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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.
Perimenopause and Fibromyalgia
Perimenopause symptoms can be very similar to fibromyalgia symptoms. 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 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 a 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:
Inflammation of joints/tendons/ligaments and includes conditions such as frozen shoulder, plantar fasciitis and archilles tendonitis
Sarcopenia which is the progressive loss of muscle mass and strength.
Loss of muscle satellite cells (muscle stem cells) which are important for maintaining and repairing muscle.
Osteoporosis, which is the thinning and loss of flexibility of bones.
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, it is important that perimenopause is considered as a cause of your symptoms.
Many women who experience these pain in their joints, muscles, ligaments and tendons have normal lab tests and imaging investigations.
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.
As perimenopause symptoms can come on slowly, starting before midlife, it can catch you out as an alternative diagnosis to fibromyalgia.
There are no blood tests to diagnose fibromyalgia so doctors should exclude and treat other medical causes such as thyroid disease or rheumatoid conditions or nutrient deficiencies such as iron or vitamin B12 that can have similar symptoms to fibromyalgia.
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 HRT 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
In 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 which impacts on 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:
hot flushes
night sweats
irregular/heavy/shorter periods and cycles
pain with sex
low libido
urinary incontinence
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.
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.
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 outlines below.
Body identical estrogen patches or gel and natural progesterone has the best safety profile and it is optimal to start it prior to 10 years after menopause.
Body identical estradiol comes in patches, gels and tablets. It can be used as rings or pellets in some countries.
Body identical progesterone is available as a vaginal gel or micronised capsule that can be used orally or vaginally
Synthetic estrogens are available in tablet form.
Synthetic progestins are available as tablets or the mirena in a lower dose.
Body identical testosterone comes in the form of a gel and should be used in doses that are in the female physiological range.
There are a number of combinations of estrogen and proegstin tablets available.
There are some medications such as Tibolone that have estrogenic, progestogenic and testosterone effects.
Related: Testosterone Therapy in Menopause
Related: Guide to using Utrogestan
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 as we live in a stress-driven society.
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 number 1 support treatment if you are perimenopausal or menopausal is hormone replacement therapy.
Discuss the potential benefits and risks of antidepressants and pain medications such as amitriptyline for fibromyalgia 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 more 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.
CBT and other psychological therapies can be helpful with chronic pain.
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.
As a menopause doctor, Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you through the perimenopause and menopausal stages of life, supporting all aspects of your health and wellbeing.
Dr Deb Brunt is a menopause doctor in Dunedin, New Zealand and also provides menopause health coaching internationally to support optimal health habits for aging well so you can live your best life.
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.