Common Gynecologic Issues Linked to Chronic Fatigue Syndrome

Troy Brown, RN

February 06, 2015

Common gynecologic problems including menstrual abnormalities, endometriosis, pelvic pain, hysterectomy, and early or surgical menopause are associated with chronic fatigue syndrome (CFS), but experts caution against assuming causality, according to a new study.

Roumiana S. Boneva, MD, PhD, from the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues present their findings in an article published online February 2 in Menopause.

CFS, which is also known as myalgic encephalomyelitis, "is a debilitating and complex illness affecting more than 1 million US adults and accounting for sizable economic costs to the individual, healthcare system, and society as a whole," the authors write. "CFS is characterized by profound fatigue that is accompanied by symptoms affecting multiple body systems, including, most characteristically, postexertional malaise, unrefreshing sleep, problems with memory and concentration, and pain."

The researchers analyzed data from a subset of 157 women (84 women with CFS and 73 healthy control women) participating in the follow-up phase of a population-based longitudinal study of CFS and fatiguing illness conducted between 2004 and 2009.

The women completed a self-administered questionnaire about their gynecologic history based on the Reproductive History Questionnaire/Menstruation-Menopause History developed by the National Cancer Institute Division of Cancer Epidemiology and Genetics. The women in both groups were similar in age.

After adjusting for body mass index and other potential confounders, those with CFS described significantly more gynecologic conditions and surgeries than those in the control group (menopause status, 61.9% vs 37.0% [odds ratio (OR), 2.37; 95% confidence interval (CI), 1.21 - 4.66; earlier mean age at the start of menopause, 37.6 vs 48.6 years [adjusted OR; 1.22; 95% CI, 1.09-1.36]; excessive menstrual bleeding, 73.8% vs 42.5% [adjusted OR, 3.33; 95% CI, 1.66 - 6.70]; between-period bleeding, 48.8% vs 23.3% [adjusted OR, 3.31; 95% CI, 1.60 - 6.86]; and endometriosis, 29.8% vs 12.3% [adjusted OR, 3.67; 95% CI, 1.53 - 8.84], respectively).

Women with CFS also reported significantly more nonmenstrual pelvic pain (26.2% vs 2.7%; adjusted OR, 11.98; 95% CI, 2.57 - 55.81), use of noncontraceptive hormonal preparations (57.1% vs 26.0%; adjusted OR, 2.95; 95% CI, 1.36 - 6.38), and gynecologic surgery (65.5% vs 31.5%; adjusted OR, 3.33; 95% CI, 1.66 - 6.67), particularly hysterectomy (54.8% vs 19.2%; adjusted OR, 3.23; 95% CI, 1.46 - 7.17), compared with women in the control group.

Women in the CFS group underwent hysterectomy and oophorectomy at a significantly younger mean age than women in the control group. Hysterectomy and oophorectomy were performed before CFS onset in 71% of those with available information about dates of surgery and CFS onset.

"CFS in women is associated with self-reported menstrual abnormalities, endometriosis, pelvic pain unrelated to menstruation, early age at hysterectomy/surgical menopause, and other gynecologic conditions and surgical operations," the authors write. "It should be emphasized, however, that our findings do not demonstrate causality. These findings could be used for further hypothesis generation for future studies. Nevertheless, the significantly higher prevalence of various gynecologic conditions in women with CFS warrants clinicians' attention on tailoring these women's medical care," they conclude.

The authors have disclosed no relevant financial relationships.

Menopause. Published online February 2, 2015. Abstract

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