Fibromyalgia and Menopause: Symptoms, Causes & Relief

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Fibromyalgia – Is there a Menopause Connection? 

Fibromyalgia is one of the most common pain disorders, and it primarily affects women. In fact, about 90% of cases globally are in women. It begs the question – is there a hormone connection?

In today’s article, we’ll explore fibromyalgia and a possible connection with menopause, why getting a proper diagnosis in midlife can be tricky, and integrative strategies we use with our patients here at TārāMD. Continue reading as we discuss:

• What is fibromyalgia syndrome?
• Fibromyalgia and women’s health
• Fibromyalgia and menopause – what the data shows
• The benefits of an integrative approach to fibromyalgia

What is Fibromyalgia Syndrome?

Fibromyalgia syndrome, or fibromyalgia for short, is a chronic pain disorder, characterized by widespread musculoskeletal pain lasting at least 3 months. Diagnosis requires ruling out other conditions and finding multiple, symmetrical tender points on the body.

People with fibromyalgia develop a hypersensitivity to pain signaling and an altered pain processing response in the central nervous system. It may be fueled by an overactive stress response (HPA axis dysfunction).

Along with widespread pain, people with fibromyalgia frequently experience additional symptoms, which can be sensory, somatic, or cognitive. Fibromyalgia symptoms may include:

• Fatigue
• Cognitive changes, such as brain fog
• Sleep disturbance
• Psychiatric symptoms, such as anxiety and depression
• Headaches and migraines
• Urinary urgency and frequency
• Restless legs

Like most conditions, fibromyalgia doesn’t have a single root cause. It likely has many contributors, including genetics and environmental factors. While there may be a genetic predisposition, fibromyalgia may be triggered by physical and emotional stressors, such as Lyme disease or trauma.

Fibromyalgia and Women’s Health

Fibromyalgia affects around 2-3% of the population, and around 90% of the cases are in women. Women with rheumatologic diseases, such as lupus and rheumatoid arthritis, are more likely to develop fibromyalgia. We also see higher rates of fibromyalgia in women with endometriosis.

Women with fibromyalgia are more likely to have specific women’s health issues, including:

• PMS (pre-menstrual syndrome)
• Painful periods (dysmenorrhea)
• Breast cysts
• Sexual function issues
• Reproductive issues

Fibromyalgia x Menopause

While we can’t say that menopause causes fibromyalgia, there are many interesting connections between fibromyalgia and perimenopausal and menopausal hormone changes.

First, although fibromyalgia can occur at any age, it tends to affect middle-aged women, with most diagnoses occurring between age 40 and 60.

Second, fibromyalgia symptoms tend to become more severe after menopause or a hysterectomy (with or without oophorectomy). Women with fibromyalgia may also reach menopause at an earlier age.

Third, menopause and fibromyalgia have many shared clinical features and symptoms, which can make fibromyalgia difficult to diagnose during this phase, or perhaps overdiagnosed when clinicians aren’t educated about perimenopause.

About 70% of perimenopausal women experience musculoskeletal pain related to variable estrogen levels, known as the musculoskeletal syndrome of menopause. In some cases, fibromyalgia-like symptoms could actually be a symptom of perimenopause. In other cases, perimenopause could trigger fibromyalgia.

Symptoms common between perimenopause/menopause and fibromyalgia include:

• Musculoskeletal pain
• Joint pain
• Fatigue
• Sleep disturbance
• Mood changes
• Bladder sensitivity

Finally, underlying conditions, such as insulin resistance, may influence both menopause and fibromyalgia. Perimenopause shifts immunity towards less regulation and more inflammation, which can drive fibromyalgia flares and menopausal symptoms. 

There is limited research on hormone replacement therapy and fibromyalgia. Still, it does offer some anti-inflammatory and neuroprotective benefits, so it should be considered when it’s a good fit for the perimenopausal or menopausal patient.

An Integrative Fibromyalgia Approach

Integrative medicine lends itself well to treating fibromyalgia because it’s root cause, personalized medicine that combines both conventional and holistic tools. Our goal is to manage symptoms, address contributing factors, improve quality of life, and prevent long-term disability.

While we can’t change your genetics, we can support favorable epigenetics (gene expression) with nutrition and lifestyle tools.

Here are some interventions worth considering:

• Exercise – It can be challenging to exercise when you are in pain, but research shows that exercise helps to reduce pain, improve physical function, and reduce fibromyalgia severity. The benefits aren’t always immediate, so it’s a commitment to make to yourself. One study found benefits with only two 45-minute sessions per week.

• Nutrition – While there isn’t a standard dietary approach for fibromyalgia, research suggests the following dietary attributes to be beneficial:
  • High antioxidants (colorful fruits, vegetables, herbs, spices, etc.)
  • High-fiber plant foods (fruits, vegetables, legumes, etc.)
  • Low processed foods
  • High-quality protein
  • Healthy fats

This is excellent general guidance, but at TārāMD, we can get much more personalized and specific with our recommendations. If you have insulin resistance, we can use nutrition to support balanced blood sugar. If you have difficulty detoxifying estrogen, we can give you a plan for that too.

• Hormone Support – No matter the life phase, but particularly through perimenopause and menopause, integrative care can support hormonal patterns to ease women’s health symptoms and fibromyalgia symptoms alike. Tools include bioidentical hormone replacement therapy, targeted supplements, medication, and lifestyle medicine.

• Address Stress – Fibromyalgia care requires particular attention to stress and addressing both physical and emotional stressors. Physical stressors include toxins, infections, and nutrient deficiencies. Emotional stressors include current life circumstances and past trauma. Nervous system regulation and support may help shift the patterns that drive chronic pain.

• Explore Mind-Body Therapy – Ask your care team about Emotional Awareness and Expression Therapy, which research suggests can reduce fibromyalgia pain for some people. This approach addresses emotions and stress that may influence pain; it does not mean your pain is imagined or that emotions are its only cause.

Fibromyalgia is tricky, especially when it coincides with midlife, but you don’t have to figure it out alone. We are here to help you uncover what’s what and put the support in place so you don’t miss more of your life to pain.

Frequently Asked Questions About Fibromyalgia and Menopause

The following FAQs are designed to complement the article, address common patient questions, and support organic search visibility. They are also suitable for Google's FAQ-related search queries.

1. Can Perimenopause or Menopause Cause Fibromyalgia?

Menopause does not directly cause fibromyalgia, but hormonal changes during perimenopause and menopause may influence chronic pain and symptom severity. Declining and fluctuating estrogen levels can affect inflammation, pain sensitivity, sleep, and musculoskeletal health. Some women experience worsening fibromyalgia symptoms during this transition.

2. What Is the Connection Between Estrogen and Fibromyalgia?

Estrogen plays an important role in pain regulation, inflammation, and nervous system function. Changes in estrogen levels during perimenopause and menopause may influence how the body processes pain, potentially contributing to increased muscle discomfort, joint pain, fatigue, and heightened pain sensitivity in women with fibromyalgia.

3. Can Menopause Symptoms Be Mistaken for Fibromyalgia?

Yes. Perimenopause and fibromyalgia share several symptoms, including widespread muscle and joint pain, fatigue, brain fog, sleep disturbances, and mood changes. These overlapping symptoms can make diagnosis challenging, particularly for women between ages 40 and 60. A comprehensive evaluation can help distinguish hormonal symptoms from fibromyalgia or identify when both conditions are present.

4. Does Fibromyalgia Get Worse After Menopause?

Some women report worsening fibromyalgia symptoms following menopause or hysterectomy. Hormonal changes, disrupted sleep, increased inflammation, and changes in pain processing may contribute to greater symptom severity. However, experiences vary, and menopause does not necessarily worsen fibromyalgia in every woman.

5. Can Hormone Replacement Therapy (HRT) Help Fibromyalgia?

Hormone replacement therapy may help address certain menopause-related symptoms that overlap with fibromyalgia, including sleep disturbances, joint discomfort, and mood changes. However, research specifically evaluating HRT as a fibromyalgia treatment remains limited. Hormone therapy should be considered based on a woman's overall health, symptoms, and individual needs rather than as a primary treatment for fibromyalgia.

6. How Is Fibromyalgia Diagnosed in Women During Perimenopause?

Fibromyalgia is diagnosed through a clinical evaluation of widespread pain, symptom duration, fatigue, sleep disturbances, and cognitive symptoms. Healthcare providers also assess other possible causes, including thyroid disorders, inflammatory conditions, and menopause-related musculoskeletal symptoms. There is no single laboratory test that confirms fibromyalgia, making a comprehensive medical assessment especially important.

7. What Is the Best Treatment for Fibromyalgia in Women?

Fibromyalgia treatment typically involves a personalized, multidisciplinary approach. Depending on the patient's needs, this may include appropriate medications, regular exercise, sleep optimization, stress management, nutritional support, and mind-body therapies. For women in perimenopause or menopause, evaluating hormonal changes and related symptoms may provide additional opportunities for symptom management.

8. Can Diet and Nutrition Help Reduce Fibromyalgia Symptoms?

Nutrition may help support overall health and symptom management in women with fibromyalgia. An eating pattern emphasizing antioxidant-rich fruits and vegetables, fiber, healthy fats, quality protein, and minimally processed foods may be beneficial. Personalized nutrition strategies can also address contributing concerns such as insulin resistance or nutritional deficiencies.

9. What Types of Exercise Are Best for Women With Fibromyalgia?

Low-impact aerobic activity, walking, swimming, gentle strength training, and appropriately modified movement programs can help improve physical function and reduce fibromyalgia symptoms. Resistance training may also support muscle and bone health, which becomes increasingly important during menopause. Exercise should begin gradually and be adjusted according to individual tolerance.

10. How Can Integrative Medicine Help Women With Fibromyalgia?

Integrative medicine combines conventional medical treatment with personalized nutrition, lifestyle interventions, stress management, and evaluation of contributing health factors. For women experiencing fibromyalgia during perimenopause or menopause, this approach also considers hormonal changes, sleep quality, metabolic health, and inflammation. The goal is to improve symptom management, daily function, and overall quality of life.

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