Why are Women Mainly affected by Fibromyalgia?

Fibromyalgia is a chronic condition that is characterized by widespread musculoskeletal pain and tenderness, fatigue, altered sleep patterns, mood issues, and memory problems. Fibromyalgia is a common disorder that can be managed with the right treatment. There is no cure for fibromyalgia.

Fibromyalgia is frequently misunderstood as being a rheumatoid disease and is also classified along with other such types of rheumatic disorders, including lupus and arthritis. However, the exact underlying cause of fibromyalgia is unknown, though it has been found that it tends to affect women twice as much as men. But why are women mainly affected by fibromyalgia? Read on to find out everything you need to know about why women are primarily affected by fibromyalgia and what fibromyalgia symptoms are specific to women.

Overview of Fibromyalgia

Fibromyalgia, also known as Fibromyalgia Syndrome (FMS), is a chronic condition that causes pain and tenderness throughout the body.(1,2)

Fibromyalgia is typically characterized by widespread muscle pain accompanied by tenderness. A person with fibromyalgia is also known to experience altered sleep patterns, fatigue, mood issues, and memory challenges.(3) Due to the musculoskeletal pain, fibromyalgia is often incorrectly classified as a form of the rheumatic disorder, such as lupus and arthritis. However, the exact cause of fibromyalgia is still not known.

According to the US-based Centers for Disease Control and Prevention (CDC), fibromyalgia is twice as likely to affect women as compared to men.(4,5) Even though anyone can get fibromyalgia, the hormonal changes in a woman’s menstrual cycle are believed to be a reason for the gender bias of the disorder.(6)

Fibromyalgia in Women Versus Men: Why are Women Mainly affected by Fibromyalgia?

The symptoms of fibromyalgia vary from person to person, but fibromyalgia is said to be more common in women than in men, with both genders experiencing the symptoms differently. An example of this is that women with fibromyalgia tend to report experiencing higher levels of pain. They are also likely to have additional symptoms, such as painful menstruation or heavier bleeding during their period.(7)

According to estimates by the American College of Rheumatology, nearly two to four percent of people have fibromyalgia, and out of this, it is more commonly observed in women.(8)

One of the most identifiable fibromyalgia symptoms is chronic, widespread muscle pain that cannot be explained by any other conditions, such as arthritis, muscle injury, a herniated disc, or even an autoimmune disorder. However, everyone experiences the symptoms of fibromyalgia differently, but here are some of the most commonly experienced symptoms of the condition:

  • Dizziness
  • Chronic fatigue, even after getting a good night’s sleep
  • Hair loss
  • Muscle stiffness in the morning
  • Heightened sensitivity to pain
  • Sensitivity to light, noises, and temperature changes
  • Jaw or facial pain and tenderness
  • Dry eyes
  • Cognitive challenges such as memory loss or inability to concentrate
  • Forgetfulness, also known as ‘fibro fog
  • Vomiting
  • Urinary problems such as urinary incontinence or increased frequency of urinating
  • Diarrhea and other gastrointestinal issues
  • Sleeping difficulties
  • Headaches, either migraines or tension headaches
  • Persistent backache

And of course, the most common symptom – feeling persistent pain in various areas of the body, including the thighs, hips, back, and neck.
While the symptoms can vary in intensity, many people find that any other illness, exhaustion, and stress make the symptoms worse. For the diagnosis of fibromyalgia, the type of pain a person is experiencing is not as crucial for diagnosis, as is the chronic and widespread nature of the pain.

Women with fibromyalgia are likely to experience different or more aggravated symptoms as compared to men. Some of the women-specific symptoms of this condition are:

  • Pain all over the body
  • Feeling fatigued in the morning even after a good night’s sleep
  • Symptoms of irritable bowel syndrome (IBS) (9)

A study carried out in 2015 found that women with fibromyalgia are more likely to experience frequent symptoms of primary dysmenorrhea and premenstrual syndrome (PMS), or severely painful periods. (10) The women participants in the study were found to experience lower back pain and severe lower abdominal pain for at least two days before their periods.

Other researchers have also pointed out another explanation as to why fibromyalgia is more prevalent in women. A 2010 study carried out by

Danish researchers found that men are likely to be underdiagnosed with fibromyalgia because there is a lack of the noticeable ‘tender points’ commonly associated with the disease. (11) So while men do not experience any menstrual symptoms, they are more likely to experience other forms of pressure points that are usually ignored.

Here are the fibromyalgia symptoms that are common to women.

Menstruation: Fibromyalgia is known to impact the menstrual cycle. Women may experience heavier periods, irregular periods, or severe pain during their periods, a condition known as dysmenorrhea. (12)

Pregnancy: Usually, most women with fibromyalgia do not experience any problems during pregnancy, but in some cases, being pregnant can worsen the symptoms of the disorder. Fibromyalgia is also known to increase fatigue and mood swings, especially during pregnancy. It is always better to consult your doctor and let them know that you are planning to conceive because certain medications prescribed for the treatment of fibromyalgia can impact the fetus.

Fibromyalgia in Women and Tender Points

Tender points are 18 painful or tender spots present in nine locations on the body. These points are usually paired and located on both sides of the spine. While not everyone with fibromyalgia experiences these tender points, but in those who do, pain in these spots helps diagnose and distinguish fibromyalgia from other painful conditions.

Women with fibromyalgia are more likely to have these tender points than men. The location of these tender points are as follows: (13)

  • On the inside of the knees
  • On the lower back, just above the buttocks
  • Just above the outer hip on the bony part
  • Underneath the collarbone, at the side of the breastbone
  • Just above the collarbone
  • One on each forearm, next to the crease of the elbow
  • Point where the muscles of the back meet the shoulder blade
  • A point between the base of the neck and the shoulder tip
  • Point at the base of the head, where the head meets the neck

Diagnosing Fibromyalgia

Diagnosing fibromyalgia is a challenging process because the symptoms are not visible on any diagnostic tests such as an X-ray, blood tests, or other imaging examinations. It is also more than likely that women who experience painful menstrual cycles tend to simply pass it off as a common hormonal issue rather than fibromyalgia.(14)

Before being diagnosed with fibromyalgia, most people should have experienced widespread pain and fatigue for at least three months or longer. A rheumatologist will first rule out any other potential causes of pain before diagnosing you with fibromyalgia.(15)

Treatment for Fibromyalgia

Once you are diagnosed with fibromyalgia, here are the various treatment options available:(16,17)

  • Prescription pain relievers
  • Prescription muscle relaxants
  • Antidepressants for controlling hormonal fluctuations
  • Physical therapy
  • Oral contraceptives such as birth control pills to ease menstrual symptoms such as premenstrual syndrome and primary dysmenorrhea
  • Exercise
  • Psychotherapy
  • Acupuncture or chiropractic therapy
  • Sleep therapy
  • Neuromodulator medications

Remember that there is no cure for fibromyalgia, and the goal of your treatment will only be to provide you relief from the persistent pain, thereby improving the overall quality of your life.

Conclusion

Fibromyalgia is a chronic condition that can affect someone for their entire lifetime, regardless of whether they are men or women. The good news is that even though it is a chronic condition, it is not a progressive disease, meaning it does not worsen with time and neither does it cause any direct damage to the bones or muscles of the body. Fibromyalgia is also not a fatal condition.

The key to managing the pain of fibromyalgia is to follow what your doctor says and keep up with the treatment plan. If you find that the current treatment is not working for you, then it is recommended that you consult a rheumatologist.

With more and more research being done on fibromyalgia and its effect on people living with the condition, there is much hope that some more preventive treatments will come out in the future.

References:

  1. Wolfe, F., 1991. Fibromyalgia. In Prognosis in the rheumatic diseases (pp. 321-332). Springer, Dordrecht.
  2. Clauw, D.J., 2014. Fibromyalgia: a clinical review. Jama, 311(15), pp.1547-1555.
  3. Goldenberg, D.L., Burckhardt, C. and Crofford, L., 2004. Management of fibromyalgia syndrome. Jama, 292(19), pp.2388-2395.
  4. Cdc.gov. 2020. Fibromyalgia | Arthritis | CDC. [online] Available at: <https://www.cdc.gov/arthritis/basics/fibromyalgia.htm> [Accessed 9 September 2020].
  5. Clauw, D.J., 2009. Fibromyalgia: an overview. The American journal of medicine, 122(12), pp.S3-S13.
  6. Mountz, J.M., Bradley, L.A., Modell, J.G., Alexander, R.W., Triana‐Alexander, M., Aaron, L.A., Stewart, K.E., Alarcon, G.S. and Mountz, J.D., 1995. Fibromyalgia in women. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 38(7), pp.926-938.
  7. Østensen, M., Rugelsjoen, A. and Wigers, S.H., 1997. The effect of reproductive events and alterations of sex hormone levels on the symptoms of fibromyalgia. Scandinavian journal of rheumatology, 26(5), pp.355-360.
  8. Rheumatology.org. 2020. Fibromyalgia. [online] Available at: <https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia> [Accessed 9 September 2020].
  9. Johnson, C.M. and Makai, G.E., 2018, March. Fibromyalgia and irritable bowel syndrome in female pelvic pain. In Seminars in reproductive medicine (Vol. 36, No. 02, pp. 136-142). Thieme Medical Publishers.
  10. Terzi, R., Terzi, H. and Kale, A., 2015. Evaluating the relation of premenstrual syndrome and primary dysmenorrhea in women diagnosed with fibromyalgia. Revista Brasileira de Reumatologia (English Edition), 55(4), pp.334-339.
  11. Bartels, E.M., Dreyer, L., Jacobsen, S., Jespersen, A., Bliddal, H. and Danneskiold-Samsøe, B., 2009. Fibromyalgia, diagnosis and prevalence. Are gender differences explainable?. Ugeskrift for laeger, 171(49), p.3588.
  12. Terzi, R., Terzi, H. and Kale, A., 2015. Evaluating the relation of premenstrual syndrome and primary dysmenorrhea in women diagnosed with fibromyalgia. Revista Brasileira de Reumatologia (English Edition), 55(4), pp.334-339.
  13. Tunks, E., Crook, J., Norman, G. and Kalaher, S., 1988. Tender points in fibromyalgia. Pain, 34(1), pp.11-19.
  14. Wolfe, F. and Häuser, W., 2011. Fibromyalgia diagnosis and diagnostic criteria. Annals of medicine, 43(7), pp.495-502.
  15. Katz, R.S., Wolfe, F. and Michaud, K., 2006. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 54(1), pp.169-176.
  16. Rossy, L.A., Buckelew, S.P., Dorr, N., Hagglund, K.J., Thayer, J.F., McIntosh, M.J., Hewett, J.E. and Johnson, J.C., 1999. A meta-analysis of fibromyalgia treatment interventions. Annals of behavioral medicine, 21(2), pp.180-191.
  17. Rooks, D.S., 2007. Fibromyalgia treatment update. Current opinion in rheumatology, 19(2), pp.111-117.

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