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Ask An Expert: Surgically Induced Menopause and Fibromyalgia
Question:
Is there any connection between surgically induced menopause and fibromyalgia? And does taking estrogen seem to help or hurt the condition?
Answer:
Fibromyalgia is a condition of unknown cause marked by chronic pain throughout the body that is often associated with poor sleep quality. Treatment includes low-dose anti-depressant medications, pain relievers and exercise. Unfortunately, treatment is only partially effective in most cases. Doctors and researchers have not yet identified a therapy that is both highly reliable and highly effective.
Because fibromyalgia is much more common in women than men and because it tends to begin between the ages of 30 and 55, there has been interest in the connection between the disease and menopause for some time. In fact, one small study in the mid-1980s suggested that early, surgically induced menopause with lack of estrogen replacement played a role in the disease; however, subsequent studies have failed to confirm this.
Most experts draw no clear connection between menopause (whether spontaneous or surgically induced) and fibromyalgia and do not recommend estrogen therapy as a specific treatment for fibromyalgia. Given the small, but real, risks of hormone replacement therapy, I would be reluctant to prescribe estrogen therapy for fibromyalgia in the absence of compelling evidence that it works.
On the other hand, a key goal of fibromyalgia treatment is to improve sleep quality, and sleep can be disrupted by hot flashes. Therefore, estrogen therapy may be worth considering for women with the combination of fibromyalgia, hot flashes and poor sleep. However, hormone therapy could be considered for any woman with menopause-related hot flashes, with or without fibromyalgia.
Researchers are actively investigating possible triggers and more effective therapies for fibromyalgia. Future studies may clarify the relationship, if any, between estrogen levels, menopause and fibromyalgia.
Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.
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| Last updated: | January 24, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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