Chronic Fatigue Syndrome: Implications for Women and Their Health Care Providers During the Childbearing Years

Peggy Rosati Allen, CNM, WHNP, MS, LCCE


J Midwifery Womens Health. 2008;53(4):289-301. 

In This Article

Epidemiology of Chronic Fatigue Syndrome

Epidemiologic estimates indicate that up to 4 million people in the United States meet the Centers for Disease Control and Prevention (CDC) criteria for the diagnosis of CFS, and that 85% of US citizens with CFS remain undiagnosed.[4] The disorder affects individuals of all racial, ethnic, and socioeconomic backgrounds with no difference in prevalence between rural, urban, or metropolitan populations. It is at least as common among African Americans and Hispanics as in whites. CFS strikes 3 to 5 times more women than men, with incidence in females peaking between the ages of 40 and 59 years.[4] Children and adolescents can be afflicted with the disorder, but incidence in younger populations is less common.

A recent CDC-sponsored, population-based study in Georgia provides evidence that CFS is 6 to 10 times more common than previously estimated and is a significant public health problem in the United States.[5] Evidence-based estimates by the CDC also indicate that CFS has severe economic impact in the United States. The disorder results in a $9 billion annual loss in productivity, not including medical costs or disability benefits, and results in a $20,000 annual loss in wages and income per family.[4]

The nature of CFS is that it "waxes and wanes," following a cyclical pattern of improvement alternating with unpredictable relapses of variable severity. The percentage of people who recover from CFS is unknown, although preliminary estimates are that at least partial recovery is possible in 40% to 60% of patients.[4] Delays in CFS diagnosis and treatment may lead to a more complicated course of illness and poorer prognosis for recovery.[6]

Complications related to CFS may have serious health implications beyond those currently known. Nancy Klimas, MD, an immunologist and internationally recognized CFS and HIV researcher, cautions that although the long-term consequences of CFS are unknown, loss in the function and number of natural killer (NK) cells in persons with CFS may increase the risk for certain types of malignancies in women, particularly cancers related to viral reactivation such as human papillomavirus (HPV)-induced cervical cancer (personal communication, May 5, 2007). A DePaul University study of causes of death among persons with CFS echoes Klimas' concern that women with CFS may have an increased incidence and younger onset of cancer from abnormalities in immune function.[7] Also in support of Klimas' concern, preliminary studies indicate that the expression of CD26 activation marker, which acts as a costimulatory molecule for T and NK cell activity, is significantly depleted in persons with CFS compared to healthy controls.[8] Furthermore, host susceptibility to HPV-induced cervical cancer and resistance to chemotherapy in advanced cases may be increased by a loss in function and number of NK cells and depleted T-lymphocyte levels.[9,10]


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