during peri and menopause.

Dr Deborah Brunt | Rebelle Health | Book Appointment

 

Article references

Australian Family Physician, Fibromyalgia. Oct 2013 42 (10).

IMS Menopause Live. Fibromyalgia and menopause: any link? 26 May 2014

Chlebowski RT, Cirillo DJ, Eaton CB, et al. Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial. Menopause 2013;20:600-8

Aakre CA. Fibromyalgia screening in patients with unexplained chronic fatigue. Menopause. 2020 Nov 2;28(1):93-95.

Berger AA, Keefe J, Winnick A, et al. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia.

Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):617-631.

Dahlgren MK, El-Abboud C, Lambros AM, et al. A survey of medical cannabis use during perimenopause and postmenopause. Menopause. 2022 Sep 1;29(9):1028-1036.

Athnaiel O, Cantillo S, Paredes S, et al. The Role of Sex Hormones in Pain-Related Conditions. Int J Mol Sci. 2023 Jan 18;24(3):1866.

Wright VJ, Schwartzman JD, Itinoche R, et al. The musculoskeletal syndrome of menopause. Climacteric. 2024 Jul 30:1-7.

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