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Fibromyalgia Tied To Hysterectomy, Gynecologic Disease
Monday 21 September 2015
Fibromyalgia Tied to Hysterectomy, Gynecologic Disease
Did you have a gynecologic surgery, such as a hysterectomy, in the few years before you developed fibromyalgia? A study published in late summer 2015 shores up the link between these types of surgeries and fibromyalgia onset. It also provides further evidence for an association between fibromyalgia and comorbid conditions that are gynecologic, endocrine, or autoimmune.
Researchers reviewed charts of 219 women with fibromyalgia and hundred and 16 women with non-fibromyalgia chronic pain.
Specifically, they examined the time between illness onset and gynecologic surgery as well as the number of overlapping conditions in each group. The charts were selected from patients at an academic medical center in 2009 and 2010.
They 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.
The timing of the gynecologic surgeries in relation to pain onset was especially interesting. Researchers found more surgeries in the year 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% 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 prevention.
For the women who develop fibromyalgia after gynocologic surgery, we also need to know what, if any, relationship the surgery itself has, as well as the resulting hormonal changes and hormone replacement therapy.
Doctors have long suspected that fibromyalgia has strong hormonal ties and triggers. Earlier research has supported this belief. A 2013 study found links between early onset menopause and fibromyalgia which may be due to increasing pain hypersensitivity from dropping estrogen levels.
Women with fibromyalgia also are especially prone to painful menstrual periods (dysmenorrhea) and certain pregnancy complications. You can learn more about those here:
This study really speaks to my own experience. I was 34 when my youngest child was born via c-section, and 35 when I stopped breast-feeding. The hormonal changes from that, according to my gynecologist, launched me into premature menopause. (I'm using menopause here as it used colloquially. Medically speaking, it was perimenopause.)
I menstrual cycle became erratic and periods were extremely heavy and painful, whereas they'd always been regular and fairly mild for me. Within weeks of weaning my daughter, I developed severe allergies that twice sent me to the emergency room in anaphylaxis. Then, as the allergies began to taper off, the first fibromyalgia pain hit.
Six months later I had a diagnosis and began identifying a pattern — my flares came regularly between ovulation and the start of my period. My gynecologist recommended an endometrial ablation to get rid of hormones put off by the thickening uterus. The procedure not only put an end to the painful periods (and periods in general,) it took the edge off of my flares and made them fewer and farther between. (Learn more about my personal journey in Thrown Off Course: Fibromyalgia Enters My Life.)
I didn't have a hysterectomy, but between two pregnancies and two c-sections, plus breastfeeding, my body had clearly been put through a hormonal ringer.
Several years before that, though, when I was 30, I developed hypothyroidism (low thyroid hormone levels.) I don't know if it was a coincidence or not, but my thyroid levels dipped right after I went off of birth control pills to try getting pregnant for the first time.
And then there's the autoimmune connection. In the early years of my thyroid disorder, I tested negative for the autoimmune thyroid disease called Hashimoto's. However, I later tested positive for it. In addition, I now have rheumatoid arthritis, which is also autoimmune.
It seems to be more common for fibromyalgia to come after the autoimmune diseases rather than before, but the two illness types come together often enough that it's almost a cliché. I can't remember the last time I met someone with fibromyalgia who didn't have at least one autoimmune condition.
I've heard from many women who've had similar experiences with hormonal changes and the start of their illness. I suspect that research will continue to bear out the links and hope that someday, will be a lot better equipped to recognize, treat, and prevent hormone-related fibromyalgia.
Brooks L, et al. Journal of pain research. 2015 Aug 20;8:561-9. 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?
Martinez-Jauand M, et al. clinical rheumatology. 2013 Jul;32(7):975-81. Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia.
The above originally appeared here.
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